Category: Nursing

Assignment: Asthma and Stepwise Management

Stepwise Approach for Asthma Treatment

 

Assignment: Asthma and Stepwise Management Introduction

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Asthma is a chronic respiratory condition

Stepwise approach includes a long-term control framework

Stepwise approach also outlines contingencies for quick relief

Pharmacology seeks to optimize the impacts of drugs used

Stepwise approach involves customizing treatment for the patient

The approach effectively manages asthma in most patients

It is a step by step process of determining most suitable treatment

Asthma is a respiratory condition in which the airway is obstructed due to spasm, mucus, swelling, or a combination of these, causing difficulty in breathing (McCance & Huether, 2019). Asthma affects both children and adults. Millions of Americans are affected by asthma (CDC, 2020). Asthma does not have a cure. It can, however, be managed using medications and lifestyle modifications. Management of asthma is dependent on its severity (McCance & Huether, 2019) Assignment: Asthma and Stepwise Management. The purpose of this presentation is to describe a stepwise approach to the treatment of asthma and how the stepwise approach will help both health care providers and patients manage the condition.

 

Long term control of Asthma

Treatments are taken daily to treat persistent asthma and provide long-term control (Zahran et al., 2017)

Corticosteroids: acts by decreasing inflammatory response that supports or cause airway obstruction (Zahran et al., 2017)

Leukotriene modifiers: modifies  inflammatory effects of leukotrienes in the airway (Zahran et al., 2017)

Immunomodulators:  helps regulate immune responses that promote airway inflammation and obstruction (Zahran et al., 2017)

Medications are taken even in the absence of symptoms to maintain control

Managing asthma aims to prevent exposure to triggers, reduce patient symptoms, and decrease complications (McCance & Huether, 2019). For long term control (LTC), certain medications are administered daily to help manage the condition (Zahran et al., 2017). LTC drugs include glucocorticoids, monoclonal antibodies, leukotriene modifiers, and long-acting beta-agonists (LABA) (Maine Line Health, 2020). Assignment: Asthma and Stepwise Management

Examples of LTC medications

Corticosteroids; prednisone, betamethasone

Leukotriene modifiers; montelukast sodium, zafirlukast

Immunomodulators; omalizumab, mepolizumab

 

Quick relief options for Asthma patient

Bronchodilators: prevents occlusion by dilating the bronchi

Beta 2 agonists : provides immediate relief by relaxing smooth muscles in the airway

Anticholinergics: inhibits acetylcholine to prevent airway obstruction

Can be bought over the counter (without prescription)

Are quick acting but can’t replace prescribed long-term treatments

Has more side effects such as increased heart rate

FDA approval is for 12 years and older (Onge et al., 2019)

Leading drugs used include Albuterol, Xopenex and Ipratropium (MedlinePlus, 2020)

Can be used before exercising to prevent an asthma attack (MedlinePlus, 2020)

Although asthma can be controlled, certain things may trigger a flare up thus causing acute symptoms that needs immediate treatment. Quick relief medications also known as rescue drugs are fast acting medications that can be used to provide immediate relief of symptoms when there is an asthma attack (Rosenthal & Burchum, 2018).

Short term medication examples

Bronchodilators; Theophylline

Short acting Beta 2 agonists; Albuterol, levalbuterol

Anticholinergics; Ipratropium

 

 

Impact Asthma drugs may have on the patient

Positive effects

uPrevents troublesome and chronic symptoms

uSustain close to normal pulmonary function

uMinimize the need for hospitalization

uImproves lung function and decrease inflammation

Adverse effects

uBronchodilators may cause dysrhythmias, convulsion

uCorticosteroids may cause adrenal insufficiency and weaken the immune system

uShort term beta agonists may cause tachycardia, angina, and tremors (Rosenthal & Burchum, 2018).

Generally, the impact of asthma quick relief drugs on the patient includes tachycardia, angina, low lung function, and bronchial hyper-responsiveness (Medlineplus, 2020).

The impact of long-term medications used in treating asthma varies based on the medications used. However, most long-term medications such as inhaled glucocorticoids and leukotriene modifiers also suppress the immune system therefore causing symptoms associated with a suppressed immune system such as adrenal suppression, respiratory infection (Zahran et al., 2019). Also long acting beta agonists have an increased risks of causing asthma-associated deaths especially when used alone (Rosenthal & Burchum, 2018). Leukotriene modifiers may also cause psychiatric related effects such as depression, suicidal thoughts (Rosenthal & Burchum, 2018).

 

uStepwise approach treatment to the patient

The stepwise approach for managing  asthma is a guideline of six steps used by healthcare providers to effectively treat and manage asthma (Rosenthal & Burchum, 2018). This approach helps providers decide the best treatment regimen based on the patients’ symptoms and response to treatment. The patient is assessed after which the medication is chosen based on the symptoms. The patient is then reassessed, medication dosages are increased or completely changed to the next step to improve symptoms. Patients must be reassessed in 2-6 weeks after a step up change to ensure symptoms are in control (Falk & Hughes, 2016).  Providers can step down medication treatment after symptoms are in control, however, the provider must reassess the patient in three months after a step down and every three to six months after symptoms are stabilized (Maine line Health, 2020)

u
Stepwise approach treatment to the patient

The stepwise approach for managing  asthma is a guideline of six steps used by healthcare providers to effectively treat and manage asthma (Rosenthal & Burchum, 2018). This approach helps providers decide the best treatment regimen based on the patients’ symptoms and response to treatment. The patient is assessed after which the medication is chosen based on the symptoms. The patient is then reassessed, medication dosages are increased or completely changed to the next step to improve symptoms. Patients must be reassessed in 2-6 weeks after a step up change to ensure symptoms are in control (Falk & Hughes, 2016).  Providers can step down medication treatment after symptoms are in control, however, the provider must reassess the patient in three months after a step down and every three to six months after symptoms are stabilized (Maine line Health, 2020)

The stepwise approach for managing  asthma is a guideline of six steps used by healthcare providers to effectively treat and manage asthma (Rosenthal & Burchum, 2018). This approach helps providers decide the best treatment regimen based on the patients’ symptoms and response to treatment. The patient is assessed after which the medication is chosen based on the symptoms. The patient is then reassessed, medication dosages are increased or completely changed to the next step to improve symptoms. Patients must be reassessed in 2-6 weeks after a step up change to ensure symptoms are in control (Falk & Hughes, 2016).  Providers can step down medication treatment after symptoms are in control, however, the provider must reassess the patient in three months after a step down and every three to six months after symptoms are stabilized (Maine line Health, 2020)

uMerits of Stepwise approach to HCWs and patients

uStepwise approach prevents recurrent exacerbations

uThe method is flexible allowing optimal care (Zahran et al., 2017)

uPharmacological parameters are established uniquely

ucustomizes treatment according to age of the patient

uProvides best possible treatment while minimizing side effects

uHealthcare providers have clear guidelines for different scenarios

uPatients are educated on how to  manage asthma  crisis effectively

The stepwise approach assists the healthcare provider in ensuring the provision of individualized care and allows for continuous monitoring of the intensity of the disease, treatment with the appropriate medications, and therapy (Falk & Hughes, 2016). This eliminates the possibility of treating patients with the wrong dose or class of drugs.

This approach also enables patients to participate in their plan of care. Patients or families can identify when symptoms have improved or worsened, thus assisting the provider in adjusting medications and controlling the disease effectively.

uConclusion

uBoth long term treatment and quick relief are incorporated

uPharmacokinetic and pharmacodynamics factors are considered

uStepwise approach establishes the best treatment for a specific patient

uDrugs with adverse effect are minimized in this approach

Assignment: Asthma and Stepwise Management

uThe approach helps maintain close to normal pulmonary function

uStepwise approach is inherently adjustable to condition of the patient

u

uReferences

Beasley, R. Braithwaite, I., Semprini, A. Kearns, C., Weatherall, M. & Pavord, I. D. (2019). Optimal Asthma Control: Time for a new target. 
American Journal of Respiratory and Critical Care Medicine
,
201
(12): 1480–1487. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/31905013/

Falk, N. P., & Hughes, S. W. (2016). Medications for Chronic Asthma.
American Family Physician, 94
(6), 454-462. Retrieved from
https://www.aafp.org/afp/2016/0915/p454.html#:~:text=Step%2Ddown%20therapy%20starts%20with,control%20is%20not%20initially%20attained

Onge, I., McDowell, K. M., & Guilbert, T. W. (2019). stepwise pharmacological approach to severe childhood asthma.
Severe Asthma in Children and Adolescents
: 113–131. Retrieved from
http://link-springer-com-443.webvpn.fjmu.edu.cn/chapter/10.1007%2F978-3-030-27431-3_6

Maine Line Health. (2020).
Long-term Control Medications for Asthma
. Retrieved from
https://www.mainlinehealth.org/conditions-and-treatments/treatments/asthma-long-term-control-medications

McCance, K. L., & Huether, S. E. (2019).
Pathophysiology: The biologic basis for disease in adults and children.
St Louis, MO: Mosby/Elsevier.

MedlinePlus. (2020).
Asthma – quick-relief drugs
. Retrieved from
https://medlineplus.gov/ency/patientinstructions/000008.htm

Rosenthal, L. D. & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advance practice providers. St. Louis: MO: Elsevier

Zahran, H. S., Bailey, C. M., Qin, X. & Johnson, C. (2017). Long-term control medication use, and asthma control status among children and adults with asthma.
Journal of Asthma
54(10) 1065–1072. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/28282217/

u

Assignment: Asthma and Stepwise Management

Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors. Assignment: Asthma and Stepwise Management

Photo Credit: Photo Library / Getty Images

One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.

To Prepare

Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.

Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.

Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

By Day 7 of Week 3

Create
 a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:

Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.

Explain the stepwise approach to asthma treatment and management for your patient.

Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific. Assignment: Asthma and Stepwise Management

Submission and Grading Information

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Click the 
Week 3 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 3 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK3Assgn+last name+first initial.(extension)” and click 
Open
.

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I agree to submit my paper(s) to the Global Reference Database
. Assignment: Asthma and Stepwise Management

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NURS_6521_Week3_Assignment_Rubric

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List View

Excellent

Good

Fair

Poor

Describe the long-term control and quick relief treatment options for the asthma patient from your practice, as well as the impact these drugs might have on your patient.

27 
(27%)
 – 30 
(30%)

The presentation clearly and accurately describes in detail the long-term control and quick relief treatment options for the asthma patient from their practice.

The presentation clearly and accurately describes in detail the impact these drugs might have on their patient.

24 
(24%)
 – 26 
(26%)

The presentation accurately describes the long-term control and quick relief options for the asthma patient from their practice.

The presentation accurately describes the impact these drugs might have on their patient.

21 
(21%)
 – 23 
(23%)

The presentation inaccurately or vaguely describes the long-term control and quick relief options for the asthma patient from their practice.

The presentation inaccurately or vaguely describes the impact these drugs might have on their patient.

0 
(0%)
 – 20 
(20%)

The presentation inaccurately and vaguely describes the long-term and quick relief options for the asthma patient from their practice, or is missing.

The presentation inaccurately and vaguely describes the impact these drugs might have on their patient, or is missing.

Explain the stepwise approach to asthma treatment and management for your patient.

27 
(27%)
 – 30 
(30%)

The presentation clearly and accurately explains in detail the stepwise approach to asthma treatment and management for their patient.

24 
(24%)
 – 26 
(26%)

The presentation accurately explains the stepwise approach to asthma treatment and management for their patient. Assignment: Asthma and Stepwise Management

21 
(21%)
 – 23 
(23%)

The presentation inaccurately or vaguely explains the stepwise approach to asthma treatment and management for their patient.

0 
(0%)
 – 20 
(20%)

The presentation inaccurately and vaguely explains the stepwise approach to asthma treatment and management for their patient.

Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

27 
(27%)
 – 30 
(30%)

The presentation clearly and accurately explains in detail how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

The presentation provides accurate and detailed examples to support the explanation provided.

24 
(24%)
 – 26 
(26%)

The presentation accurately explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

The presentation provides accurate examples to support the explanation provided.

21 
(21%)
 – 23 
(23%)

The presentation inaccurately or vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

The presentation provides inaccurate or vague examples to support the explanation provided.

0 
(0%)
 – 20 
(20%)

The presentation inaccurately and vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease, or is missing.

The presentation provides inaccurate and vague examples to support the explanation provided, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Assignment: Asthma and Stepwise Management

3.5 
(3.5%)
 – 3.5 
(3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

0 
(0%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 
(5%)
 – 5 
(5%)

Uses correct grammar, spelling, and punctuation with no errors

4 
(4%)
 – 4 
(4%)

Contains a few (1–2) grammar, spelling, and punctuation errors

3.5 
(3.5%)
 – 3.5 
(3.5%)

Contains several (3–4) grammar, spelling, and punctuation errors

0 
(0%)
 – 3 
(3%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

Total Points: 100

Name: NURS_6521_Week3_Assignment_Rubric

Assignment: Asthma and Stepwise Management

Discussion 1: Leadership Theories in Practice

A walk through the Business section of any bookstore or a quick Internet search on the topic will reveal a seemingly endless supply of writings on leadership. Formal research literature is also teeming with volumes on the subject Discussion 1: Leadership Theories in Practice.

However, your own observation and experiences may suggest these theories are not always so easily found in practice. Not that the potential isn’t there; current evidence suggests that leadership factors such as emotional intelligence and transformational leadership behaviors, for example, can be highly effective for leading nurses and organizations.

Yet, how well are these theories put to practice? In this Discussion, you will examine formal leadership theories. You will compare these theories to behaviors you have observed firsthand and discuss their effectiveness in impacting your organization. Discussion 1: Leadership Theories in Practice

To Prepare:

Review the Resources and examine the leadership theories and behaviors introduced.

Identify two to three scholarly resources, in addition to this Module’s readings, that evaluate the impact of leadership behaviors in creating healthy work environments.

Reflect on the leadership behaviors presented in the three resources that you selected for review. Discussion 1: Leadership Theories in Practice

By Day 3 of Week 4

Post
two key insights you had from the scholarly resources you selected. Describe a leader whom you have seen use such behaviors and skills, or a situation where you have seen these behaviors and skills used in practice. Be specific and provide examples. Then, explain to what extent these skills were effective and how their practice impacted the workplace. Discussion 1: Leadership Theories in Practice

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Leadership is defined by Marshall (2021 ) as the “discipline and art of guiding, directing, motivation, and inspiring a group or organization toward the achievement of common goals” (P.14). While there are many styles of leadership I focused on the difference between transactional and transformational leadership due to my personal experience with both types of leadership styles.

The first key insight discussed is the style of the transactional leader. Manning (2016) discussed how the transactional leader focuses on job performance outcomes, the correction of mistakes and makes little to no effort to address the needs of employees. The second insight is the style of the transformational leader. Hughes (2019) finds that a transformational leader will focus on job performance outcomes as well as staff outcomes.

I have worked for several different leaders that had a stark difference in leadership styles. I worked for a manager at my first nursing job that utilized the transactional leadership style. This manager was solely focused on organizational outcomes and took a hands-off approach to management.  The nursing staff yearly performance evaluation was based on patient satisfaction scores, medication errors, number of days missed work, and any other complaints or employment issues. Nurses would get a raise percentage based upon the value of these scores. In this situation, staff satisfaction and morale were very low and there was a high nurse turnover rate. My current employers use a transactional approach to leadership. My current manager is engaged in providing nursing staff the support needed to perform our jobs to the best of our ability. This done by providing the nursing staff with opportunities for education, self-scheduling, emotional support after traumatic events, and fostering a team-based nursing approach in the Emergency Department. Yearly performance evaluations are based more on nursing achievement and outcomes than on negative factors. This type of leadership style has created a positive working environment, high job satisfaction, and low turnover rates. Discussion 1: Leadership Theories in Practice

My personal experience with the two described styles of leadership has taught me that the transformational leadership style that empowers and supports staff to complete their jobs to the best of their ability will result in better organizational outcomes, staff satisfaction, and will ultimately lead to higher patient outcomes.

 

Hughes, Victoria & DSN, RN. (2019). Nurse leader impact: A review. 
Nursing Management
, 
50
, 42-49. https://doi.org/10.1097/01.NUMA.0000554338.47637.23 Discussion 1: Leadership Theories in Practice

Manning, Jennifer, DNS, APRN & CNS, CNE. (2016). The Influence of Nurse Manager Leadership Style on Staff Nurse Work Engagement. 
Journal of Nursing Administration
, 
46
, 438-443. https://doi.org/10.1097/NNA.0000000000000372

Marshall, E., & Broome, M. (2017). 
Transformational leadership in nursing: From expert clinician to influential leader
 (2nd ed.). New York, NY: Springer.

By Day 6 of Week 4

Respond
 to at least 
two
 of your colleagues 
on two different days
 by explaining how the leadership skills they described may impact your organization or your personal leadership, or by identifying challenges you see in applying the skills described.

            Great post , I enjoyed reading your post and agree with you that good leadership qualities improve patient outcomes and also improve work environment for the staff. Transformational leadership increased the nurses’ satisfaction in all institutional areas, reduced burnout, and provided a favorable work environment (Balsanelli & Cunha, 2015). Working in many different hospitals I realized the difference between managers and how they went about doing things. The outcomes were different and some strategies retained many nurses and other strategies made many nurse leave which effects patient outcomes. The emphasis on improving patient satisfaction is forefront in the nurse leader’s mind as pressures mount to improve healthcare reimbursement related to quality indicators and nurse leaders appreciate interventions that improve patient satisfaction through knowing the patient and, thus, affecting overall care in a positive manner (Penque, & Kearney, 2015). Being a leader means working with your staff, showing them appreciation for what they do and letting them know that what they did is very important. By doing so I noticed that having parties for them, food and fun raffles can make a difference because it boosts the morale in the working environment. Discussion 1: Leadership Theories in Practice

References

Balsanelli, A., & Cunha, I., 2015 Jan-Feb; 23(1): Nursing Leadership in Hospitals and their

Relationship to Quality of care.  106–113. doi: 10.1590/0104-1169.0150.2531

Penque, S., & Kearney, G., (2015). The effect of nursing presence on patient

satisfaction. 
Nursing Management
, 
46
, 38-44.

https://doi.org/10.1097/01.NUMA.0000462367.98777.40

Great post! I have also worked in places where transactional and transformational leadership was exhibited. I will say I enjoy working for someone that displays a transformational leadership over transactional. It makes you feel like you are important unlike transactional. Abdelhafiz, Alloubani, & Almatari (2016) suggests that when nurses have a transformational leadership, they have a higher satisfaction with their job. A higher job satisfaction results in better over all care. Pishgooie, Atashzadeh, Falcó, & Lotfi (2019) did a study on the correlation of leadership styles and they discovered that using a combination of transformational and transactional leadership together could also improve job satisfaction. Transactional leadership doesn’t seem to be as effective unless it is paired with transactional leadership. Motivating and inspiring others seems to be more of an effective way to produce positive outcomes.

References

Abdelhafiz, I. M., Alloubani, A. M., & Almatari, M. (2016). Impact of leadership styles adopted by head nurses on job satisfaction: a comparative study between governmental and private hospitals in Jordan. 
Journal of Nursing Management (John Wiley & Sons, Inc.)
, 
24
(3), 384–392. https://doi-org.ezp.waldenulibrary.org/10.1111/jonm.12333

Pishgooie, A. H., Atashzadeh, S. F., Falcó, P. A., & Lotfi, Z. (2019). Correlation between nursing managers’ leadership styles and nurses’ job stress and anticipated turnover. 
Journal of Nursing Management (John Wiley & Sons, Inc.)
, 
27
(3), 527–534. https://doi-org.ezp.waldenulibrary.org/10.1111/jonm.12707 Discussion 1: Leadership Theories in Practice

Assignment: Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders

Introduction

Cardiovascular diseases are one of the leading causes of death for Americans and the world (Centers for Disease Control and Prevention, 2019). Cardiovascular disorders refer to diseases that affect the heart or blood vessels. These disorders usually interfere with the normal function of the heart and blood vessels (Centers for Disease Control and Prevention, 2019). Many factors contribute to cardiovascular disease development, including age, genetics, lifestyle, and habits. Thus, when managing cardiovascular diseases, it is important to consider several factors for each patient that could influence their drug therapy and lifestyle modification. Various factors influence the pharmacokinetic (PK) and pharmacodynamics (PD) of medications. Therefore, healthcare providers need to understand CVD’s pharmacokinetics and pharmacodynamics to manage and enhance medication therapy for patients with CVD effectively. This paper aims to analyze age as a factor that influences pharmacokinetics and pharmacodynamics for CVD patient AO. The paper will also discuss how age may affect drug therapy and suggestions on improving the patient’s drug therapy. Assignment: Pharmacotherapy for Cardiovascular Disorders

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How age might Influence the Pharmacokinetic and Pharmacodynamic Processes

Although heart disease can affect anyone, certain factors increase the risk of developing cardiovascular diseases, such as age, genetics, race, and sedentary lifestyle (Centers for Disease Control and Prevention, 2019). Many factors also affect the way the body responds to cardiovascular medications, just as many factors can affect the development of cardiovascular diseases. One of the factors that influence the pharmacodynamic and pharmacokinetics of cardiovascular medications is age. Age can influence the pharmacokinetic and pharmacodynamic of the patient AO in this case scenario. The aging process slows down gastric motility, the secretion of gastric acid, glomerular filtration, and renal clearance; this process may affect the way the body absorbs, metabolizes, and excretes drugs (HealthinAging.org, 2020).

For this patient, A/O, the therapeutic effects, as well as adverse and toxic effects, may be affected due to the aging process. Drug absorption and distribution for certain drugs may slow down for older patients, thus requiring lower doses; for example, hydralazine is rapidly absorbed in the GI tract, and the absorption rate varies from person to person. Hence the absorption rate for older adults may be slowed due to the aging process affecting the GI tract (Healthinaging.org, 2020). In addition to absorption and distribution, the excretion of drugs is affected by the decreased renal function in the elderly (National Kidney Foundation, 2020). For example, atenolol is primarily excreted by the kidneys; therefore, renal function assessment is imperative before prescribing this medication (Rehman et al., 2020). Age also affects PK and PD by

How Changes in the Processes might Impact the Patient’s Recommended Drug Therapy

Changes in the way drugs are absorbed, distributed, metabolized, utilized, and excreted affect how medications will be prescribed. Healthcare providers must assess potential factors that may affect the PK and PD of medications before choosing them. When treating an elderly patient with cardiovascular diseases, the provider, for example, must assess the patient’s renal and liver function, which may impact the dosage or choice of medication. Decreased renal function in the elderly may cause drugs needing renal clearance to be accumulated in the body, thus leading to toxicity and decreased hepatic function may cause drug-induced liver injury (HealthinAging.org, 2020). For example, this patient AO in this scenario was prescribed hydralazine, assuming there is decreased liver function in this patient, Drug induced liver injury could occur (Herman & Tivakaran, 2020).

Also, many elderly patients may have underlying health conditions or comorbidities. When choosing drug therapies, providers must assess for a potential drug to drug interaction and medications to be avoided with certain conditions, after which an alternative therapy can be recommended, or close monitoring can be done (Teka et al., 2016).  Changes in the elderly and comorbidities may increase the side effects of medications for patients. For example, verapamil acts by dilating blood vessels to decrease blood pressure. Therefore, it must be used with caution in the elderly or avoided if the patient has postural hypotension (Pavlou et al., 2018).

How to Improve the Patient’s Drug Therapy Plan

The patient AO in this scenario, is obese and reportedly gained 9 pounds. Although this patient is obese, this may be indicative of fluid overload, therefore indicating that the current regimen for hypertension needs to be modified. Firstly, this patient needs to be further assessed to determine the current blood pressure level and its effectiveness. Renal function also needs to be assessed to determine if changes need to be made for drugs needing renal clearance. This patient is prescribed hydralazine 10mg; hydralazine acts by dilating blood vessels to decrease blood pressure, thereby increasing cardiac output (Herman & Tivakaran, 2020). However, due to its first-pass effect, the dosage may need to be increased to be more effective (prescriber’s Digital Reference, 2020).

Atenolol is not a preferred choice as the first line of treatment for hypertension (Pavlou et al., 2018). Atenolol may also worsen this patient’s hyperlipidemia and increase the risk for diabetes; Therefore, atenolol can be removed and replaced with another beta-blocker like Coreg (Herink & Ito, 2018). A beta-blocker or diuretic in combination with hydralazine for patient AO to decrease cardiac volume due to the hydralazine. Finally, the combination of many blood pressure medications may be counter-productive for this patient. For example, doxazosin may cause hypotension, especially when combined with atenolol. Cutting off doxazosin may be needed to avoid complications from polypharmacy (Masnoon et al., 2017).

Conclusion

cardiovascular conditions, especially in the presence of other comorbidities, can be challenging. Therefore, providers must ensure they consider patients’ history, age, comorbidities, and ethnicity to impact their drug therapy and care. Adequate medication therapy is also heavily dependent on appropriate follow-up, including lab values assessment, to ensure that it is effective and prevents complications. With further history and assessment of patient AO, their drug therapy could be modified to be more effective in managing their cardiovascular disease and comorbidities.

References

Centers for Disease Control and Prevention. (2019). Centers for Disease Control and Prevention, 2019. Heart Disease: Know your Risk for Heart Disease. Retrieved from
https://www.cdc.gov/heartdisease/risk_factors.htm

HealthinAging.org (2020). Medications work differently in older adults. Retrieved from
https://www.healthinaging.org/medications-older-adults/medications-work-differently-older-adults

Herman, L. L. & Tivakaran, V. S. (2020). Hydralazine. Retrieved from 
https://www.ncbi.nlm.nih.gov/books/NBK470296/

Herink, M. & Ito, M. K. (2018). Medication Induced Changes in Lipid and Lipoproteins. Retrieved from 
https://www.ncbi.nlm.nih.gov/books/NBK326739/

Pavlou, D. I., Paschou, S. A., Anagnostis, P., Spartalis, M., Spartalis, E., & Vryonidou, A., Tentolouris, N., and Siasos, G. (2018). Hypertension in patients with type 2 diabetes mellitus: Targets and management. 
Maturitas
, 
112
, 71-77. Retrieved from 
https://doi.org/10.1016/j.maturitas.2018.03.013

Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is

polypharmacy? A systematic review of definitions. BMC Geriatrics, 17, 230.Retrieved from

https://doi:10.1186/s12877-017-0621-2

National Kidney Foundation. (2020). GFR. Kidney.org. Retrieved from
https://www.kidney.org/kidneydisease/siemens_hcp_gfr

Prescriber’s Digital Reference, 2020). hydralazine hydrochloride – Drug Summary. Retrieved from 
https://www.pdr.net/drug-summary/Hydralazine-Hydrochloride-Injection-hydralazine-hydrochloride-739

Rehman B., Sanchez, D. P, & Shah S. (2020). Atenolol. Retrieved from 
https://www.ncbi.nlm.nih.gov/books/NBK539844/

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier

Teka, F., Teklay, G., Ayalew, E., & Teshome, T. (2016). Potential drug-drug interactions among elderly patients admitted to the medical ward of Ayder Referral Hospital, Northern Ethiopia: a cross-sectional study. 
BMC research notes
, 
9
(1), 431. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009535/

 

Assignment: Pharmacotherapy for Cardiovascular Disorders

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…

ORDER A CUSTOM-WRITTEN, PLAGIARISM-FREE PAPER HERE

—Murphy et al., 2018

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.

Photo Credit: Getty Images/Science Photo Library RF Assignment: Pharmacotherapy for Cardiovascular Disorders

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

To Prepare

Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.

Review the case study assigned by your Instructor for this Assignment. Assignment: Pharmacotherapy for Cardiovascular Disorders

Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.

Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.

Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.

Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient. Assignment: Pharmacotherapy for Cardiovascular Disorders

By Day 7 of Week 2

Write
 a 2- to 3-page paper that addresses the following:

Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.

Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.

Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Reminder:
The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting. Assignment: Pharmacotherapy for Cardiovascular Disorders

 

 

NURS_6521_Week2_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.

23 
(23%)
 – 25 
(25%)

The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.

20 
(20%)
 – 22 
(22%)

The response provides a basic explanation of how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.

18 
(18%)
 – 19 
(19%)

The response inaccurately or vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.

0 
(0%)
 – 17 
(17%)

The response inaccurately and vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient, or is missing.

Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.

27 
(27%)
 – 30 
(30%)

The response accurately and completely describes in detail how changes in the processes might impact the patient’s recommended drug therapy.

Accurate, complete, and aligned examples are provided to support the response.

24 
(24%)
 – 26 
(26%)

The response accurately describes how changes in the processes might impact the patient’s recommended drug therapy.

Accurate examples may be provided to support the response.

21 
(21%)
 – 23 
(23%)

The response inaccurately or vaguely describes how changes in the processes might impact the patient’s recommended drug therapy.

Inaccurate or vague examples are provided to support the response.

0 
(0%)
 – 20 
(20%)

The response inaccurately and vaguely describes how changes in the processes might impact the patient’s recommended drug therapy, or is missing.

Inaccurate and vague examples may be provided to support the response, or is missing.

Explain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements.

27 
(27%)
 – 30 
(30%)

The response accurately and clearly explains in detail how to improve the patient’s drug therapy plan.

The response includes an accurate and detailed explanation to support the recommended improvements.

24 
(24%)
 – 26 
(26%)

The response accurately explains how to improve the patient’s drug therapy plan.

The response may include an accurate explanation to support the recommended improvements.

Assignment: Pharmacotherapy for Cardiovascular Disorders

21 
(21%)
 – 23 
(23%)

The response inaccurately or vaguely explains how to improve the patient’s drug therapy plan.

The response may include an inaccurate, vague, or misaligned explanation to support the recommended improvements.

0 
(0%)
 – 20 
(20%)

The response inaccurately and vaguely explains how to improve the patient’s drug therapy plan, or is missing.

The response may include an inaccurate and vague explanation to support the recommended improvements, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.5 
(3.5%)
 – 3.5 
(3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

0 
(0%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 
(5%)
 – 5 
(5%)

Uses correct grammar, spelling, and punctuation with no errors

4 
(4%)
 – 4 
(4%)

Contains a few (1–2) grammar, spelling, and punctuation errors

3.5 
(3.5%)
 – 3.5 
(3.5%)

Contains several (3–4) grammar, spelling, and punctuation errors

0 
(0%)
 – 3 
(3%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

5 
(5%)
 – 5 
(5%)

Uses correct APA format with no errors

4 
(4%)
 – 4 
(4%)

Contains a few (1–2) APA format errors

Assignment: Pharmacotherapy for Cardiovascular Disorders

3.5 
(3.5%)
 – 3.5 
(3.5%)

Contains several (3–4) APA format errors

0 
(0%)
 – 3 
(3%)

Contains many (≥ 5) APA format errors

Total Points: 100

Name: NURS_6521_Week2_Assignment_Rubric

Ethical and Legal Implications of Prescribing Drugs

Introduction

Advanced Practice Registered Nurse (APRN) are Registered nurses with obtained further education and specialization. They play a vital role in the healthcare system; with prescription authority, they can assess, diagnose, treat, and manage patients’ conditions. Like many other healthcare professions, this level of responsibility comes with its legal and ethical standards of practice that must be upheld by every licensed APRN. The legal standards and code of ethics for APRNs may vary from state to state. However, they are all in place to ensure the safety of patients and APRNs. Providing care and prescribing medications may sometimes have some conflicting legal and ethical implications. Therefore, APRNs need to know the state and federal regulations governing all aspects of their practice and specialty (American Association of Nurse Practitioners, 2015) Ethical and Legal Implications of Prescribing Drugs. This paper aims to discuss the ethical and legal implications of an APRN prescribing narcotics for a family member who is not a patient; the paper will also discuss the process of writing prescriptions and strategies to minimize medication errors.

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Ethical and Legal Implications of an APRN Prescribing Narcotics for a Family Member

APRNs in the united states have been granted various prescriptive authority levels for medications, procedures, and services. APRNs need to understand the prescriptive authority in their state and federal and state legal and ethical guidelines. Prescribing medication like most healthcare services provided by healthcare professionals first requires an assessment, a review of patients’ history, diagnosis, education, and follow up (American Association of Nurse Practitioners, 2015); this guideline is in line with the nursing ethical responsibility to do no harm (ANA, n.d.). Ethical and Legal Implications of Prescribing Drugs

Many state laws prohibit or restrict the prescription of medication or provision of medical services to family members for safety purposes and to avoid legal and ethical dilemmas, (Conde, 2017). For example, Texas does not prohibit treating family members if a medical record with appropriate assessment and diagnosis is maintained; however, prescription of controlled substances to self, family members, or friends is prohibited unless in the case of emergency (Conde, 2017). The legal implication in this scenario could be the APRN breaking the state law. Ethical implications implied in this scenario could be responsive to the APRN’s duty to do no harm, which may have prompted a narcotic prescription if this was a case of emergency. It could also be a violation of the duty to do no harm if the APRNs are supporting her spouse’s case of substance abuse by prescribing narcotics to them. However, this case scenario will need to be further reviewed to determine whether this was done in good faith.

Strategies to Address Disclosure and Nondisclosure of Medication Error

A medication error can occur from the point of prescription to the point of administration; for APRNs, the risk of medication error is substantial when prescribing. Medication errors are capable of causing serious harm to patients, including death; hence, state and federal laws are put in place to help protect patients against such errors. It is the APRN’s responsibility and any healthcare professional who witnesses a mishap to report when errors or abuse occurs. (Westrick & Jacob, 2016). Making the decision for disclosure or nondisclosure of medication error can be challenging; however, understanding state and federal laws about reporting medication errors and the facility policy can make the process a little less daunting. Therefore, it is important for every APRN to be educated on state, federal, and institutional policies on medication errors and reporting them (Sorrell, 2017)

Medical errors can occur in healthcare at any point during treatment; one of such error includes medication error. When medical errors occur, it is important for patients affected to be informed; this can potentially prevent further errors from occurring and allow the patient to make decisions about their care moving forward. There is the possible legal implication for the spouse as a stakeholder in this scenario if there is a chance that the narcotics prescribed are being abused. According to section 74.106 of the Texas civil law, nondisclosure of medical error or potential harm to a patient is considered a violation of state laws in Texas that could lead to criminal charges for negligence and suspension revocation of license (Texas.gov, n.d.).

Two Strategies an Advanced Practice Nurse Would use to Guide Decision Making in this Scenario

Nurses and all healthcare professionals have a responsibility to do no harm, and patients have a right to full disclosure when receiving medical care; therefore, when a nurse witnesses potential harm to patients occurring, it is their responsibility to address the situation. APRNs must be diligent in making controversial decisions about ethical dilemmas; patient safety must be of the utmost importance when making this decision (Rosenthal & Burchum, 2018). In this scenario, as a nurse witnessing another APRN prescribing medications for a spouse who is not a patient, the first strategy would be to consult with the organizational policy and follow the guidelines for reporting the incident. Another strategy would be to address the said APRN in a professional manner to gather more details and determine if a legal or ethical code is being violated.

Process of Writing Prescriptions

The process of writing a prescription is complex and sensitive due to the potential for life-threatening errors; therefore, every provider, including the APRN, must be familiarized with this process. There are important things that must be included in a prescription, whether electronic or written, although they may differ with state and organizational policies, certain elements are standard and should be included in all prescriptions; these include the provider’s name and information (including signature and DEA/NPI number), the patient’s name and a second identifier (for example, date of birth), drug name, drug strength, route, and frequency (Rosenthal & Burchum, 2018)

Strategies to Minimize Medication Errors

Prescription writing is an important aspect of managing a patient’s care, errors made when writing prescriptions can cause harm, including death to patients (Dyasanoor & Urooge, 2016). Therefore, APRNs and organizations must pay special attention and continually strive to improve the process of writing a prescription. The use of EMAR has been instrumental in improving the process of writing prescriptions and preventing medication errors. The use of EMAR decreases the chances of misinterpreting some elements of a written prescription. For example, an abbreviation or illegible word on a written order has the potential to cause a medication error, whereas, on an EMAR, the probability to misinterpret an abbreviation is greatly decreased.

Another strategy to help prevent medication errors from prescription writing is avoiding the use of verbal orders (American Academy of Ophthalmology, 2015). Verbal orders have the potential to cause medication errors due to being misinterpreted. Another strategy is to utilize a double verification system for prescribed medication before administering it. For example, the pharmacy. Healthcare organizations need to ensure staff are educated and feel comfortable reporting errors to prevent future recurrences; this can be done by providing a safe and non-judgmental environment to promote reporting (Moffatt-Bruce et al., 2016).

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Conclusion

Providing medical services, including medication prescription, has the potential to cause harm. Therefore, APRNs with prescriptive authority need to know state laws, federal laws, and ethical guidelines that govern the prescription of medications. In addition to ethical guidelines and state laws, APRNs need to follow organizational policies and evidence-based guidelines when prescribing medications to avoid medical errors.

 

References

American Academy of Ophthalmology. (2015). Minimizing Medication Errors: Communication about Drug Orders – 2015. 
https://www.aao.org/patient-safety-statement/minimizing-medication-errors-communication-about-d#top

American Association of Nurse Practitioners. (2015). Standards of practice for nurse practitioners. Retrieved from 
https://www.aanp.org/advocacy/advocacy-resource/position-statements/standards-of-practice-for-nurse-practitioners

ANA. (n.d.). Ethics and Human Rights. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics

Conde, C. (2017). Treating your own. Retrieved from 
https://www.texmed.org/template.aspx?id=22563

Dyasanoor & Urooge (2016). Insight into the quality of prescription writing – An Institutional study. Journal of Clinical and Diagnostic Research: 10(3) ZC16-ZC64. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843389/

Moffatt-Bruce, S. D., Ferdinand, F. D., & Fann, J. I. (2016). Patient Safety: Disclosure of Medical Errors and Risk Mitigation. 
https://www.sts.org/sites/default/files/documents/patient_safety/DisclosureofMedicalErrors.pdf

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St Louis, MO: Elsevier.

Sorrell, J.M. (2017). Ethics: Ethical Issues with Medical Errors: Shaping a Culture of Safety in Healthcare. Retrieved from 
https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Ethics/Ethical-Issues-with-Medical-Errors.html

Texas.gov. (n.d.). Civil practice and remedies code. 
https://statutes.capitol.texas.gov/Docs/CP/htm/CP.74.htm#74.104

Westrick, S. J., & Jacob, N. (2016). Disclosure of Errors and Apology: Law and Ethics. 
The Journal for Nurse Practitioners, 12
(2), 120-126. 
https://doi.org/10.1016/j.nurpra.2015.10.007

Assignment: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should 
you
 be prescribing drugs to 
this 
patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.

Photo Credit: Getty Images/Caiaimage

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

Review the scenario assigned by your Instructor for this Assignment.

Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.

Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family. Ethical and Legal Implications of Prescribing Drugs

Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

By Day 7 of Week 1

Write a 2- to 3-page paper that addresses the following:

Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state. Ethical and Legal Implications of Prescribing Drugs

Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.

Explain the process of writing prescriptions, including strategies to minimize medication errors.

Reminder:
 The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at 
https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632
). All papers submitted must use this formatting.

NURS_6521_Week1_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Explain the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family.

23 
(23%)
 – 25 
(25%)

The response accurately and thoroughly explains in detail the ethical and legal implications of the scenario selected on all stakeholders involved.

The response includes accurate, clear, and detailed explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

20 
(20%)
 – 22 
(22%)

The response explains the ethical and legal implications of the scenario selected on all stakeholders involved.

The response includes accurate explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

Ethical and Legal Implications of Prescribing Drugs

18 
(18%)
 – 19 
(19%)

The response inaccurately or vaguely explains the ethical and legal implications of the scenario selected for all stakeholders involved.

The response includes vague explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

0 
(0%)
 – 17 
(17%)

The response vaguely and inaccurately explains the ethical and legal implications of the scenario selected for all stakeholders involved, or the response is missing.

The response vaguely and inaccurately explains how these implications affect the prescriber, pharmacist, patient, and the patient’s family, or is missing.

Describe strategies to address disclosure and nondisclosure as identified in the scenario selected. Be sure to reference laws specific to your state.

18 
(18%)
 – 20 
(20%)

An accurate, detailed, and clear description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes specific, detailed, and accurate reference to state laws related to the scenario.

16 
(16%)
 – 17 
(17%)

An accurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes accurate reference to state laws related to the scenario.

14 
(14%)
 – 15 
(15%)

A vague or inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes inaccurate or vague reference to state laws related to the scenario.

0 
(0%)
 – 13 
(13%)

A vague and inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided, or is missing.

The response includes vague and inaccurate reference to state laws related to the scenario, or is missing.

Explain two strategies that you, as an advanced practice nurse would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.

18 
(18%)
 – 20 
(20%)

The response accurately and thoroughly explains in detail at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.

The response accurately and completely explains whether they would disclose the error, including an accurate, detailed, and clear justification for the explanation provided.

16 
(16%)
 – 17 
(17%)

The response accurately explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.

The response accurately explains whether they would disclose the error, including an accurate justification for the explanation provided.

14 
(14%)
 – 15 
(15%)

The response inaccurately or vaguely explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario, or only explains one strategy.

The response inaccurately or vaguely explains whether they would disclose the error, including a justification that is vague, inaccurate, or misaligned to the explanation provided.

0 
(0%)
 – 13 
(13%)

The response inaccurately and vaguely explains only one strategy that an advanced practice nurse would use to guide decision making in the scenario, or is missing.

The response inaccurately and vaguely explains whether they would disclose the error, with no justification provided, or is missing.

Ethical and Legal Implications of Prescribing Drugs

Explain the process of writing prescriptions including strategies to minimize medication errors.

18 
(18%)
 – 20 
(20%)

The response provides an accurate, detailed, and thorough explanation of the process of writing prescriptions, including detailed strategies to minimize medication errors.

16 
(16%)
 – 17 
(17%)

The response provides an accurate explanation of the process of writing prescriptions, including some strategies to minimize medication errors.

14 
(14%)
 – 15 
(15%)

The response provides an inaccurate or vague explanation of the process of writing prescriptions, including inaccurate or vague strategies to minimize medication errors.

0 
(0%)
 – 13 
(13%)

The response provides an inaccurate and vague explanation of the process of writing prescriptions, including inaccurate and vague strategies to minimize medication errors, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Ethical and Legal Implications of Prescribing Drugs

3.5 
(3.5%)
 – 3.5 
(3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

0 
(0%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 
(5%)
 – 5 
(5%)

Uses correct grammar, spelling, and punctuation with no errors

4 
(4%)
 – 4 
(4%)

Contains a few (1–2) grammar, spelling, and punctuation errors

3.5 
(3.5%)
 – 3.5 
(3.5%)

Contains several (3–4) grammar, spelling, and punctuation errors

0 
(0%)
 – 3 
(3%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

5 
(5%)
 – 5 
(5%)

Uses correct APA format with no errors

4 
(4%)
 – 4 
(4%)

Contains a few (1–2) APA format errors

3.5 
(3.5%)
 – 3.5 
(3.5%)

Contains several (3–4) APA format errors

0 
(0%)
 – 3 
(3%)

Contains many (≥ 5) APA format errors

Total Points: 100

Name: NURS_6521_Week1_Assignment_Rubric Ethical and Legal Implications of Prescribing Drugs

NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

NURS6521 Module 1 week1 discussion Main Post

Case Study: A 65 year old obese female presents to the ED via ambulance with a compound fracture of the Left ankle. VS: BP= 175/92, HR= 110, RR=26, O2 sats= 95% on RA. Pt is diaphoretic and hollering in pain. Pulse +1 at site of injury. Unable to get PMH.  2mg Morphine given in the field.  Total of 1.5mg of Dilaudid given in ED. Routine lab drawn which indicates the patient has liver disease and a blood glucose of 365.  All other lab WNL.  X-ray tech is present to take film.  While adjusting left foot, patient experiences a level of conscious change. Patient becomes lethargic.  Arousable to stimulation but returns to previous state almost immediately.  VS: BP= 90/50, HR= 82.  Patient is apneic with sats 87% on RA.  When family arrived you learn that the patient takes Gabapentin daily for neuropathy.  The family thinks it is 300mg BID but can not remember for sure. NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

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Disease can effect the pharmacokinetics of drugs.  The liver disease noted in this case study can change the kinetics of drugs the liver has biotransformed (Rodighiero, 1999).  The metabolism and excretion of drugs can be delayed.  With these delays you can see a compounded and extended effect on the patient.  When administering medication, especially narcotics, one should be mindful of the presence of disease and how the patient will be affected.  According to one article, the author stated “the clearance of these drugs is reduced in patients with liver failure; thus, the initial dose may need to be lower, the interval between the doses may need to be increased, and such patients will need to be assessed on a regular basis” (Swetz et al., 2010, p. 959).

In this case, where pharmacodynamics are concerned, one must remember that all drug responses are not created equal.  One patient’s pain may respond significantly to 1 mg of morphine while another patient may not have the same effect until 2 mg of morphine have been given.  With this scenario, age and pathophysiological changes can contribute to increased effects and slow metabolism and excretion.  According to an article in 
The American Geriatrics Society, 
mixing opioids and gabapentin can produce overdose in patients indicating that substantial harm can occur (American Geriatrics Society 2019 Beers Criteria Update Expert Panel, 2019).

In developing a plan of care for this patient, education is key using a multidisciplinary approach.  If available and possible, having a family member present for teaching would be beneficial.  Providing information and teaching on each diagnosis will be beneficial and key to a successful management plan.  Having a pharmacist on the team that can evaluate current medications and provide necessary education can help prevent drug interactions that can cause adverse reactions.  I would have case management involved so they could identify areas of need that might affect good quality care and/or the ability to access resources needed.  Once the big picture is reviewed, there could be a need for referrals to other doctors, facilities, or disciplines.

References

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. 
The American Geriatrics Society
, 
67
(4), 674–694. 
https://doi.org/10.1111/jgs.15767

Rodighiero, V. (1999). Effects of liver disease on pharmacokinetics. 
Clinical Pharmacokinetics
, 
37
(5), 399–431. 
https://doi.org/10.2165/00003088-199937050-00004

Swetz, K. M., Carey, E. C., Rho, R. H., Mauck, W. D., Whitford, K. J., Moynihan, T. J., Kaur, J. S., Coyne, P. J., & Smith, T. J. (2010). Safe use of opioids to manage pain in patients with cirrhosis. 
Mayo Clinic Proceedings
, 
85
(10), 959. 
https://doi.org/10.4065/mcp.2010.0294

Thank you for your post.

With these patients that have liver failure it is important to get some specific labs that will give the clinicians an idea of the extent of the liver failure. This is an important addition to the care plan. These liver function and bilirubin levels will tell us a lot about the disease. Patients with severe liver disease, are on medications that lower the Bili levels. One example is taking Colace three times a day.This is given to bind some of the excess bilirubin in their stool. This causes frequent bowel movements. Patients complain about this effect because it disrupts their activities of daily living. So many patients omit a dose or omit all of the doses. This can increase  their Bili levels and their chances of hepatic encephalopathy. They can become unconscious. We need to know what has caused them to be unconscious.  When a patient is unconscious or is sub optimally breathing they can become acidotic. When these patients have frequent bowel movements, this puts them at risk for metabolic alkalosis. Whether a patient is in an acidotic or alkaline state, the medications they take can be greatly effected . They could overdose or underdose depending on their PH and coupled with the metabolism deficiency they have from hepatic failure.  Also when a patient has liver failure they have decreased albumin (M.Z.,n.d.) This can cause low blood pressure, increasing the likelihood of a patient passing out and becoming unconscious. When patients with liver failure have less circulating albumin this effects the medications that they may take that are protein bound medications (Rosenthal, &Burchum, 2021).This scenario can become even more dire if the patient is much older than 65 when liver clearance and renal function have a tendency to decline. NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Another addition to the care plan for this patient would be to get a Medic Alert bracelet indicating the patient has liver failure. This will alert medical staff that special precautions need to be taken.

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Reference

LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD):

National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Acute Liver Failure. [Updated 2019 Dec 11]. Available from: 
https://www.ncbi.nlm.nih.gov/books/NBK548171/

 

M;, Z. (n.d.). The role and indications of albumin in advanced liver disease. Retrieved September 05, 2020, from 
https://pubmed.ncbi.nlm.nih.gov/31314192/

Rosenthal, L. D., & Burchum, J. R. (2021). 
Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants
. St. Louis, MO: Elsevier.

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body. NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease. NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post
 a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

By Day 6 of Week 1

Read
 a selection of your colleagues’ responses and 
respond
 to 
at least two
 of your colleagues on 
two different days
 by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

 

 

WK1 Main post.

Rosenthal states that the to better understand and properly prescribe medication to our patients one must understand the pharmacokinetics, or drugs movement throughout the body, as well as pharmacodynamics, or the drugs physiological or biological effect on the body. (Rosenthal, 2021) Both pharmacokinetics and pharmacodynamics are dependents upon the patient’s comorbidities as well as other pharmacological treatment, as many drugs could have a synergistic or antagonistic affect.

There is a growing concern of opioid use and subsequent tolerance this patient population can experience. “The term 
pharmacodynamic tolerance refers to the familiar type of 
tolerance associated with long-term administration of drugs such as morphine and heroin.” (Rosenthal, 2021) This result is an adaptation to the receptors for this type of medication as a result of long term or chronic exposure to the opioid narcotic. This forces the provider to administer more frequent and often higher dose levels to attain the desired effect.

This brings to mind one of many examples that I have encountered throughout my career. This particular patient was a 42-year-old white male with a history of uncontrolled hypertension, polysubstance abuse and bipolar disorder. This patient received coronary artery bypass surgery and was extubated post-operative day zero following an uneventful surgery. NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

This patient did require higher than normal levels of sedation while conducting the weaning process from the ventilator. Following the patient’s removal from the ventilator, pain management remained the focal point and largest obstacle for this patient. Anxiety levels where also of concern as the lack of pain control contributed higher levels of anxiety. In order to affectively manage this patient level of comfort a continuous of morphine was ordered to achieve a baseline level of comfort. Dilaudid pushes where ordered at a frequency of every hour for breakthrough pain as well as Ativan pushes to assist with rising anxiety levels.

Opioid tolerance and subsequent lack of pain management often delays recovery for patients as they are less likely to adhere to treatment pathways due to the increased levels of discomfort NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion. (Owodunni, 2019) It is important that providers understand that opioid tolerance affects the pharmacodynamics of prescribed medications for pain management.

 

References

Owodunni, O. P., Zaman, M. H., Ighani, M., Grant, M. C. Bettick, D., Sateri, S., Magnuson, T., & Gearhart, D. (2019). Opioid tolerance impacts compliance with enhanced recovery pathway after major abdominal surgery, 
166
(6), 1055-1060. https://doi-org.ezp.waldenulibrary.org/10.1016/j.surg.2019.08.001 NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Rosenthal, L.D., & Burchum, J. R. (2021). 
Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants 
(2
nd
 ed.) St. Louis, MO: Elsevier Retrieved September 2, 2020 from https://mbsdirect.vitalsource.com/#/books/9780323598125/cfi/6/34!/4/2/4/2/2@0:45.7

Villegas-Pineda, M. H., & Palacio-Garcia, C. A. (2017). Case report: Opioid tolerance and hyperalgesia after abdominal injury. 
Colombian Journal of Anesthesiology, 45
(Supplement 1), 12-15. Retrieved September 2, 2020 https://doi-org.ezp.waldenulibrary.org/10.1016/j.rcae.2016.03.005 NURS 6521 Pharmacokinetics and Pharmacodynamics Discussion

Week 1 Main Post Discussion: Pharmacokinetics and Pharmacodynamics

Understanding how prescription and non-prescription influences the body, first a clear understanding is needed to the function of pharmacokinetics and pharmacodynamics and how these components how any drugs that maybe administered and interact in the body.  Pharmacokinetics refers to movement of drug into and out of the body by absorption, metabolism, excretion, and distribution the amount of time it takes for a drug to be utilized by the body.  Also, pharmacokinetics determines the onset, duration, and intensity of a drug effect Discussion: Pharmacokinetics and Pharmacodynamics.  Pharmacodynamics described what a drug does to the body once it attaches to the appropriate receptor site.  Pharmacodynamics also involves the molecular effect of the drug to bind with the receptors site of the cell to cause a reaction. (Farinde, 2019).

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A drug pharmacodynamic and pharmacokinetic effect centers around many factors concerning the patient for example, the age of the patient, hepatic, and renal function, other drug – drug interaction competing for receptor binding sites.  Looking at the current pandemic of Coronavirus many different anti-viral medications was used to reverse the effect of acute respiratory syndrome that affect the patient from the coronavirus.  Some of these medications such as lopinavir, remdesivir, azithromycin, and chloroquine was used to help combat or reverse the effect of coronavirus Discussion: Pharmacokinetics and Pharmacodynamics.

The pharmacokinetic process for each of these drugs are the same but the pharmacodynamics may differ depending on their molecular structure and the receptors site which they bind and how they cross the cell membrane.  As stated by Srivalli & Lakshmi, (2012) these drugs are substrates of P-glycoprotein an efflux membrane transporter and a member of the ATP-binding transporter found primarily in epithelial cells which are inhibitors.  Which means these drugs stop the progress of the coronavirus from attacking the cells or other cell which mostly affect respiratory function.

During this pandemic I worked in the ICU and saw the affects the positive and not so positive effects that chloroquine has in response to patients being removed from the ventilators with a lower peep and FIO2 level.   Depending on the co-morbidity’s patient has and how soon the antiviral medication was started the patient had a fair chance for being extubated.  If a child was given an overdose of antiviral medication to combat the coronavirus that was meant for adult many rapid action steps need to be executed.  Looking at azithromycin administration in children is given by body for 3-5 days an overdose of this medication causes prolongation of QT complex, Torsade de point, and unresponsiveness.  Reason, azithromycin in the tissue has an extreme high plasma and high lipid solubility and its half-life is 68 hours and excretion or elimination is characteristic of this drug remain unchanged. (Tijjani, Ishola 2020).     The APRN must take in account that a children body surface is must smaller than an adult and over medicating disaster can occur quickly.  Administering any medications understanding the pharmacokinetic and pharmacodynamic properties is a must to assure patient safety and ethical practice.

References

Farinde, A. (2019). Overview of Pharmacodynamics – Clinical Pharmacology: Merck Manual Professional Version Retrieved from: Merck Manuals >professional > overview

Srivalli, K. Lakshmi, P. (2012). Overview of P-glycoprotein inhibitors: A rational outlook. Brazilian Journal of Pharmaceutical Science 48(3) 353-367

Tijjani, H. Ishola, A. (2020). Repurposing of choloroquine and some clinically approved antiviral  drugs as effective therapeutics to prevent cellular entry and replication of coronavirus Retrieved from: 
https://www.researchgate.net/publication/341601496

 

Response

Good post

Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used in the treatment of malaria. Moreover, their antiviral properties have been previously studied, including against coronaviruses, where evidence of efficacy has been found. In the current race against time triggered by the COVID-19 pandemic, the search for new antivirals is very important. However, consideration are given to old drugs with known anti-coronavirus activity, such as CQ and HCQ. These could be integrated into current treatment strategies while novel treatments are awaited, also in light of the fact that they display an anticoagulant effect that facilitates the activity of low-molecular-weight heparin, aimed at preventing acute respiratory distress syndrome (ARDS)-associated thrombotic events.

There has been significant research on the possible antiviral actions of CQ/HCQ. Their safety aspects have been studied extensively for over 50 years, but the evidence is not necessarily applicable to those most at risk of mortality from COVID-19 (e.g. frail older people), who at the same time are most vulnerable to drug side effects. The challenge that SARS-CoV-2 launches into science is to create new specific drugs. However, because COVID-19 causes cardiac problems, the cardiac toxicity of HCQ can be enhanced in the short-term.

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References

Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. 
Cell Discov. 
2020;
6
:16. doi: 10.1038/s41421-020-0156-0. 

Zhu RF, Gao RI, Robert SH, Gao JP, Yang SG, Zhu C. Systematic review of the registered clinical trials of coronavirus disease 2019 (COVID-19) 
medRxiv. 
2020 Mar 17 doi: 10.1101/2020.03.01.20029611. 

 

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease. Discussion: Pharmacokinetics and Pharmacodynamics

Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post
a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case Discussion: Pharmacokinetics and Pharmacodynamics. Be specific and provide examples.

By Day 6 of Week 1

Read
 a selection of your colleagues’ responses and 
respond
 to 
at least two
 of your colleagues on 
two different days
by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure. Discussion: Pharmacokinetics and Pharmacodynamics.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

 

 

Week 1 Discussion post

Case: A person on medication for weight loss. States she has taken it for numerous years to get her through the hard times and curbed her appetite so she can continue to look the way she does.

Prescription medicine has the potential to change the practice of medicine by tailoring treatments to individuals (Grottick, A., Whelan, K., Sanabria, E., Behan, D., Morgan, M., & Sage, C. (2015). We have all been taught the medication rights- right medication, dose, route, time, and reason. Even though this client is a friend, and I have known her to be on this medication for years Discussion: Pharmacokinetics and Pharmacodynamics. I have watched her take it, also know she has a ton of underlying medical problems such as thyroid disease, PCOS, lupus, and has pulmonary hypertension that is poorly managed. I realize that Adipex is a medication that has both positive and negative effects (depending on the person and the situation). It may be used to help with concentration, decrease appetite, and used as a stimulant, but is often given to individuals that have not had a complete physical. For someone that has chronic illnesses, filtration and absorption mechanisms are vastly reduced and have multiple allergies to medications due to autoimmune disorders- supplying the medication without continued to follow up, a proper assessment would be negligent. Discussion: Pharmacokinetics and Pharmacodynamics This patient has an issue with fluid retention at baseline, takes Bumex twice a day, and has a difficult time urinating at times. Shortness of breath is part of her daily life, and increasing heart rate, on a pump that already fails would be disastrous.

Pharmacokinetics and pharmacodynamics determine the clinical effects of drug therapy. It is necessary to know what the body specifically does to the drug, how it is absorbed, distributed, metabolized, and eliminated. To further understand medication choice, usage, and dosage, the physiological effects on the body must be known. If an individual has chronic medical conditions, including those listed on the contraindications and or side effects sections, prescribing with caution would be the best practice or not prescribing at all. We as providers must deliver care with accuracy, precision, and efficiency (Grottick, A., Whelan, K., Sanabria, E., Behan, D., Morgan, M., & Sage, C., 2015). Practitioners are being held to high standards based on prescribing guidelines that have been made more readily accessible thanks to upgraded technology (Durney, P. M., & Lebov, H. L., 2019) Discussion: Pharmacokinetics and Pharmacodynamics.

Things that we, as prescribers should consider when writing for medications: documenting medication indications on the prescription. Cross-checking through computer data bases also allow for further verification of the medication, dosing, and determine if the medication is questionable with other prescribed medications. This will be a more efficient way to tailor patient-centered care, and to perform safety checks (Kron, Myers, Volk, Nathan, Neri, Salazar, Amato, Wright, Karmiy, McCord, Seoane-Vazquez, Eguale, Rodriguez-Monguio, Bates, & Schiff, 2018)

 

Durney, P. M., & Lebov, H. L. (2019). The Perils of Prescribing Medication and the Goldilocks

Principle: Defending Related Claims of Malpractice. 
Defense Counsel Journal
, 
86
(4), 1–

20.

Grottick, A., Whelan, K., Sanabria, E., Behan, D., Morgan, M., & Sage, C. (2015). Investigating

interactions between phentermine, dexfenfluramine, and 5-HT agonists, on food intake in

the rat. 
Psychopharmacology
, 
232
(11), 1973–1982. Discussion: Pharmacokinetics and Pharmacodynamics

Kron, K., Myers, S., Volk, L., Nathan, A., Neri, P., Salazar, A., Amato, M. G., Wright, A.,

Karmiy, S., McCord, S., Seoane-Vazquez, E., Eguale, T., Rodriguez-Monguio, R., Bates,

D. W., & Schiff, G. (2018). Incorporating medication indications into the prescribing

process. 
American Journal of Health-System
Pharmacy : AJHP : Official Journal of the

American Society of Health-System Pharmacists
, 
75
(11), 774–783.

response 1

I enjoyed reading your post.  I do not know too much about weight loss medication, but I do know that they can affect how other medications are absorbed within the body.  Makiani, Nasiripour, Hosseini, & Mahbubi (2017) state that “knowing about medications mechanisms of action and where and how they are absorbed is important, especially when other medications are being given at the same time”.  I know the medication that you speak of is not over the counter, however, some weight loss supplements are and can affect the patient’s other medications.  One thing that really came to mind for me was that CAM therapies can have negative effects on patients and their medications. Discussion: Pharmacokinetics and Pharmacodynamics National Cancer Institute (2019) states “not all-natural materials are safe; vitamins can have unwanted effects within your body.”  There are also food and drinks that can alter medications for example, Rosenthal & Burchum (2020), state that “grapefruits can cause major issues with patients and their medications”.  I really enjoyed your post, did you feel that because of this discussion board you were forced to think through patient medication the next time you worked?  Thanks for creating a great discussion.

 

References

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Makiani, M., Nasiripour, S., Hosseini, M., & Mahbubi, A. (2017). Drug-drug Interactions: The Importance of Medication Reconciliation. Retrieved September 05, 2020, from 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348861/

National Cancer Institute. (2019). Complementary and Alternative Medicine (CAM). Retrieved September 05, 2020, from 
https://www.cancer.gov/about-cancer/treatment/cam

National Caregivers Library. (2019). Caregivers Resources. Retrieved September 05, 2020, from http://www.caregiverslibrary.org/Caregivers-Resources/GRP-Home-Care/HSGRP-Medications/Understanding-Drug-Interactions-Article Discussion: Pharmacokinetics and Pharmacodynamics

 

response 2

I’ve enjoyed reading your discussion. The most commonly used weight‐loss medication in the United States is phentermine, a sympathomimetic amine that acts by inhibiting appetite and that was originally approved for weight loss in 1959 (Ard et., 2019). Like you, I’ve also known many individuals who’ve taken phentermine. Several months later, the weight was regained. This caused them to remain on the medication longer, or use it “off and on. “Given the physical and psychological harms related to weight regain, weight cycling should be considered as an adverse effect of therapy (Murali, 2019). Discussion: Pharmacokinetics and Pharmacodynamics Recently, many studies have shown that longer‐term phentermine users experienced greater weight loss without apparent increases in cardiovascular risk as mentioned by (Ard et al., 2019). Addressing chronic illnesses and disease care maintenance is critical for medication safety. Existing pharmacotherapies continue to focus on winning the battle of weight loss while progress toward winning the war of weight loss maintenance remains stagnant (Murali, 2019). Discussion: Pharmacokinetics and Pharmacodynamics

References

Ard, J., Lewis, K. H., Arterburn, D. E., Fischer, H., Barton, L., Koebnick, C., Yamamoto, A., Young, D. R., Bessesen, D. H., Daley, M. F., Desai, J., Fitzpatrick, S. L., Horberg, M., & Oshiro, C. (2019). Safety and Effectiveness of Longer-Term Phentermine Use: Clinical Outcomes from an Electronic Health Record Cohort. Obesity (19307381), 27(4), 591–602. 
https://doi-org.ezp.waldenulibrary.org/10.1002/oby.22430

Murali, S. (2019). Knowledge Gaps in Long-Term Phentermine Use: Making the Case for Maintenance. Obesity (19307381), 27(8), 1219. https://doi-org.ezp.waldenulibrary.org/10.1002/oby.22516 Discussion: Pharmacokinetics and Pharmacodynamics

Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

Episodic/Focused SOAP Note Template

Patient Information:

Initials, RB.

Age 50, Sex

Male, Race. Caucasian

Subjective

CC
 (chief complaint); nasal congestion and itchy eyes, nose, and palate for five days

HPI
: Mr. Brown is a 50-year-old white male presenting with a complaint of nasal congestion, sneezing, rhinorrhea, nasal drainage, itchy nose, eyes, and palate for five days Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment. He states that he has been taking Mucinex for the past two nights with minimal relief. He denies a headache or pain.

Current Medications
:

Mucinex OTC at bedtime

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Hydralazine 25mg TID

Allergies: 
NKDA

-reports seasonal allergies

-denies environmental allergy

PMHx
: has a history of hypertension. Denies other illnesses. Immunizations are up to date; he received a flu shot this season. He Received a Tetanus booster last year. Hospitalized in 2018 for left femur fracture repair from a fall. No other significant medical or surgical history Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

Soc Hx
: Mr. Brown lives in a one-story single-family home with his wife and three children. He has his master’s degree in business administration and works in a consulting firm where he has worked for 15 years. He is a former smoker, smoked cigarette from 17-38 years, and marijuana from the age of 18-30. He drinks socially about 1-2 drinks weekly. He states that he does not exercise but takes a walk around the neighborhood about three times weekly. He is a Christian and sometimes attends church on Sundays if he is not too tired. His wife is a beautician who enjoys making healthy meals for the family.

Include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx
:

-Father has a history of hypertension and BPH

-Mother died at 78 from a stroke.

-Two sisters with no significant medical history

-Three children aged 15, 17, and 20 with no significant medical history.

-Maternal Grandparents died from a car accident when he was 18. He does not remember their ages at death.

-Paternal grandparents are deceased, but he doesn’t remember the ages and cause of death

ROS
:

GENERAL: Alert and oriented to person, place, situation, and time. Denies recent weight changes. Denies fatigue, fever, chills, and weakness.

HEENT: Denies headache. Eyes are itchy and red. No visual loss, blurred vision, double vision or yellow sclerae. States that Ears are itchy, erythematic, and inflamed, denies hearing loss and discharge from the ear. The nose is itchy with sneezing, congestion, and runny nose. Clear nasal discharge. Reports sore throat. Denies difficulty swallowing.

SKIN: No changes in pigmentation. No discoloration, moles, rash, or itching. Denies any other skin abnormalities.

CARDIOVASCULAR: Denies chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: Denies shortness of breath or cough

GASTROINTESTINAL: Denies anorexia, nausea, vomiting, or diarrhea. No abdominal pain or discomfort. Reports regular daily bowel movements.

GENITOURINARY: Denies burning or pain on urination. Denies urinary tract infection.

NEUROLOGICAL: Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: Denies muscle, back pain, joint pain, fatigue, or stiffness.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

ALLERGIES: No history of asthma, hives, eczema or rhinitis. Reports seasonal allergies.

Objective

Physical Exam: 

General: Alert and oriented to person, place, situation, and time. Appears well groomed and nourished. Eyes are itchy and red. PERRLA

V/S: Temp: 97.9 degrees Fahrenheit, Pulse:72 beats per minute and regular. Resp:18 beats per minute, Blood Pressure: 141/76, weight: 185 pounds Height: 68 inches

HEENT: Head is normocephalic. Eyes are itchy and red, with no discharge noted in eyes. No vision changes. Ears are red and inflamed. Nasal mucosa is pale and edematous with enlarged nasal turbinate. Clear thin secretions noted in nasal cavities. The throat is mildly erythematous, with no purulent discharge or bleeding noted. Tonsils are symmetrical and pink, no swelling noted.

NECK: Trachea in the midline, no deviation noted. No swollen Lymph nodes noted.

CARDIOVASCULAR: No palpitations or edema. Bilateral radial and dorsalis pedis pulse 2+ and regular.

RESPIRATORY: No shortness of breath, cough, or sputum noted. Lung sounds are clear anteriorly, posteriorly, and laterally. Respirations are even and unlabored.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

Diagnostic results
:

Allergy Skin tests:
This can be done for this patient in this scenario. The test is done by introducing an allergen into the body intradermally to determine if there is an immune reaction (Nelvis, 2016). This test will help diagnose allergic rhinitis and determine what allergen the patient is reacting to (Health Quality Ontario, 2016). In this case, the patient tested positive for pollen, hence indicative of allergic rhinitis.

Radioallergosorbent test
: (RAST) is an antibody blood test that can be performed in this scenario. Testing for immunoglobulin E antibody in the blood will help determine if there has been an immune response; this is because the body produces antibodies in response to allergens (NHS, 2016).

Sinus CT scan:
A Sinus CT scan can be performed to rule out Sinusitis. CT scan of the sinus will reveal inflammation of the sinuses (Alam, 2020).

Throat culture:
A sputum culture can be performed to test for the presence of infectious microorganisms in the throat that may be responsible for an upper respiratory tract infection (Arberfeville et al., 2018). The test is done by swabbing the back of the throat after which the secretions are cultured, the test result for a throat culture takes days but is effective in identifying the presence of microorganisms in the upper respiratory tract and in this scenario may be useful in diagnosing tonsillopharyngitis.

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Differential Diagnoses

 Allergic Rhinitis:  
Allergic rhinitis is an allergic response characterized by sneezing, itchy, watery eyes, congestion, and clear nasal discharge in response to exposure to allergens such as dust, chemicals, or pollen (American College of Allergy, Asthma & Immunology, 2015). When allergens are inhaled, it triggers an immunoglobulin E (IgE) mediated reaction, which then causes the symptoms (Wheatley & Alkis, 2015). This is the most likely diagnosis due to the positive skin test for pollen allergen and the presenting symptoms.

Nonallergic Rhinitis: 
Nonallergic rhinitis is the inflammation of the nasal tissues causing sneezing, congestion, and runny nose. It is not caused by allergens rather by a build of fluid due to inflamed blood vessels due to viral infections, hormonal imbalances, or environmental factors (NHS, 2019). It is often diagnosed with history, negative tests for allergens, and a lack of improvement when treated like allergic rhinitis (NHS, 2019). Nonallergic rhinitis is a possible diagnosis for this patient; however, the presence of a positive pollen test suggests that allergic rhinitis is a more likely diagnosis. This patient also has itchy eyes, nose, and throat, which are symptoms more suggestive of allergic rhinitis.

Sinusitis: 
Sinusitis is the inflammation of the tissue lining the sinuses due to viral, bacteria, fungal infections, or allergic reactions. When Sinusitis occurs, the sinus becomes filled and is unable to drain due to sinus blockage. Sinus blockage may be caused by smoking, weakened immune system, structural problems with the sinus, or following a cold (CDC, 2019b). It is characterized by cough, congestion, purulent rhinorrhea, facial pain, or pressure; It is sometimes accompanied by headache, malaise, and fever (Marvin, 2017). Symptoms usually diagnose it; however, a sinus CT scan may be used to ascertain the extent of infection if it persists (CDC, 2019b). Although there are similar symptoms such as congestion and rhinorrhea, Sinusitis is a less likely diagnosis in this scenario because rhinorrhea in Sinusitis is often purulent. This patient also lacks pertinent symptoms such as headaches, facial pain, or pressure.

Common cold: 
Common cold is an acute viral infection of the upper respiratory tract. It usually affects the nose, sinuses, larynx, and pharynx, causing symptoms such as cough, sore throat, runny nose, malaise, headache, mild fever, and sneezing (Solo-Josephson, 2017). It is usually transmitted by direct or indirect contact with the cold virus into the eyes or nose; symptoms usually appear within two to three days after exposure to the virus (CDC, 2019a). It is usually self-limiting in generally healthy people, clearing up after 7-10 days (CDC, 2019a). It is often diagnosed using symptoms and history. The common cold is unlikely for this scenario due to the absence of sore throat, headache, malaise, and fever.

Tonsillopharyngitis. 
Tonsillopharyngitis is an acute inflammation of the tonsils, pharynx, or both. It may also be caused by bacteria. It is transmitted through direct or indirect contact with the secretions of an infected person (Marvin, 2016). Symptoms include rhinorrhea, cough, sore throat, diarrhea, and conjunctivitis (Marvin, 2016). Symptoms usually start about two to seven days after exposure. There is often fever in bacterial tonsillopharyngitis; there may be no fever in viral tonsillopharyngitis. Although some of these symptoms are present in Mr. Brown, the absence of enlarged tonsils and sore throat makes this diagnosis less likely.

 

References

American College of Allergy, Asthma & Immunology (2015). Allergic rhinitis. Retrieved from 
https://acaai.org/allergies/types/hay-fever-rhinitis

Alam, R. (2020). Allergic Rhinitis (Hay Fever): Diagnosis. Retrieved from   
https://www.nationaljewish.org/conditions/allergic-rhinitis-hay-fever/diagnosis

Arbefeville, S., Nelson, K., Thonen-Kerr, E., & Ferrieri, P. (2018). Prospective postimplementation study of Solana group A streptococcal nucleic acid amplification test vs conventional throat culture.
American journal of clinical pathology
,
150
(4), 333-337.

Centers for Disease Prevention and Control (2019). Common colds: Protect yourself and others. Retrieved from  
https://www.cdc.gov/features/rhinoviruses/index.html

CDC (2019). Sinus Infection (Sinusitis). Retrieved from  
https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/sinus-infection.html

Delves, P. J. (2016). Allergic Rhinitis. 
Merck Manual Professional Version. 
Retrieved from 
https://www.merckmanuals.com/professional/immunology-allergic-disorders/allergic,-autoimmune,-and-other-hypersensitivity-disorders/allergic-rhinitis#v651577

Health Quality Ontario (2016). Skin Testing for Allergic Rhinitis: A Health Technology Assessment. 
Ontario health technology assessment series
, 
16
(10), 1–45. Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

Marvin, P. F. (2016). Sore Throat. 
Merck Manual Professional Version. 
Retrieved from 
https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/approach-to-the-patient-with-nasal-and-pharyngeal-symptoms/sore-throat

Marvin, P. F. (2017). Sinusitis. 
Merck Manual Professional Version. 
Retrieved from 
https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/nose-and-paranasal-sinus-disorders/sinusitis

Nelvis, F. I., Binkley, K., and Kabali, C. (2016). Diagnostic accuracy of skin-prick testing for allergic rhinitis: a systematic review and meta-analysis. 
Allergy, Asthma & Clinical Immunology 12
(20). Retrieved from https://aacijournal.biomedcentral.com/articles/10.1186/s13223-016-0126-0

NHS (2016). Allergic rhinitis: diagnosis. Retrieved from 
https://www.nhs.uk/conditions/non-allergic-rhinitis/

NHS (2019). Nonallergic rhinitis. Retrieved from 
https://www.nhs.uk/conditions/non-allergic-rhinitis/

Solo-Josephson, P. (2017). Colds. Retrieved from  
https://kidshealth.org/en/parents/cold.html
 Wheatley, L. M., & Togias, A. (2015). Allergic Rhinitis. 
The New England Journal of Medicine
, 372(5), 456–463. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324099/

Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat

Photo Credit: Getty Images/Blend Images

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.

Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.

In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

To Prepare

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.

With regard to the case study you were assigned:

Review this week’s Learning Resources and consider the insights they provide.

Consider what history would be necessary to collect from the patient.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each. Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

By Day 6 of Week 5

Submit
 your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK5Assgn1+last name+first initial.(extension)” as the name.

Click the 
Week 5 Assignment 1 Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 5 Assignment 1 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
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Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
 button to complete your submission.

NURS_6512_Week_5_Assignment_1_Rubric

Excellent

Good

Fair

Poor

Using the Episodic/Focused SOAP Template:

· Create documentation or an episodic/focused note in SOAP format about the patient in the case study to which you were assigned.

·  Provide evidence from the literature to support diagnostic tests that would be appropriate for your case.

45 
(45%)
 – 50 
(50%)

The response clearly, accurately, and thoroughly follows the SOAP format to document the patient in the assigned case study. The response thoroughly and accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study. Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

39 
(39%)
 – 44 
(44%)

The response accurately follows the SOAP format to document the patient in the assigned case study. The response accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.

33 
(33%)
 – 38 
(38%)

The response follows the SOAP format to document the patient in the assigned case study, with some vagueness and inaccuracy. The response provides evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study, with some vagueness or inaccuracy in the evidence selected.

0 
(0%)
 – 32 
(32%)

The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study. The response provides incomplete, inaccurate, and/or missing evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.

·   List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

30 
(30%)
 – 35 
(35%)

The response lists five distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the five conditions selected. Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

24 
(24%)
 – 29 
(29%)

The response lists four or five different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the five conditions selected.

18 
(18%)
 – 23 
(23%)

The response lists three to five possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

0 
(0%)
 – 17 
(17%)

The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 
(3%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 
(0%)
 – 2 
(2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors.   Total Points: 100 Name: NURS_6512_Week_5_Assignment_1_Rubric Assessing the Head, Eyes, Ears, Nose, and Throat Episodic/Focused SOAP Note Case Study Assignment

.

NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Comprehensive SOAP Template

Patient Initials: AC                             Age: 68                                   Gender: Male

 

SUBJECTIVE DATA: “
About a week ago, I noticed some rash on my right chest, back, and neck. I thought it would get better, but the rash is itchy and painful, it has also gotten worse. I also feel a little feverish.” NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Chief Complaint (CC): 
The patient reported noticing skin abnormality about a week ago, “I have an itchy rash on my neck, chest, and back that is peeling and getting worse.” The rash is swollen with clear liquid and painful.

History of Present Illness (HPI):  
Mr. Alexander Cortez is a 58-year-old Hispanic male. Presents with a patchy rash on the neck, chest, and back region. He states that the rash started about two weeks ago and has progressively gotten worse. He denies changing skin routine or location within the last two weeks, no history of environmental allergies, no known allergy to dye, or latex. Mr. Cortez states he has not tried any treatment for the rash, no worsening, or alleviating factors noted. He complained of pain level 7 on a scale of 1-10. He describes the pain as sharp and states Tylenol 1000mg has helped relieve the pain. He is worried about the rash getting worse and states that the rash and its associated pain interferes with his daily activities and quality of life. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Medications:  

– Acetaminophen 1000mg

PO Q 6 HRS for pain

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– Metformin 500mg daily for diabetes

– Atorvastatin 40mg at bedtime for high cholesterol

– Hydralazine 10mg BID for Hypertension

– Amlodipine 5mg daily for hypertension

Allergies: 

– Penicillin Reaction (itching)

Past Medical History (PMH): 

Hypertension-diagnosed at 43 years old

Hyperlipidemia- diagnosed at 45 years old

Diabetes Mellitus Type 2 diagnosed at 38 years old

Chickenpox: 7 years old

Appendicitis – hospitalization at 28 years old

Past Surgical History (PSH): 

Appendectomy 1992

Sexual/Reproductive History: 

Currently sexually active with his wife, he denies sexual/reproductive issues. Heterosexual and currently using no barrier methods, no past history of STDs.

Personal/Social History: 

The patient is a non-smoker, never smoked. His wife smokes 1pack/day. Mr. Cortez drinks alcohol occasionally, about 1-2 drinks a week. He denies the use of recreational drugs.

Immunization History: 

Received flu shot last season

Received pneumococcal vaccine 8/12/2019 during the annual check-up

He does not remember the last tetanus vaccination.

Significant Family History:

-Mother had diabetes mellitus type 2 and died from diabetes complication at 81

-Father had chronic hypertension and died at the age of 78 from a stroke

-Patient does not recall the medical history of grandparents

-Denies any noted illness for his siblings and children.

Lifestyle: 
Mr. Cortez runs a small family construction business, which he runs with his son. He is a Christian and attends church with his family every Sunday. The highest level of education is high school with certifications in HVAC and plumbing. He lives at home with his wife, daughter, who is a single mother and grandson. His wife works full time as a secretary, and his health coverage is through his wife’s job. He states he is too busy to exercise, and his diet comprises mainly of heavy meals due to his job. Reports drinking socially, about 2-3 drinks weekly, mostly beer. Never smoked, denies the use of recreational or illicit drugs

Review of Systems

General: 
Mr. Cortez appears well dressed and well-nourished. Denies weakness and fatigue. No recent weight changes or changes in appetite. No apparent signs of distress.

HEENT: 
The patient uses glasses, denies vision changes, discharge from eyes, tinnitus, hearing loss, and discharge from ears. Denies loss or decreased sense of smell, nasal drainage, or congestion.

Neck: 
The patient denies any injury to the neck, swelling, or history of compression. Rash currently present in the neck region.

Breasts: 
denies lump, discharge, or rash

Respiratory: 
denies shortness of breath, denies cough or respiratory distress, no history of respiratory disorders except occasional seasonal allergies

Cardiovascular/Peripheral Vascular: 
Denies chest pain, reports history of hypertension and high cholesterol. He denies history of stroke, edema or heart failure.

Gastrointestinal: 
Denies nausea or vomiting, and diarrhea. Reports consistent bowel movement every two days.
 
He also reported that his wife occasionally gives him prune juice to aid his
 
occasional constipation.

Genitourinary: 
Pt denies any feeling of urgency or urinary retention. No history of UTI or incontinence denies burning sensation when urinating, denies frequency, and urgency.

Musculoskeletal: 
The patient reported a history of fall six months ago when he woke up and could not find his cane at the bedside. The patient stated that he takes 30 mins to walk in the evenings three times per week with his wife.

Psychiatric: 
The patient denies any history of mental illness, no suicidal or homicidal ideations. Reports no history of mental illness in his family.

Neurological: 
The patient reported feeling lightheaded after his fall 6 months ago but was seen by the ER doctor and has not had any dizziness episodes since then. Denies any headaches or sudden/abnormal movements.

Skin: 
The patient reports a red rash with blisters filled with clear fluid on his right torso and neck. Patient denies any other skin issues, a history of chickenpox when he was eight years old

Hematologic: 
Denies any abnormal bleeding. Denies any history of bleeding disorder in his family. Never been diagnosed with anemia, no history of incidents with significant blood loss.

Endocrine: 
Denies any use of hormonal therapies, denies a history of thyroid disorders.

Allergic/Immunologic: 
Patient denies any history of allergies, reported that he and his children often have seasonal allergies but usually resolves within a few days

OBJECTIVE DATA:

Physical Exam:

Vital signs:

– Blood Pressure: 148/93 mmHg -Weight.: 285 lbs

– Pulse: 76 BPM -Height: 170 cm

– Respiratory Rate: 18 – Blood glucose: 148 mg/dl

– Temperature: 98.9 F

General: 
The patient is alert and oriented, able to communicate clearly, posture, and gesture appropriately, maintains eye contact. Well dressed and groomed, appropriate affect, and reaction. Ambulates independently, gait even and steady

HEENT: 
Head, Face is symmetrical, bilateral eyes, ears, and nose symmetrical. No drainage or foul odor noted, no discoloration noted.

Neck: 
No swelling or deviation was noted. No Jugular Vein Distention noted that the carotid artery is palpable bilaterally, rash noted on the right side, and able to move from side to side.

Chest: 
Equal rise and fall of chest noted. Clear to auscultation Anterior, Posterior and Lateral

Lungs: 
Lung sounds clear, bilaterally anteriorly, posteriorly, and laterally. The respiratory pattern regular, the chest wall is symmetrical, no cough is noted.

Heart: 
No murmurs or palpitations noted

Peripheral Vascular: 
symmetrical, No edema or discoloration noted in extremities, Pulse regular 2+ pulse in the bilateral pedal, and 2+ in bilateral radial.

Abdomen:  
Abdomen soft, flat, and non-tender, no distention noted, no organomegaly noted.

Genital/Rectal: 
External genitalia intact, no swelling or discoloration noted

Musculoskeletal: 
Uneven gait noted; the patient uses a cane for balance.

Neurological:  
Alert and oriented to person, place, time, and situation. CN I – XII intact

Skin: 
Patients’ skin is generally warm, intact, and dry. Red raised vesicles with clear fluids on the right chest, underarms, neck, and back. Site warm to touch. No other skin abnormality was noted.

Clinical Terminology for Skin Condition in Graphic five

The skin condition in graphic five presents as a rash, which is red in color. The rash is present on the right lateral side of the patient’s chest and back. Some of the rashes are fluid-filled and appears blistering.

Differential Diagnosis

Contact Dermatitis
: Contact dermatitis is a common skin disorder that occurs after exposure to allergens or irritants (World, Allergy Organization, 2015). Irritants such as soaps, detergents, stool, and urine trigger irritant contact dermatitis while cosmetics, drugs, food, or dye in people genetically predisposed or sensitized triggers allergic contact dermatitis.

The skin condition is characterized by red vesicles that are itchy (World, Allergy Organization, 2015). The location of the rash depends on the exposure to allergens. It is often diagnosed with history and physical (American Academy of Allergy Asthma & Immunology, 2019).

Psoriasis
: Psoriasis is an autoimmune skin condition characterized by dry, red, and scaly rash (Nair & Badri, 2018). There are different types of psoriasis, however, psoriasis in general, is often seen with red scales covered with silver scales (Nair & Badri, 2018). The exact etiology of psoriasis is unknown; however, it has been seen to be genetically transmitted (Nair & Badri, 2020). the rash can appear anywhere in the body, including the eyes and scalp; it is also commonly seen in the knees and elbows; thus, the rash location and progression are often used when diagnosing the condition (Nair & Badri, 2020).

Shingles
: Shingles is a skin condition also called Herpes Zoster caused by the varicella-zoster virus; it usually occurs in a patient who has previously had chickenpox virus or people older people with weakened immunity. The shingles rash are blistering red vesicles that usually appear in the face and torso (Carter, 2020). The rash may be itchy and painful with a burning or stinging sensation. It commonly affects one side of the body. It is usually diagnosed by the characteristics of the rash (National Institute of Neurological Disorders and Stroke, 2020).

Most Likely Diagnosis

Like many other conditions, diagnosing skin conditions starts with a good assessment, history, and physical (Ball, 2019). Assessment of Certain criteria is critical in helping a provider diagnose a skin disorder. For example, location, color, shape, measurement, surrounding skin, and texture of skin disorders will provide insight and help with accurate diagnosis (Ball, 2019). Other presenting symptoms, including systemic symptoms, are also used to identify and diagnose skin conditions (Ball, 2019) NURS-6512 Differential Diagnosis for Skin Conditions SOAP note. When collecting history and physical for skin conditions, it is important to collect a focused history that helps in diagnosing the skin conditions for example, the onset of skin condition, changes, presence of itch or discharge are some of the histories that help to diagnose skin conditions (Ball, 2019). Diagnostic tests can also help providers rule out certain conditions when diagnosing skin disorders. For example, shingles can be identified by testing for herpes or varicella-zoster virus. (Centers for Disease Control and Prevention, 2019).

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The skin condition presented in this graphic is seen on the torso’s right lateral side; the rash appears to be red, fluid-filled, and blistering. Mr. Cortez states that the rash began about a week ago and is present only on his right side; he denies change in routine or exposure to irritants that could suggest allergic or irritant contact dermatitis. Also, the rash seen in contact dermatitis is scaly (Dains et al., 2019). Psoriasis rash, in this case, is unlikely because while psoriasis rash is red, it is also scaly and often appears on the knees, elbows, lower back, and scalp (Roland, 2018). Also, psoriasis is characterized by unique systemic symptoms such as swollen and painful joints, which Mr. Cortez denies (Davis, 2020). Shingles are the most likely diagnosis in this case because the rash, in this case, is red vesicles clustered together, appears in a linear arrangement, and is located on the right side of the torso without crossing the midline. According to Carter (2020), shingles rash are red lesions that are usually unilateral. During history, Mr. Cortez denies systemic symptoms that may suggest psoriasis; he also denies history, suggesting contact dermatitis. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

 

References

American Academy of Allergy Asthma & Immunology (2019). Contact dermatitis overview. Retrieved from 
https://www.aaaai.org/conditions-and-treatments/library/allergy-library/contact-dermatitis

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). 
Seidel’s guide to physical examination: An interprofessional approach
 (9th ed.). St. Louis, MO: Elsevier Mosby.

Carter, T. M. (2020). Shingles: Not Just a Rash. Journal for Nurse Practitioners, 16(2), 111–115.

https://doi-org.ezp.waldenulibrary.org/10.1016/j.nurpra.2019.10.013

Centers for Disease Control and Prevention (2019). Laboratory Testing for VZV. Retrieved from 
https://www.cdc.gov/shingles/lab-testing/index.html

Conceicao, V. (2018). Prevention and management of shingles and associated

complications.
Journal of Community Nursing, 32
(6), 40–43. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and

clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Nair, P. A. & Badri, T. (2020). Psoriasis. Retrieved from 
https://www.ncbi.nlm.nih.gov/books/NBK448194/

National Institute of Neurological Disorders and Stroke (2020). Shingles Information Page. Retrieved from 
https://www.ninds.nih.gov/Disorders/All-Disorders/Shingles-Information-Page

Roland, J. (2018). Shingles vs. psoriasis: What’s the difference? Retrieved from  
https://www.healthline.com/health/psoriasis/shingles-vs-psoriasis#symptoms

World, Allergy Organization (2015). Contact dermatitis: Synopsis. Retrieved from 
https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/contact-dermatitis-synopsis

 

 

Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To Prepare

Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.

Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?

Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.

Consider which of the conditions is most likely to be the correct diagnosis, and why.

Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.

Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.

The Lab Assignment

Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of 
three to five 
possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources. NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

By Day 7 of Week 4

Submit
 your Lab Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK4Assgn1+last name+first initial.(extension)” as the name.

Click the 
Week 4 Assignment 1 Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 4 Assignment 1
 link. You will also be able to “View Rubric” for grading criteria from this area.

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NURS_6512_Week_4_Assignment_1_Rubric

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Excellent

Good

Fair

Poor

Using the SOAP (Subjective, Objective, Assessment, and Plan) note format:

·  Create documentation, following SOAP format, of your assignment to choose one skin condition graphic (identify by number in your Chief Complaint). ·   Use clinical terminologies to explain the physical characteristics featured in the graphic.

30 
(30%)
 – 35 
(35%)

The response clearly, accurately, and thoroughly follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response clearly and thoroughly explains all physical characteristics featured in the graphic using accurate terminologies.

24 
(24%)
 – 29 
(29%)

The response accurately follows the SOAP format to document one skin condition graphic and accurately identifies the graphic by number in the Chief Complaint. The response explains most physical characteristics featured in the graphic using accurate terminologies.

NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

18 
(18%)
 – 23 
(23%)

The response follows the SOAP format, with vagueness and some inaccuracy in documenting one skin condition graphic, and accurately identifies the graphic by number in the Chief Complaint. The response explains some physical characteristics featured in the graphic using mostly accurate terminologies.

0 
(0%)
 – 17 
(17%)

The response inaccurately follows the SOAP format or is missing documentation for one skin condition graphic and is missing or inaccurately identifies the graphic by number in the Chief Complaint. The response explains some or few physical characteristics featured in the graphic using terminologies with multiple inaccuracies.

·   Formulate a different diagnosis of three to five possible considerations for the skin graphic.    ·   Determine which is most likely to be the correct diagnosis, and explain your reasoning using at least three different references from current evidence-based literature.

45 
(45%)
 – 50 
(50%)

The response clearly, thoroughly, and accurately formulates a different diagnosis of five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained clearly, accurately, and thoroughly using three or more different references from current evidence-based literature.

39 
(39%)
 – 44 
(44%)

The response accurately formulates a different diagnosis of three to five possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained accurately using at least three different references from current evidence-based literature.

NURS-6512 Differential Diagnosis for Skin Conditions SOAP note

33 
(33%)
 – 38 
(38%)

The response vaguely or with some inaccuracy formulates a different diagnosis of three possible considerations for the skin graphic. The response determines the most likely correct diagnosis with reasoning that is explained vaguely and with some inaccuracy using three different references from current evidence-based literature.

0 
(0%)
 – 32 
(32%)

The response formulates inaccurately, incompletely, or is missing a different diagnosis of possible considerations for the skin graphic, with two or fewer possible considerations provided. The response vaguely, inaccurately, or incompletely determines the most likely correct diagnosis with reasoning that is missing or explained using two or fewer different references from current evidence-based literature.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 
(3%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 
(0%)
 – 2 
(2%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1 or 2) APA format errors. 3  (3%)  – 3  (3%) Contains several (3 or 4) APA format errors. 0  (0%)  – 2  (2%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_6512_Week_4_Assignment_1_Rubric NURS-6512 Differential Diagnosis for Skin Conditions SOAP note