Category: Nursing

RC is a 58-year-old female presenting with early-onset Alzheimer’s disease. Her labs reveal a vitamin D deficiency (22 ng/mL), but otherwise stable thyroid, B12, hemoglobin, and glucose parameters

SCENARIO 3

RC is a 58-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease. What would you prescribe? Consider her labs and provide a drug therapy plan. Include complete medication orders. How would you monitor therapy? Labs: TSH 3.4 mU/L, vitamin D 22 ng/mL, B12 501 pg/mL, Hgb 12.8 g/dL, BG 96 mg/dL, A1C 5.9%, BP 115/72, HR 76. Medications include: Tresiba 15 units SC once daily QHS, Novolog 5 units SC before each meal TID (adjusting based on carbohydrate intake and glucose monitoring), and lisinopril 10 mg po daily

RC is a 58-year-old female presenting with early-onset Alzheimer’s disease. Her labs reveal a vitamin D deficiency (22 ng/mL), but otherwise stable thyroid, B12, hemoglobin, and glucose parameters

 

Scenario 3: RC – Early-Onset Alzheimer’s Disease

RC is a 58-year-old female presenting with early-onset Alzheimer’s disease. Her labs reveal a vitamin D deficiency (22 ng/mL), but otherwise stable thyroid, B12, hemoglobin, and glucose parameters. She is already on insulin therapy for diabetes and lisinopril for blood pressure. Management should focus on initiating therapy to slow cognitive decline while correcting nutritional deficiency.

Drug Therapy Plan

Donepezil 5 mg po once daily at bedtime, #30 tablets, 2 refills

Class
: Acetylcholinesterase inhibitor.

MOA
: Inhibits acetylcholinesterase in the CNS, increasing acetylcholine levels and enhancing cholinergic neurotransmission to slow cognitive decline (Kumar et al., 2023).

Cholecalciferol (Vitamin D3) 2000 IU po once daily, #30 capsules, 2 refills

Class
: Vitamin D supplement.

MOA
: Enhances calcium absorption and bone mineralization; correcting deficiency also supports cognitive and overall health (Al-Hashimi & Abraham, 2024).

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Monitoring

Cognitive function using standardized tools (MMSE or MoCA) every 6–12 months (Wang et al., 2022).

Monitor for donepezil adverse effects (nausea, diarrhea, insomnia, bradycardia) (Kumar et al., 2023).

Recheck serum vitamin D in 3 months.

Continue monitoring BP, A1C, and renal function due to comorbid conditions.

Patient Education

Donepezil is not curative, but it may slow symptom progression.

Take at bedtime to minimize GI upset.

Encourage physical activity, cognitive stimulation, and good sleep hygiene.

Stress adherence to vitamin D supplementation.

RC is a 58-year-old female presenting with early-onset Alzheimer’s disease. Her labs reveal a vitamin D deficiency (22 ng/mL), but otherwise stable thyroid, B12, hemoglobin, and glucose parameters

Does nitroglycerin have a high or low first pass effect? Please discuss why this is important to know and how it relates to bioavailability. What route has 100% bioavailability?

SCENARIO 4

Does nitroglycerin have a high or low first pass effect? Please discuss why this is important to know and how it relates to bioavailability. What route has 100% bioavailability? In addition to parenterally, how can this medication be given to counter the first pass effect? Write a sample prescription for this medication.

 

The need for nitroglycerin and its ability to depict a high first-pass effect is confirmed. This means that if it is taken through the mouth there will be some contents of drugs to be metabolized by the liver before it comes to systemic circulation which will bring critically low oral bioavailability (Meunier et al., 2023).

The importance of this aspect of first-pass effect and bioavailability is helps in the calculation of the amount of drugs that will reach the target system in active form. When there are medicines that have high pass effects then other routes of administration will be used (Twiner et al., 2022).

The route that gives 100% bioavailability includes the intravenous (IV) route since the drugs are directed wired to the bloodstream hence bypassing the liver and other tissues that metabolize drugs. Countering these past effects of drugs can be solved using sublingual tablets, transdermal patches, and intravenous (IV) administration (Meunier et al., 2023).

A prescription sample of Nitroglycerin 0.4 mg of the sublingual tablets is administered by taking one tablet of this drug and placing it under the tongue when the chest pains start.

AB is a 34-year-old female presenting to the clinic with ongoing migraine headaches.

SCENARIO 2

AB is a 34-year-old female presenting to the clinic with ongoing migraine headaches. “I’m still getting migraines once a week, even though I take Ubrelvy when they start.” She reports experiencing 3 to 4 migraine attacks per month, typically associated with throbbing pain on one side, light sensitivity, and nausea. Migraines can last from 6-24 hours. AB has been taking Ubrelvy 50 mg po as needed at migraine onset for the past 3 months. She says it helps sometimes, but not consistently, and the pain often returns in a few hours. PMH: migraine without aura (diagnosed at age 27) Current medications: Ubrelvy 50 mg po PRN at onset of migraine, ondansetron 4 mg ODT dissolve on tongue PRN nausea, may repeat in 8 hours if needed. Vitals: BP 118/74, HR 78. What treatment plan would you implement for AB? What medication changes would you make? How would you monitor the effectiveness of this plan, and what patient education would you provide? Is a patient with migraines more likely to start on an acute or preventive agent? What are examples of each? AB is a 34-year-old female presenting to the clinic with ongoing migraine headaches.

Scenario 2

AB is a 34-year-old female with a history of migraine without aura who presents with ongoing headaches despite the use of Ubrelvy (ubrogepant) as needed. She experiences three to four migraines per month, lasting up to 24 hours, and reports that her current acute treatment provides only partial and inconsistent relief. Given her migraine frequency and functional impairment, she is a candidate for preventive therapy in addition to optimizing acute treatment.

Treatment Plan and Medication Changes

Continue Ubrelvy 50 mg po PRN at migraine onset, but consider increasing to 100 mg po once at onset (maximum 200 mg/24 hours), as higher doses have shown greater efficacy for some patients (Dighriri et al., 2023).

Add a preventive agent:

Propranolol 40 mg po BID, #60 tablets, 2 refills

Classification: Non-selective beta-blocker.

MOA: Decreases neuronal excitability and modulates vascular tone, reducing migraine frequency and severity (Shahrokhi & Gupta, 2023).

Provide an alternative acute option if Ubrelvy remains insufficient:

Sumatriptan 50 mg po at migraine onset; may repeat once in 2 hours, maximum 200 mg/24 hours, #9 tablets, 1 refill.

AB is a 34-year-old female presenting to the clinic with ongoing migraine headaches

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Monitoring Effectiveness

Ask patient to keep a headache diary documenting frequency, severity, duration, and response to medications.

Reassess in 8–12 weeks to evaluate preventive therapy effectiveness.

Monitor for propranolol side effects (e.g., bradycardia, hypotension, fatigue) (Shahrokhi & Gupta, 2023).

Track any medication overuse (risk of rebound headaches if acute agents are used for more than 10 days/month).

Patient Education

Explain that preventive medications take several weeks to show benefit.

Stress adherence to propranolol even if headaches are not daily.

Educate on avoiding migraine triggers (e.g., disrupted sleep, caffeine, alcohol, stress, certain foods).

Encourage lifestyle modifications such as hydration, stress management, and exercise.

Reinforce safe use of acute medications (do not exceed maximum doses).

Acute vs. Preventive Therapy

Most patients begin with acute therapy (e.g., triptans, NSAIDs, gepants like ubrogepant) for infrequent migraines. Patients with frequent or disabling migraines benefit from preventive therapy (e.g., propranolol, topiramate, amitriptyline, CGRP monoclonal antibodies) (Pellesi et al., 2024). In AB’s case, because of frequent attacks and incomplete control with acute treatment, adding preventive therapy is appropriate AB is a 34-year-old female presenting to the clinic with ongoing migraine headaches

NRNP 6552 Gynecologic Week 4 Case Study Assignment answers

 

Outline Subjective data.

 

Identify data provided in your chosen case and any additional data needed.

 

 

Patient Particulars

Name: Debbie

Age: 19 years

Gender: Female

Chief Complaint (CC)
: “I have been having mild lower abdominal pain and a lot of vaginal

discharge for about a week.”

History of Present
Illness (HPI): Debbie is a 19-year-old female, gravida 1 para 0-0-1-0,

presenting with mild lower abdominal pain and copious vaginal discharge for approximately one

week. She describes the discharge as yellowish and thick and reports associated mild dysuria and

discomfort during intercourse. She denies fever, chills, nausea, vomiting, or severe pelvic pain.

Her last menstrual period was two weeks ago and was normal.

Past Medical History (PMH)
: Debbie has a history of depression diagnosed during adolescence

and genital herpes simplex virus type 2 (HSV-2) diagnosed two years ago. She reports occasional

HSV outbreaks treated with antiviral medication but denies current symptoms. Her surgical

history includes a surgical termination of pregnancy one year ago without complications. She

reports that she has never had a Pap smear.

Medications

Debbie currently takes Lo Loestrin Fe once daily for contraception. She occasionally takes

ibuprofen 400 mg as needed for menstrual cramps.

Allergies

 

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Debbie reports no known drug allergies (NKDA) and denies food or environmental allergies.

Family History (FH)

Her mother has a history of depression, and her father’s medical history is unknown. Debbie

denies a family history of gynecologic cancers, breast cancer, or endocrine disorders.

Social History (SH)

Debbie lives with her parents and works full-time as a waitress. She graduated from high school

but is not currently enrolled in college. She denies tobacco use, alcohol consumption, and

recreational drug use. Debbie reports being sexually active with four male partners within the

past six months and admits that condom use has been inconsistent. She denies intimate partner

violence and reports feeling safe in her relationships.

Review of Systems (ROS)

General: Denies fever, chills, fatigue, or weight changes.

Skin: Denies rashes or lesions.

Cardiovascular: Denies chest pain or palpitations.

Respiratory: Denies cough or shortness of breath.

Gastrointestinal: Reports mild lower abdominal discomfort but denies nausea, vomiting, or

diarrhea.

Genitourinary: Reports copious vaginal discharge, mild dysuria, dyspareunia, and

occasional post-coital spotting. Denies urinary frequency or urgency.

Musculoskeletal: Denies joint pain or muscle weakness.

Neurological: Denies headaches, dizziness, or syncope.

 

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Psychiatric: Reports a history of depression but denies current mood changes or suicidal

ideation.

Outline

Objective findings.

 

Identify findings provided in your chosen case and any additional data needed.

 

 

Vital Signs

Blood Pressure: 112/80 mmHg

Pulse: 72 bpm

Respiratory Rate: 16 breaths/min

Temperature: 98.4°F

Weight: 110 lbs

Height: 54 inches

BMI: 18.9 kg/m²

Physical Examination

General: Well-developed, well-nourished female in no acute distress.

Abdominal Exam: Abdomen soft and non-distended with mild lower abdominal tenderness. No

guarding or rebound tenderness noted.

Genitourinary Exam: External genitalia appear normal without lesions or erythema. Speculum

examination reveals mucopurulent endocervical discharge. The cervix appears friable with easy

bleeding upon contact with the swab. Bimanual examination reveals mild cervical motion

tenderness, but there is no uterine or adnexal tenderness and no palpable adnexal masses.

Identify diagnostic tests, procedures, laboratory work indicated.

 

Describe the rationale for each test or intervention with supporting references.

 

 

Diagnostic Tests, Procedures, and Laboratory Work

1. A nucleic acid amplification test (NAAT) for Chlamydia trachomatis and Neisseria

gonorrhoeae should be performed. NAAT is the most sensitive and specific test for

diagnosing these infections, which are common causes of cervicitis among sexually

active adolescents (Workowski et al., 2021).

2. A vaginal wet mount microscopy should also be conducted to evaluate for Trichomonas

vaginalis, bacterial vaginosis, and candidiasis. Wet mount examination can identify

motile trichomonads, clue cells, or yeast, which helps determine the etiology of vaginal

discharge (Hinkle & Cheever, 2022).

3. A vaginal pH test should be performed because elevated vaginal pH may indicate

bacterial vaginosis or trichomoniasis.

4. A pregnancy test (β-hCG) is necessary in reproductive-aged women presenting with

pelvic pain to exclude pregnancy or ectopic pregnancy.

5. Additionally, screening for HIV and syphilis is recommended because patients with

suspected sexually transmitted infections are at increased risk for other STIs (CDC,

2023).

Distinguish at least three differential diagnoses.

 

Describe the rationales for your choice of each diagnosis with supporting references.

 

 

 

1. Cervicitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae (Most Likely

Diagnosis)

Cervicitis is an inflammation of the uterine cervix most commonly caused by sexually

transmitted infections, particularly Chlamydia trachomatis and Neisseria gonorrhoeae. These

pathogens infect the columnar epithelial cells of the endocervix, triggering an inflammatory

 

6

immune response that leads to increased mucus production, cervical edema, and friability

(Workowski et al., 2021). The inflammatory process occurs when the bacteria adhere to and

invade epithelial cells, stimulating the release of pro-inflammatory cytokines and neutrophils,

which cause mucopurulent discharge and cervical tenderness. The most common symptoms of

cervicitis include abnormal vaginal discharge, dysuria, dyspareunia, intermenstrual bleeding, and

postcoital spotting. Some patients may also experience mild pelvic discomfort or lower

abdominal pain. Physical examination findings often include mucopurulent endocervical

discharge, cervical erythema, and cervical friability, meaning the cervix bleeds easily upon

contact with a swab.

Debbie’s presentation strongly supports cervicitis as the most likely diagnosis. She

reports copious vaginal discharge, mild dysuria, dyspareunia, and postcoital spotting, which are

classic symptoms of cervical inflammation. Additionally, the physical examination revealed

mucopurulent discharge and cervical friability, which are hallmark findings of cervicitis. Her

sexual history of multiple partners and inconsistent condom use further increases her risk for

sexually transmitted infections. Therefore, cervicitis secondary to Chlamydia trachomatis or

Neisseria gonorrhoeae is the most consistent explanation for her symptoms and clinical findings.

 

2. Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease is an infection of the upper female reproductive tract,

including the uterus, fallopian tubes, and ovaries. It typically results from the ascending spread

of microorganisms from the cervix or vagina into the upper genital tract, most commonly caused

by Chlamydia trachomatis and Neisseria gonorrhoeae. The infection triggers an inflammatory

 

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response that leads to edema, epithelial damage, and possible scarring of the fallopian tubes

(Haggerty et al., 2021). If untreated, PID can cause infertility, chronic pelvic pain, and ectopic

pregnancy due to tubal damage. Symptoms of PID often include lower abdominal or pelvic pain,

fever, abnormal vaginal discharge, dyspareunia, irregular vaginal bleeding, and dysuria. On

physical examination, clinicians may observe cervical motion tenderness, uterine tenderness, or

adnexal tenderness, which are classic findings associated with upper reproductive tract

inflammation.

Although Debbie demonstrates lower abdominal pain and mild cervical motion

tenderness, which may raise concern for early PID, several findings make this diagnosis less

likely as the primary condition. She denies fever, severe pelvic pain, nausea, or systemic

symptoms, which are commonly seen in moderate to severe PID. Additionally, her pelvic

examination did not reveal uterine or adnexal tenderness, which are typically present in

established PID. While PID cannot be entirely ruled out and early infection may still be possible,

Debbie’s symptoms appear more consistent with localized cervical inflammation rather than an

established upper genital tract infection.

 

3. Trichomoniasis

Trichomoniasis is a sexually transmitted infection caused by the protozoan parasite

Trichomonas vaginalis. The organism infects the squamous epithelium of the lower genital tract,

including the vagina and urethra. The parasite causes epithelial cell damage and triggers an

inflammatory response characterized by increased vaginal secretions and irritation (Kissinger,

2022). The inflammatory reaction leads to the characteristic frothy vaginal discharge and vaginal

 

8

irritation associated with the infection. Common symptoms of trichomoniasis include yellow-

green frothy vaginal discharge, vulvar itching, vaginal irritation, dysuria, dyspareunia, and a foul

vaginal odor. Some patients may also develop a “strawberry cervix,” which appears as punctate

hemorrhages on the cervical surface due to inflammation.

Although Debbie reports copious vaginal discharge and mild dysuria, which may occur in

trichomoniasis, several aspects of her presentation make this diagnosis less likely. She does not

report vaginal itching, irritation, or foul-smelling discharge, which are commonly associated with

trichomoniasis. Additionally, the physical examination findings of mucopurulent cervical

discharge and cervical friability are more characteristic of bacterial cervicitis caused by

chlamydia or gonorrhea rather than protozoal infection. For this reason, trichomoniasis remains a

possible but less likely differential diagnosis until laboratory testing confirms or excludes it.

Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.

 

Describe rationales and supporting references for each.

 

1. Cervicitis (Chlamydia/Gonorrhea)

Ceftriaxone 500 mg IM single dose PLUS Doxycycline 100 mg orally twice daily for 7 days

Rationale:
This dual therapy covers both
Neisseria gonorrhoeae
and
Chlamydia trachomatis
, which commonly co-infect. Early treatment prevents complications such as PID and infertility (CDC, 2023).

Counsel on abstinence until treatment completion

 

Partner notification and treatment (expedited partner therapy if applicable)

 

2. Pelvic Inflammatory Disease (if suspected or confirmed)

Ceftriaxone 500 mg IM single dose + Doxycycline 100 mg BID for 14 days + Metronidazole 500 mg BID for 14 days

Rationale:
Broad-spectrum coverage is required to target polymicrobial infection including anaerobes. Early treatment prevents long-term complications like infertility (Haggerty et al., 2021).

3. Trichomoniasis

Metronidazole 500 mg orally twice daily for 7 days

Rationale:
Metronidazole is highly effective against
Trichomonas vaginalis
and also treats bacterial vaginosis if present (Kissinger, 2022).

 

Additional Interventions

 

STI counseling and safe sex education (consistent condom use)

Routine cervical cancer screening (Pap smear initiation)

Follow-up testing in 3 months for reinfection

 

Mental health support if needed

 

 

Explain key

Social Determinants of Heath (SDoH) for your chosen case.

 

 

 

Debbie’s young age, multiple sexual partners, and inconsistent condom use increase her

risk of sexually transmitted infections. Additionally, her employment in the service industry and

lack of regular healthcare visits may limit access to preventive healthcare and STI screening.

Addressing these factors is essential to reduce future infection risk and improve health outcomes

(Office of Disease Prevention and Health Promotion, 2023)

NRNP 6552 Gynecologic Week 4 Case Study Assignment answers.

Describe collaborative care referrals and patient education needs for your chosen case.

 

Describe rationales and supporting references for each.

 

 

Collaborative Care and Patient Education

 

Debbie should be referred for gynecologic follow-up to monitor treatment response and

reproductive health. Because she has a history of depression, coordination with a mental health

provider may also be beneficial. Patient education should focus on safe sexual practices,

including consistent condom use and routine STI screening. Debbie should also be counseled on

 

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completing the full antibiotic course, avoiding sexual intercourse during treatment, and ensuring

sexual partner notification and treatment. She should be instructed to seek medical care if she

develops fever, worsening pelvic pain, or abnormal bleeding (CDC, 2023).

 

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References

 

American College of Obstetricians and Gynecologists. (2022). Pelvic inflammatory disease.

Centers for Disease Control and Prevention. (2023). Sexually transmitted infections treatment

guidelines. https://www.cdc.gov

Haggerty, C. L., Ness, R. B., & Amortegui, A. J. (2021). Pelvic inflammatory disease: Current

concepts in diagnosis and treatment. Journal of Infectious Diseases, 224(S2), S113–S120.

Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth’s textbook of medical-surgical

nursing (15th ed.). Wolters Kluwer.

Kissinger, P. (2022). Trichomoniasis: Clinical manifestations, diagnosis, and management.

Clinical Infectious Diseases, 74(S1), S160–S165.

Workowski, K. A., Bachmann, L. H., & Chan, P. A. (2021). Sexually transmitted infections

treatment guidelines. MMWR Recommendations and Reports, 70(4), 1–187.

 

 

 

 

 

 

 

 

To prepare:

Review the 4 case studies in this week’s Learning Resources. Select one of the cases to prepare your written assignment.

Review the Learning Resources for this week and specifically review the clinical guideline resources specific to your chosen case study.

Assignment Instructions:

Use the Case Study Template from the Learning Resources to complete the assignment. Your submission must include a brief case write-up, followed by the fully completed template, which must be integrated into the document rather than submitted separately.

Include a title page, a case summary in your own words, the completed template, and a reference page formatted in APA style.

Ensure your submission meets all criteria outlined in the template and rubric for completeness and accuracy.

By Day 7 of Week 4

Submit
 your case study assignment by 
Day 7 of Week 4
.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
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 area.

To submit your completed assignment, save your Assignment as 
Wk4Assgn_LastName_Firstinitial

Then, click on 
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 near the top of the page.

Next, click on 
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Rubric

NRNP_6552_Week4_Case_Study_Assignment_Rubric

NRNP_6552_Week4_Case_Study
_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeAnalyzes subjective and objective data and outlines applicable diagnostic tests related to case studies.

30 to >26.7 ptsExcellent
The response provides clear, complete, and comprehensive descriptions of subjective and objective case data, appropriately outlining all diagnostic tests, clinical procedures and pharmacological interventions.

26.7 to >23.7 ptsGood
The response provides clear, complete partial descriptions of the components of the subjective and objective case data, appropriately outlining most of the diagnostic tests, clinical procedures and pharmacological interventions.

23.7 to >20.7 ptsFair
The response provides some components of the subjective and objective case data, but they are incomplete, vague or inaccurate, outlining some of the diagnostic tests, clinical procedures and pharmacological interventions.

20.7 to >0 ptsPoor
The response provides unclear or incomplete components of subjective and objective case data. The diagnostic tests, clinical procedures and pharmacological interventions are missing, incorrect, or inappropriately applied NRNP 6552 Gynecologic Week 4 Case Study Assignment answers

30 pts

This criterion is linked to a Learning OutcomeIdentifies differential diagnoses related to case studies.

30 to >26.76 ptsExcellent
The response contains at least 3 differential diagnoses relevant and applicable to the case.

26.76 to >23.7 ptsGood
The response contains at least 2 differential diagnoses relevant and applicable to the case.

23.7 to >20.7 ptsFair
The response contains at least 1 differential diagnosis relevant and applicable to the case.

20.7 to >0 ptsPoor
The response contains few or no differential diagnoses and/or diagnoses are not relevant and applicable to the case.

30 pts

This criterion is linked to a Learning OutcomeFormulates a treatment plan related to case studies based on scientific rationale, evidence- based standards of care, and practice guidelines. Integrates ethical, psychological, physical, financial issues and Social Determinants of Health in plan.

30 to >26.76 ptsExcellent
Formulates a thorough treatment plan including explanations of appropriate diagnostic tests and treatment options. Fully incorporates syntheses representative of knowledge gained from the resources for the module and current credible sources, with no less than 75% of the treatment plan having exceptional depth and breadth. Supported by at least 3 current peer- reviewed, references or professional practice guidelines.

26.76 to >23.7 ptsGood
Formulates a partially complete treatment plan including partial explanations of appropriate diagnostic tests and treatment options. Somewhat incorporates syntheses representative of knowledge gained from the resources for the module and current credible sources with no less than 50% of the treatment plan having exceptional depth and breadth. Supported by at least 3 current peer- reviewed, references or professional practice guidelines.

23.7 to >20.7 ptsFair
Formulates a minimally complete treatment plan including incomplete or vague explanations of appropriate diagnostic tests and treatment options. Lacking in synthesis of knowledge gained from the resources for the module and current credible sources. Supported by at least 2 current peer- reviewed, references or professional practice guidelines.

20.7 to >0 ptsPoor
Formulates a treatment plan that contains incomplete explanations of appropriate diagnostic tests and treatment options and/ or explanations are missing. Lacks synthesis gained from the resources for the module and current credible sources. Supported by 1 or no current peer- reviewed, references or professional practice guidelines.

30 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 to >4.45 ptsExcellent
Uses correct grammar, spelling, and punctuation with no errors.

4.45 to >3.95 ptsGood
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.95 to >3.45 ptsFair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

3.45 to >0 ptsPoor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 to >4.45 ptsExcellent
Uses correct APA format with no errors.

4.45 to >3.95 ptsGood
Contains a few (1 or 2) APA format errors.

3.95 to >3.45 ptsFair
Contains several (3 or 4) APA format errors.

3.45 to >0 ptsPoor
Contains many (≥ 5) APA format errors.

5 pts

Total Points: 100 NRNP 6552 Gynecologic Week 4 Case Study Assignment answers

NRNP 6552 GYNECOLOGIC HEALTH – WEEK 3 CASE STUDY Maxine, a 31-year-old nulligravida, is seen for a routine well-woman examination.

Case 2:  Maxine

Case Write-Up

Maxine, a 31-year-old nulligravida, is seen for a routine well-woman examination. She notices a recent pattern of missed periods, and over the last three months, she has had an episode of heavy bleeding and has required an hourly tampon change. Her last period was two weeks ago, and she is not on any form of contraception as her husband wants to get her pregnant. Maxine has an unremarkable past medical and surgical history and is taking prenatal vitamins. Examination shows of concern includes weight loss of 21 pounds within one year, BMI of 17.3, withdrawn, poor eye contact, and a bruise on the inner thigh. Other than that, the vag and breast examinations are normal. She has a social history of recent marriage, loss of job as per her husband, and alcohol use during the day. Breast cancer is noted in her family history under her maternal grandmother. All these together, with the history of menstrual changes and weight loss, elicit behavioral and psychosocial issues related to the possible reproductive endocrine system and to warrant further evaluation.

 

Outline Subjective data.

 

Identify data provided in your chosen case and any additional data needed.

Outline

Objective findings.

 

Identify findings provided in your chosen case and any additional data needed.

Identify diagnostic tests, procedures, laboratory work indicated.

 

Describe the rationale for each test or intervention with supporting references.

Distinguish at least three differential diagnoses.

 

Describe the rationales for your choice of each diagnosis with supporting references.

Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.

 

Describe rationales and supporting references for each.

 

Explain key

Social Determinants of Heath (SDoH) for your chosen case.

Describe collaborative care referrals and patient education needs for your chosen case.

 

Subjective information is Maxine’s description of her last period which was heavy, and menstrual irregularity over the last three months which includes skipped periods. She does not have any gynecologic pain, she denies infections, and she has no other systemic complaints.

Her plans for pregnancy have led her to discontinue contraceptive use. Menarche for this patient was at age ten, and she has no record of pregnancies, sexually transmitted infections, or reports of complications. Her gynecological cycles have been normal and average five days. Three years ago, she was due for a Pap smear and her results came back normal. Maxine described her wine consumption as one to two glasses and that she drinks while her husband is at work. Since her husband requested her to leave, she has been socially isolated. Though she is without complaints, her withdrawn demeanor and poor eye contact are distressing and suggest the need for further evaluation to determine the presence of psychological distress or safety issues and to assess for intimate partner violence, stress, eating disorders and reproductive coercion.

 The objective data shows vital signs are stable. Blood pressure, pulse, temperature, and respiratory rate are within normal limits. She is underweight, with a BMI of 17.3. Last year, she weighed 122 lbs and now weighs 101 lbs. Her appearance is withdrawn, disheveled, and she avoids eye contact. A bruise is present on her right inner thigh which raises concerns for trauma or potential interpersonal violence. No abdominal tenderness or masses were found in the normal examination of her abdomen.

On pelvic exam, no lesions were seen on external genitalia, there’s no cervical motion tenderness, and the uterus is normal-sized with no adnexal masses. While the reproductive exam is mostly unremarkable, weight loss, the bruising, and the behavioral changes stand out. Other objective information required includes:  pregnancy status, lab evaluation of the hormonal balance, screens for sexually transmitted infections, nutritional evaluation, and formal screening for partner violence.

In case of potential early pregnancy complications such as heavy bleeding or missed periods, a pregnancy test should be part of the primary evaluation. To determine the cause of heavy menstrual bleeding, a complete blood count (CBC) test is required to assess potential anemia. A thyroid function test (including TSH and free T4) is also required, as thyroid disorders are often associated with menstrual irregularities (Javed et al., 2025). To assess ovulatory dysfunction and STIs such as chlamydia, gonorrhea, HIV, and syphilis, a pelvic ultrasound should be done to check if there are structural issues such as fibroids or polyps causing the bleeding. Some metabolic and nutritional lab tests may be warranted considering the weight and BMI. Due to the bruising, behavioral changes, or social history, screening for partner violence is recommended (Javed et al., 2025) NRNP 6552 GYNECOLOGIC HEALTH – WEEK 3 CASE STUDY Maxine, a 31-year-old nulligravida, is seen for a routine well-woman examination..

One potential diagnosis is abnormal uterine bleeding due to dysfunctional ovulation, which could be attributed to considerable stress or significant weight loss. That is because hypothalamic-pituitary-ovarian axis function can be disrupted leading to cycle irregularities (Zhang et al., 2023). Another differential is thyroid disease, hyper or hypothyroidism, which presents frequent concomitant factors (Javed et al., 2025). Intimate partner violence with reproductive coercion is also a strong consideration evidenced by bruises and withdrawal attributed to the husband’s control over employment and reproductive decisions (Grace et al., 2020). Pregnancy-related bleeding, early loss, or implantation bleeding must be excluded and is imperative concerning the age of the female. Finally, bleeding disorders and uterine structural abnormalities like fibroids may account for the heavy bleeding (Zhang et al., 2023). All these conditions can be better evaluated and explained through laboratory tests and imaging to ascertain the cause and treatment.

Maxine’s condition management will depend on the confirmed diagnosis. That is because for patients with ovulatory dysfunction due to low body weight or stress, treatment is centered on nutritional rehabilitation, stress management, and possibly hormonal therapy to regulate cycles (Zhang et al., 2023). On the same, for those with diagnosed complications of pregnancy, care may involve obstetric monitoring, expectant management or treatment of the identified miscarriage. Also, in patients with thyroid disease, management of hypothyroidism may involve the use of the drug levothyroxine and hyperthyroidism may involve antithyroid medications. Javed et al. (2025) state that heavy menstrual bleeding may be treated with nonsteroidal anti-inflammatory drugs or tranexamic acid to reduce the bleeding. Where intimate partner violence is suspected like in Maxine’s case, first priority is given to the safety of the patient, followed by emergency counseling and referral to assistance while in the presence of anemia, iron supplements may be necessary. Hence, Maxine’s case must be developed and adopt personalized management that is in line with the recognized gynecology and primary healthcare guidelines (Zhang et al., 2023).

Maxine’s health is influenced by several social determinants. First, relationship power dynamics may affect her autonomy in employment and reproductive decisions because her husband demands that she stop working and become pregnant (Grace et al., 2020). This is further compounded by the financial reliance on a partner, which increases one’s exposure to domestic violence, abuse, and the financial and geographical barriers that compromise one’s ability to access healthcare. Second, social isolation is a real possibility since she is now a housewife and appeared withdrawn during the visit. This is because isolation is a known precursor for domestic violence and mental health issues (Grace et al., 2020). She may also be utilizing coping strategies or experiencing some stress, which may be evidenced by her health behaviors such as alcohol abuse during the day and her possible nutritional deficiencies as indicated by her weight (Javed et al., 2025). The absence of strong social support networks that integrate health care also limits her ability to access health care. This explains the need for trauma-informed care, partner violence screening, and community and counseling referrals to address the social determinants at play.

Maxine would benefit from a multidisciplinary care approach and a referral for evaluation of abnormal uterine bleeding and fertility planning may be warranted for obstetrician-gynecologist (Kerns et al., 2022). Furthermore, assessing mental health may be necessary to evaluate stress, possible depression, or concerns regarding relationships. Also, if there is suspected intimate partner violence, referrals to social work and community advocacy are critical to creating a safe plan and assisting with resources while if low BMI or disordered eating is a concern, a nutritionist or dietitian may be of assistance. Javed et al. (2025) state that patient education includes information regarding what is normal for menstrual cycles, what is considered excessive or concerning bleeding, and planning for future pregnancies. Additionally, counseling around the use of alcohol and healthy coping strategies is advised. However, it is important that education is provided in a private setting to ensure that Maxine has a safe way to speak about issues that are sensitive and may not be able to be talked about with a partner to achieve better outcomes.

 

References

Grace, K. T., Decker, M. R., Alexander, K. A., Campbell, J., Miller, E., Perrin, N., & Glass, N. (2020). Reproductive coercion, intimate partner violence, and unintended pregnancy among Latina women.
Journal of Interpersonal Violence
,
37
(3-4), 886260520922363. https://doi.org/10.1177/0886260520922363

Javed, N., Shakoor, H., Khattak, S., Mustafa, Y., Maghar, M. M., & Jabeen, S. (2025). Exploring the Relationship Between Thyroid Dysfunction and Menstrual Irregularities in Women.
Indus Journal of Bioscience Research
,
3
(10), 317–324. https://doi.org/10.70749/ijbr.v3i10.2563

Kerns, J., Itriyeva, K., & Fisher, M. (2022). Etiology and management of amenorrhea in adolescent and young adult women.
Current Problems in Pediatric and Adolescent Health Care
,
52
(5), 101184. https://doi.org/10.1016/j.cppeds.2022.101184

Zhang, Y., Luo, Z., Jia, Y., Zhao, Y., Huang, Y., Ruan, F., Ying, Q., Ma, L., Luo, J., & Zhou, J. (2023). Development and validation of a predictive model of abnormal uterine bleeding associated with ovulatory dysfunction: a case-control study.
BMC Women’s Health
,
23
(1). https://doi.org/10.1186/s12905-023-02589-5 NRNP 6552 GYNECOLOGIC HEALTH – WEEK 3 CASE STUDY Maxine, a 31-year-old nulligravida, is seen for a routine well-woman examination.

Psychopharmacology Scavenger Hunt Concept Map

 

 

References

Auerbach, A. (2024). Dynamics of receptor activation by agonists.
Biophysical Journal
,
123
(14), 1915–1923.
https://doi.org/10.1016/j.bpj.2024.01.003

Berg, K. A., & Clarke, W. P. (2023). Making sense of pharmacology: Inverse agonism and functional selectivity.
International Journal of Neuropsychopharmacology
,
21
(10), 962–977.
https://doi.org/10.1093/ijnp/pyy071

Dutta, S., Selvam, B., Das, A., & Shukla, D. (2022). Mechanistic origin of partial agonism of tetrahydrocannabinol for cannabinoid receptors.
Journal of Biological Chemistry
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298
(4).
https://doi.org/10.1016/j.jbc.2022.101764

Fatunde, O. A., & Brown, S.-A. (2020). The role of CYP450 drug metabolism in precision cardio-oncology.
International Journal of Molecular Sciences
,
21
(2), 604.
https://doi.org/10.3390/ijms21020604

Gilani, B., & Cassagnol, M. (2023, April 24).
Biochemistry, cytochrome P450
. PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK557698/

Heim, B., Peball, M., Krismer, F., Djamshidian, A., & Seppi, K. (2023). Pimavanserin: A truly effective treatment for Parkinson’s disease psychosis? A review of interventions.
Neuropsychiatric Disease and Treatment
,
19
, 1303–1312.
https://doi.org/10.2147/NDT.S371641

Jordan, M. R., & Morrisonponce, D. (2024, May 5).
Naloxone
. Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK441910/

Kikuchi, T., Maeda, K., Suzuki, M., Hirose, T., Futamura, T., & McQuade, R. D. (2023). Discovery research and development history of the dopamine D2 receptor partial agonists, aripiprazole and brexpiprazole.
Neuropsychopharmacology Reports
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41
(2), 134–143.
https://doi.org/10.1002/npr2.12180

Le, G. H., Wong, S., Bargiota, S., Jennifer, S., Lo, H. K. Y., Orsini, D., Teopiz, K., Guillien, H., Lim, P. K., & McIntyre, R. S. (2025). Biased agonism in psychopharmacology: An opportunity to improve efficacy and safety of treatments.
CNS Spectrums
, 1–39.
https://doi.org/10.1017/s109285292510045x

Martin, D., & Le, J. K. (2023).
Amphetamine
. PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK556103/

McNeil, S. E., & Cogburn, M. (2023).
Risperidone
. Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK459313/

Rahman, S., & Marwaha, R. (2023). Haloperidol. In
www.ncbi.nlm.nih.gov
. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK560892/

Sadiq, N. M., Dice, T. J., & Mead, T. (2024, February 20).
Oxycodone
. PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK482226/

Siwek, M., Wojtasik-Bakalarz, K., Krupa, A. J., & Chrobak, A. A. (2023). Brexpiprazole—Pharmacologic properties and use in schizophrenia and Mood Disorders.
Brain Sciences
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13
(3), 397–397.
https://doi.org/10.3390/brainsci13030397

 

Psychopharmacology Scavenger Hunt Concept Map

RESOURCES

Goldin, D. S. (2023). 
Fast facts for psychopharmacology for nurse practitioners
. Springer Publishing.

Chapter 4, “Neurotransmitters Overview” (pp. 38–50)

Stahl, S. M. (2021). 
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications
 (5th ed.). Cambridge University Press.

Chapter 3, “Ion Channels as Targets of Psychopharmacological Drug Action” (pp. 51–76)

Drugs.comLinks to an external site.
. (2023). https://www.drugs.com/

Note:
 Please use the following resource to check the most up-to-date box warnings, FDA approvals and indications, recommendations for follow-up evaluations. changes, etc.

Simple Nursing Team. (2022, May 2). 
How to create a basic nursing concept mapLinks to an external site.
.

How to Create a Basic Nursing Concept Map

NEI Psychopharm. (2022, March 14). 
How neurotransmitters are transported: Psychotropic transportersLinks to an external site.
 [Video]. YouTube. https://www.youtube.com/watch?v=qcT3XEDKnZc&list=PLYAIFzMMgrFpTVhVqfIyB9tPLT43Ec7In&index=3

NEI Psychopharm. (2016, August 16). 
The agonist spectrumLinks to an external site.
 [Video]. YouTube. https://www.youtube.com/watch?v=dkbV_PA61bg

Olivier, B. (2021, August 20). 
6 ways to use concept mapping your researchLinks to an external site.
 [Multimedia]. https://www.researchmasterminds.com/life-and-academia/concept-mapping-in-your-research

Taber, K. S. (n.d.). 
Concept mapping as a research techniqueLinks to an external site.
. https://science-education-research.com/research-methodology/research-techniques/concept-mapping-as-a-research-technique/

 

Psychopharmacology Scavenger Hunt Concept Map 

You will find that medications used to treat mental health conditions are agonists across the spectrum. It will be important for you to recognize some of those medications and how they act on a variety of neurochemicals in different ways to treat the symptoms.

In this Assignment, you will “scavenger” the literature as you research the agonist spectrum and key neurotransmitters and pathways targeted in psychopharmacology. You will have the opportunity to apply your knowledge as you create a Concept Map exploring each of the agonist spectrum listed below. Support your answers with evidence-based, peer-reviewed scholarly literature. APA style format title page, citations, and references will apply Psychopharmacology Scavenger Hunt Concept Map.

Note:
 You will not set up your Assignment as a paragraph-formatted paper but, instead, as a creative, visually appealing Concept Map.

 

To prepare for this Assignment:

Review the Learning Resources assigned this week.

Review the Concept Map resources.

Explore the listed agonist spectrum and consider the action and receptor of each:

Agonist

Partial agonist

Antagonist

Inverse agonist

The Assignment

You will submit a concept map exploring the four agonists on the agonist spectrum (agonist, partial agonist, antagonist, and inverse agonist) in which you:

Describe the different characteristics of the four agonists and how each mediates distinct biological activities. Include proposed mechanisms and the receptor it is targeting.

Identify how the P450 enzyme system plays a role in the body’s absorption, distribution, and clearance of medication.

Scavenge the literature after describing each agonist on the spectrum for research that is based on the medications in the table below.

Apply the medications to the appropriate agonist on the agonist spectrum in your Concept Map.

Medications

Oxycodone

Brexpiprazole

Haloperidol

Naloxone

Aripiprazole

Amphetamine

Risperidone

Pimavanserin

 

RUBRIC

Concept map explains the four agonists on the agonist spectrum according to different characteristics and mediation of biological activities. Concept map explains the proposed mechanism and receptor it is targeting. Identifies how the P450 enzyme system plays a role in the body’s absorption, distribution, and clearance of medication Psychopharmacology Scavenger Hunt Concept Map.

 

The eight (8) medications provided in the Assignment list are applied to the appropriate agonist on the agonist spectrum.

 

The concept map is correctly designed and includes creative visual aids.

 

Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation

 

Written Expression and Formatting: The submission contains an APA format for title page, citations, and reference list.

Psychopharmacology Scavenger Hunt Concept Map

Safford Unified School District v. Redding

Summarize your case. What happened? Why was the nurse involved?

The law case is used to show why the school nurse was named. How does the history of school nursing have any effect on what happened in the case?

What federal law would the case fall under? FERPA? FAPE? IDEA? TITLE IX? CIVIL RIGHTS?

What Pennsylvania state law could apply to this case? If your case takes place in NY or Ohio, you are still going to apply a PA state law. Many of the PA state laws can be found via

search on your case (food allergies, concussion, PA Public School Code, Environmental Issues, etc.) on the PA Department of Health, School Health website
here

What School Nursing: Scope and Standards of professional practice were not met. If the nurse Was the nurse excused from the case? What did the nurse do that showed she adhered to these practices?

What provisions of the Code of Ethics were disregarded? If the nurse was excused from the case, what did the nurse do that showed she abided by the Code
NASN Code of Ethics

 

 
Legal Case Review: Safford Unified School District v. Redding

Case Summary

Safford Unified School District v. The Redding, 557 U.S. 364 (2009), case is a historic case of the United States Supreme Court on the Fourth Amendment rights of learners in the public schools. The case focused on Savana Redding, a 13-year-old who was in grade 8 at the Safford Middle School in Safford, Arizona. Assistant Principal Kerry Wilson was tipped off by another student in October 2003, and Savana was allegedly selling prescription-strength ibuprofen (400 mg) and over-the-counter naproxen (200 mg) to other students against the school’s zero-tolerance drug policy. Following this piece of information, Wilson searched the backpack and outer clothes of Savana, finding nothing. Then he instructed the school nurse, Helen Romero, and an administrative assistant, Peggy Schwallier, to strip-search the student in the office of the nurse.

In the process of searching, Savana was asked to take off her outer garments to expose her breasts and pelvis region by taking off her bra and underwear. No drugs were found. Savana was later sued by her mother, April Redding, who claimed that the strip search infringed the Fourth Amendment right of Savana, which prohibited unreasonable search and seizure. The school nurse was a party to the suit since she was present physically when the search took place and was also involved in its performance. The Supreme Court came to the conclusion that the strip search was not constitutional as it was too intrusive due to the small suspected violation Safford Unified School District v. Redding. The qualified immunity offered to the nurse and other school officials meant that they were not personally liable, as the breach of the constitutional provision was not evident when the incident happened. However, the case posed some deep questions regarding the role of school nurses to uphold the dignity and privacy of students and their well-being (Smith, 2022).

 
Application to Readings

History of School Nursing

The history of school nursing in the United States offers the necessary background of the situation and role of the nurse in the case of Safford v. Redding. School nursing originated in New York City in 1902, as Lina Rogers was the first trained school nurse whose main task was to ensure that the number of absentees because of communicable diseases was reduced (Resha & Taliaferro, 2024). Gradually the role of school nurses grew considerably beyond controlling the spread of infectious diseases into the provision and assessment of student health, administration of medication, chronic illnesses, and promotion of student health rights.

BUY A HUMAN-WRITTEN PAPER HERE

With the development of the profession, school nurses were accepted to be the primary champions of student safety and well-being in the school setting. In 1968, the National Association of School Nurses (NASN) was organized and established formal standards of practice to regulate ethical and safe nursing practice in the school (NASN, 2022). At the beginning of the 2000s, school nurses started to become a new focal point of healthcare, legislation, and education policy. It was this positioning that put nurses like Helen Romero in a position when they were requested to execute orders of school administrators without adequate legal advice or consultations with other professionals. In the past, school nurses often worked under the umbrella of principals and administrators and not under clinical judgment, and this was a direct contributory factor to the nurse in this case involving the strip search. The history of school nursing developing into autonomous, evidence-based, and rights-conscious practice underscores the professional expectation of the nurse to have noticed the inappropriateness of the directive and defend the student (Resha and Taliaferro, 2024).

Federal Law

The federal law that is most relevant to Safford v. The fourth amendment to the United States Constitution is known as Redding, and it has banned unreasonable searches and seizures by the government actors, including the officials of the public school. The public school officials are under the standard of reasonableness of searches of students, per the precedent of New Jersey v. T.L.O., 469 U.S.325, 1985; they need no search warrant but only a reasonable suspicion that a search will yield evidence of a violation of a rule or a law. In Safford v. The Supreme Court, after which Redding argued, concluded that although the school officials had a reasonable suspicion to check the contents of the backpack and outer garments belonging to Savana, the strip search was not constitutionally reasonable because the officials did not have any factual evidence that the drugs were hidden in her undergarments, and the allegation of the infraction was not so egregious as to warrant such an invasive investigation (Safford Unified School District v. Redding, 2009).

The subject of Title IX of the Education Amendments of 1972, which outlaws sex-based discrimination in education programs funded by the federal government, is also applicable since the sexualized and gendered character of the search had a disproportionate effect on the dignity of a female student. Nonetheless, the main federal constitutional framework employed in the case is the Fourth Amendment. The case has become a pivotal federal precedent that determines that students have a reasonable expectation of privacy in their bodies in publicly funded schools and that school health officials can be involved in civil rights violations by performing constitutionally suspect searches (Resha and Taliaferro, 2024). School nurses should then be aware of the constitutional rights of students and realize that being submissive to an administrator does not protect them against professional or ethical liability.

State Law

Although Safford v. Redding, Arizona, is where the case is filed, the Pennsylvania Public School Code of 1949 (24 P.S. 1-101 et seq.) is the Pennsylvania state law that appears to be the most relevant to the facts of the case, especially concerning health services offered to students, student rights, and the administration of medications at schools. According to section 1414 of the Pennsylvania School Code, school health personnel as well as the nurses have a role to play in ensuring the safety and well-being of the students (Pennsylvania Public School Code, 1949). Most importantly, the regulations that govern the school health of the Pennsylvania Department of Health stipulate that school nurses facilitate within a professional scope of practice and that they are not simply the administrative tool.

According to Pennsylvania laws, drugs should be administered in schools in accordance with the suggested standards, such as the approval of a physician, parental consent, and appropriate documentation (Cogen et al., 2024). In Pennsylvania, the school nurse would have been supposed to interpret any exposure to medication as a clinical issue, in which the rights and health needs of the school child would have been taken into consideration in accordance with the law. The Pennsylvania School Code equally upholds that the students have the right to privacy and dignity when undergoing health-related assessments. Safford Unified School District v. Redding A strip search directed by a school administrator, with no clinical reason, and without warning of the parents, would run counter to the safeguards inherent in state health regulations as well as to those of the general structure of the PA Public School Code. This would not allow the school nurse to take on a professional judgment and decline to engage in a search that did not have a reasonable clinical or legal foundation (Resha and Taliaferro, 2024).

School Nursing Standards of Practice and Professional Performance.

ANA and NASW School Nursing: Scope and Standards of Practice (3rd ed., 2017) identifies 18 standards underpinning competent and ethical school nursing practice. There are two standards that are specifically applicable in Safford v. Redding: Standard 1 (Assessment) and Standard 7 (Ethics).

Standard 1, Assessment, demands that the school nurse gather relevant data and information that is relative to the health and well-being of the student by applying relevant evidence-based assessment techniques and tools (Gawlik et al., 2024). Applying this standard competently in the context of this case would have meant that Nurse Romero would have done a clinical evaluation of the situation before being involved in the search. This evaluation would have involved evaluating the existence of a legitimate clinical basis for the search, whether any sign of medication misuse or impairment was present in the student, and whether parental notification had been undertaken. Rather, the nurse went further to process the search only on the instruction of an administrator without any professional analysis. The lack of standard assessment principles prior to conducting an act put the student in danger of physical and psychological injuries and was a serious deviation from the evidence-based nursing practice (Resha and Taliaferro, 2024).

Ethics Standard 7, Ethics, requires the school nurse to act with ethical practice, incorporate the ethical aspects of the nursing profession in all their practice areas, and promote the health, safety, and rights of the student. The strip search of the 13-year-old girl student was a serious infringement of the girl child’s dignity and right to privacy. The ethical nursing practice would have involved the nurse recognizing the possible harm of the search, expressing her professional opposition, and defending the rights of the student instead of acting as an enforcement mechanism. Direct opposition to the ethical requirements entrenched in Standard 7 was the fact that the nurse did not object to or advocate for the search. A professional role that school nurses should assume is being the health advocate of the student, but not a continuation of school disciplinary mechanisms, especially in cases when the suggested measure presupposes the invasive examination of a minor.

Code of Ethics of the American Nurses Association.

The ANA Code of Ethics provides the ethical requirements of all registered nurses irrespective of the practice environment. The first provision of the code is that the nurse carries out his or her work with care and respect for the existing dignity, value, and distinctive qualities of each individual. The interpretive statements in Provision 1.1 indicate that the nurse should uphold human dignity in all professional interactions, safeguarding the right of self-determination and privacy of the patient.

The Safford case was a direct violation of provision 1. The strip search caused Savana Redding a lot of humiliation and psychological trauma. Savana went on to say that the experience was highly distressing, and the search made her body vulnerable in a way that no medical or safety considerations were relevant in the situation. Nurse Romero did not live up to her responsibility of preserving the natural dignity and value of Savana by being involved in the search. The ANA Code, provision 1.2, underlines the fact that the nurse should be sensitive to the vulnerability of the patient, especially when it comes to cases of coercive relationships. A school-going child ordered by an official to strip to unfamiliar people at school is obviously not in a strong position. The moral duty of the nurse in the given situation was not to participate in the coercive action but to protect the student against the latter (Anastasi et al., 2024). Nurse Romero should have shown the compassionate respect required under Provision 1 and might have avoided the constitutional infraction that eventually made it to the Supreme Court had she not consented to be involved but instead proposed a less invasive and properly authorized alternative Safford Unified School District v. Redding.

Conclusion

City of Safford Unified School District v. Redding is a landmark decision that is still relevant in the crossroads of school law, student rights, and school nursing practice. The case shows that the historical role of school nurses as subordinate to the administrative power, instead of being independent professional advocates, can be the cause of significant ethically and legally violating practices. The failure of the nurse to demonstrate professional judgment and ethical advocacy made it possible to perpetrate the Fourth Amendment violation that is at the core of the case. The pertinent federal constitutional safeguards, Pennsylvania state health statute, ANA/NASN Standards of Practice (Standard 1 and Standard 7), and ANA Code of Ethics Provision 1 all intersect at the point where the school nurse has the responsibility of upholding student dignity, safety, and rights over administrative compliance.

The school nurse is not an inactive party involved in school activities but a licensed professional who has legal and ethical responsibility towards the students under his or her care, which is independent of the school. The case is also a good reminder that professional advocacy, ethical clarity, and legal knowledge are not just competencies but also some of the required foundations of safe and responsible school nursing practice. As the profession keeps changing, the school nurses need to be enabled to challenge the orders that do not align with the interests of the students and act as the ultimate shield against the most vulnerable members of society (Smith, 2022).

References

Anastasi, G., Latina, R., Longobucco, Y., Stievano, A., & Bambi, S. (2024). Exploring Nurses’ and Nursing Students’ Attitudes Toward Coercive and Technological Measures in Mental Health: A Conceptual Framework and Study Protocol. 
Nursing Reports
, 
14
(4), 4129-4144. 
https://www.mdpi.com/2039-4403/14/4/301

Cogen, F., Rodriguez, H., March, C. A., Muñoz, C. E., McManemin, J., Pellizzari, M., … & Sherman, J. (2024). Diabetes care in the school setting: a statement of the American Diabetes Association. 
Diabetes Care
, 
47
(12), 2050-2061.
https://diabetesjournals.org/care/article-abstract/47/12/2050/157411

 Gawlik, K., Melnyk, B. M., & Teall, A. (Eds.). (2024). 
Evidence-based physical examination: Best practices for health and well-being assessment
. Springer Publishing Company.
https://books.google.com/books?hl=en&lr=&id=6tXSEAAAQBAJ&oi=fnd&pg=PP1&dq=school+nurse+gather+relevant+data+and+information+that+is+relative+to+the+health+and+well-being+of+the+student+by+applying+relevant+evidence-based+assessment+techniques+and+tools&ots=0n_Lu8E_dX&sig=5LXmPmJwvoIzrhhxmizLoI2LFFM

National Association of School Nurses. (2022). 
About NASN
. 
https://www.nasn.org/nasn/about-nasn/about

Pennsylvania Public School Code of 1949
, 24 Pa. Stat. § 1-101 
et seq
. (1949 & rev. 2022). 
https://www.legis.state.pa.us/cfdocs/legis/LI/uconsCheck.cfm?txtType=HTM&yr=1949&sessInd=0&smthLwInd=0&act=14

Resha, C., & Taliaferro, V. (2024). 
Legal resource for school health
 (2nd ed.). National Association of School Nurses.

Safford Unified School District v. Redding
, 557 U.S. 364 (2009). 
https://supreme.justia.com/cases/federal/us/557/364/

Smith, S. (2022). The Problem of Qualified Immunity in K-12 Schools. 
Arkansas Law Review
, 
74
(4), 7.
https://scholarworks.uark.edu/alr/vol74/iss4/7/
  Safford Unified School District v. Redding

 

Safford Unified School District v. Redding NURS 508 Practical Exercise Paper Rubric

NURS 508 Practical Exercise Paper

Criteria

Level 4

Level 3

Level 2

Level 1

Criterion Score

Criteria 1-

Introduction Summary

15 Points-

The legal case is summarized with relevant issues related to the school nurse’s role

12 Points-

Most of the important aspects of the case is summarized

9 Points-

The important aspects of the case is briefly summarized

0 Points-

The summarization of the case is minimal or absent

/15

Criteria 2-

 

25 points

Each topic is thoroughly addressed:

-History of school nursing about your case.

-One federal law applying to the case.

-One PA law applies to the case.

ANA & NASN School Nursing: Scope and Standards of Practice- Choose 2 of the 18 and then apply them to your case.

-ANA Code of Ethics- Choose 1 provision and its interpretive statement and apply it to your case.

20 points

Each topic is addressed somewhat thoroughly but has missing information or lacks organization.

15 points

Most topics are addressed, while others lack information and organization

10 points

Few topics were addressed but much information missing and disorganized.

/25

Criteria 3

Required citations and references

5 points

Utilized all required citations and references

3 points

Utilized most required citations and references

2 points

Utilized some of required citations and references

1 point

Utilized few required citations and references

/5

Criterion 4

Language use and references in APA 7
th
edition format

5 points

Minimal grammatical mistakes and use of APA 7
th
edition format  throughout the Safford Unified School District v. Redding paper

3 points

Few grammatical errors and use of APA 7
th
edition format  throughout the paper

2 points

Many grammatical errors and use of APA 7
th
edition format  throughout the paper

1 point

Significant number of grammatical errors and use of APA 7
th
edition format  throughout the paper.

/5

Total:

/50

 

 

 

Safford Unified School District v. Redding Practical Exercise: Case Law Review Information

You have each been assigned a legal case, though some of these are on the older side; the information remains pertinent. Complete an internet search for your assigned case. The cases are not provided by your instructor. You may also use legal sources such as Wright’s Law, Justia, FindLaw, and Casetext to locate the basic idea of the case. The EU library will not be a primary source for this information.

You don’t need to focus on how the case was processed through the court system; focus on the case’s basic idea (background, why it was brought, and the nurse’s involvement). You will likely encounter legal terminology that you aren’t expected to understand or interpret.

You can find more information about the Practical Exercise Paper here:
Practical Exercise Paper

The rubric for the paper is found under Practical Exercise Assignment: Content->Rubrics-> Practical Exercise

Summarize your case. What happened? Why was the nurse involved?

The law case is used to show why the school nurse was named. How does the history of school nursing have any effect on what happened in the case?

What federal law would the case fall under? FERPA? FAPE? IDEA? TITLE IX? CIVIL RIGHTS?

What Pennsylvania state law could apply to this case? If your case takes place in NY or

Ohio, you are still going to apply a PA state law. Many of the PA state laws can be found via

search on your case (food allergies, concussion, PA Public School Code, Environmental Issues, etc.) on the PA Department of Health, School Health website
here

What School Nursing: Scope and Standards of professional practice were not met. If the nurse

Was the nurse excused from the case? What did the nurse do that showed she adhered to these practices?

What provisions of the Code of Ethics were disregarded? If the nurse was excused from the

case, what did the nurse do that showed she abided by the Code
NASN Code of Ethics

Assignment Specifics:

The paper should be 4-6 pages typed, written in APA format

The title page and the reference page are in addition to the required 4-6 pages of written work.

Papers must conform to the 7th edition Publication Manual of the American Psychological Association for guidelines regarding APA style for written work. APA resources in Content.

It is expected that the paper will be written at the graduate course level.

Please follow the Practical Exercise Grading Rubric in Content

All papers submitted to Dropbox are automatically processed via Turnitin.com for plagiarism detection. All papers must have a Turnitin score of less than 25%. Before submitting your final paper to the Assignment Dropbox, be sure to submit to the
Draft box
until you complete your edits.
You are able to submit to the Draft box as many times as needed without negatively impacting your Turnitin score.
Papers that do not meet the criteria will be graded per the rubric. Academic dishonesty is not tolerated! Please see the syllabus and content for further information.

 

PEPARING FOR YOUR Safford Unified School District v. Redding PE LAW CASE ASSIGNMENT

Locating Your Assigned Legal Case

Content

Assignments in Detail

Practical Exercise (PE) /Case Law Review *Assigned cases listed here!

Find your name listed next to the law case

Paper expectations, requirements and due date found in Assignments in Detail and the Syllabus

Students are assigned a legal case in which a school nurse was named in the school district suit.  The case is from various states in the U.S. and not specific to Pennsylvania.

If the nurse was dismissed from the case, you will still explain why and how the nurse did follow the law or what she/he could have done better in application to the law, code of ethics, standards, etc. following the rubric.

You are responsible for locating these cases via the internet. The cases are not provided by the instructor.

Students are advised to use legal sources such as Wright’s Law, Justia, FindLaw, Casetext and general internet searches to locate the basic idea of the case.
Students do not need to use the EU library.
The easiest way to find information on your case is a general Google search using the title of your assigned case. Many links will pop up for your review so that you gain a general knowledge of what happened.

The assignment is not about knowing how the case processed through the legal system, the level of courts, appeals, etc. it is only the
basic idea of the case and the nurse’s involvement
.  Students are not expected to understand the legal jargon and interpret it.

When writing your paper follow the rubric for the PE assignment.  This is found in Content>Rubrics> Practical Exercise

Summarize your law case. What happened?  Why was the nurse involved?

The law case is used to show why the school nurse was named. How does the history of school nursing have any effect on what happened in the case? WEEK 1 Session Information

What federal law would the case fall under? FERPA?  FAPE? IDEA? TITLE IX? CIVIL RIGHTS? Weeks 2-6 Session Information and Resha & Taliaferro text (2017)

What PENNSYLVAINA state law could be applied to this case. If your case takes place in NY or Ohio, you are still going to apply a PA state law.  Many of the PA state laws can be found via search on your case (food allergies, concussion, PA Public School Code, Environmental Issues etc.) on the PA Department of Health, School Health website: https://www.health.pa.gov/topics/school/Pages/School%20Health.aspx and in Week 4 Session assignment

What School Nursing: Scope and Standards of professional practice were not met. If the nurse was excused from the case, what did the nurse do that showed she did abide by these practices. WEEK 5 Session information and from the required ANA, 2017 text.

What provisions of the Code of Ethics were disregarded? If the nurse was excused from the case, what did the nurse do that showed she abided by the Code. WEEK 6 Session Information ANA Code of Ethics

Any questions or concerns, please contact the instructor for assistance.

Graded Assignment: Practical Exercise: A Case Law Review

Course Outcomes Fulfilled: All

Grading Value: 25%

Class Session Due: Week 14

By utilizing the assigned legal case the student will summarize the legal case and provide a description of its relevance to school nurse practice.

Assignment Objectives:

At the conclusion of the assignment, the student will be able to:

Relate the history of school nursing impact on the assigned case.

Apply Federal and Pennsylvania State Law to the case.

Interpret the Standards of Nursing Practice and Performance applicable to the case

Select statements and provisions of the Nursing Code of Ethics and appraise ethical consideration within the case

Demonstrate proper APA 7
th
edition citation and graduate writing ability

Safford Unified School District v. Redding

Assignment Specifics:

The paper should be 4-6 pages typed, written paper in APA format

The title page and the reference page are in addition to the required 4-6 pages of written work.

Papers must conform to the 7
th
edition
Publication Manual of the American Psychological Association for guidelines
regarding APA style for written work. APA resources in Content.

It is expected the paper will be written at the graduate course level.

Please follow the Practical Exercise Grading Rubric in Content.

All papers once submitted to Dropbox are automatically processed via Turnitin.com for plagiarism. All papers must have less than 25% Turnitin score. Papers that do not meet the criteria will be graded per the rubric. Academic dishonesty is not tolerated! Please see the syllabus and content for further information Safford Unified School District v. Redding.

Please refer to Content>Assignments in Detail to see additional information on how to research and prepare your formal Practical Exercise paper!

Please Note:

You are responsible for locating these cases via an internet search. Many of the cases have details in accompanying news articles and/or may be located via actual court documents.
A general online search will elicit all of the information you need to complete this assignment.

Cases that are dually assigned are to be done independently.

Even though the case may be filed in a state other than Pennsylvania, you will be applying Pennsylvania law to the case in your written assignment.

If the Safford Unified School District v. Redding nurse was dismissed from the case, you will still explain why and how the nurse did follow the law to be excused and what she/he could have done better in application to the law, code of ethics, standards, etc. following the rubric.

Exploratory analysis essay example

How does nutrition influence longevity of older adults in United States today?

Inquiry question

How does nutrition influence longevity and healthy aging among older adults in the United States today?

Working thesis

Proper nutrition is crucial for increasing the lifespan of older adults in the USA, as it helps reduce the risk of chronic illness, supports overall physical and mental health, and encourages healthy aging. However, challenges such as unequal access to quality diets and limited scientific data prevent fair application of nutritional science to improve longevity.

Part 1: Essay Outline: Explorative Model

Introducing nutrition and aging in the USA context

Highlight the growing population of older adults in the United States.

Define longevity as encompassing both lifespan and healthspan.

Briefly explain why nutrition is crucial to aging research: it influences health, longevity, and the development of age-related diseases.

Present the research question along with the main thesis.

Highlight the essay’s exploratory approach.

Biological mechanisms linking nutrition to longevity

Explain how nutrition affects biomarkers associated with aging.

Describe how inflammation, oxidative stress, and metabolic regulation contribute to biological processes.

Emphasize evidence connecting dietary habits to cellular aging.

Link nutritional adequacy with physiological resilience in later years.

Utilize research that concentrates on biomarkers related to aging.

Exploratory analysis essay example

Key source
: Leitão et al. (2022)

Dietary patterns that promote healthy aging

Explore dietary approaches associated with increased lifespan.

Explore Mediterranean, plant-based, and balanced diet patterns.

Describe the advantages for heart and brain health.

Focus on preventing age-related diseases through proper nutrition.

Highlight the importance of aligning with U.S. dietary guidelines.

GET WRITING HELP HERE

Key sources
: Fekete et al. (2022); Hu (2024)

Dietary diversity and longevity outcomes

Explain what dietary diversity is and why it matters for older adults.

Explore the links between various diets and healthy aging.

Discuss the sufficiency of nutrients and their impact on functional health outcomes.

Reflect on similarities and how this applies to U.S. populations.

Recognize dietary diversity as a changeable factor that can influence longevity.

Key sources
: Molani-Gol et al. (2025); Zhu et al. (2024)

Nutrition, chronic disease, and mortality risk

Examine how diet influences the rate of chronic diseases.

Discuss cardiovascular disease, diabetes, and neurodegenerative conditions.

Describe how nutrition influences the risk of death.

Link dietary quality with independence and extended functional lifespan.

Highlight nutrition strategies that prioritize prevention.

Key sources
: Hu (2024); Fekete et al. (2022)

Nutrition and quality of life in older adults

Explore how nutrition influences physical, mental, and emotional well-being.

Discuss the risks related to malnutrition and undernutrition in older adults.

Consider quality of life as a key factor in longevity.

Highlight gaps in current research.

Emphasize the significance of comprehensive aging outcomes.

Key source
: Arensberg et al. (2023)

Socioeconomic and structural barriers to healthy nutrition

Identify obstacles such as income, food access, and education.

Explore inequalities impacting older adults in the United States.

Analyze the impact of social determinants on diet quality.

Discuss the implications of the policy at both the address and community levels.

Link disparities directly to varying longevity results.

Exploratory analysis essay example

Research gaps and ongoing discussions

Examine the present challenges faced by research on nutrition and longevity.

Emphasize the difficulties in assessing the long-term impacts of diet.

Resolve inconsistencies among different populations and methodologies.

Identify areas that need more research specific to the U.S.

Emphasize the investigatory aspect of the inquiry.

Implications for public health and aging policy

Explore how the findings can guide the development of nutrition programs for older adults.

Assess how it relates to Medicare, SNAP, and community nutrition programs.

Emphasize the importance of preventive nutrition measures.

Emphasize the significance of policy grounded in evidence.

Link nutrition science with healthy aging programs.

Conclusion

Revisit the inquiry question and thesis.

Summarize the main insights regarding nutrition and lifespan.

Highlight the importance of nutrition in prolonging both lifespan and healthspan.

Recognize the existing challenges and areas where further research is needed.

End by highlighting the significance of fair and effective nutritional strategies for aging populations.

Part 2: Two Sources

Sources

Leitão, C., Mignano, A., Estrela, M., Fardilha, M., Figueiras, A., Roque, F., & Herdeiro, M. T. (2022). The Effect of Nutrition on Aging-A Systematic Review Focusing on Aging-Related Biomarkers.
Nutrients, 14
(3), 554.
https://doi.org/10.3390/nu14030554

Molani-Gol, R., Rafraf, M., & Alipour, B. (2025). Association between dietary diversity and healthy aging: a systematic review.
BMC nutrition, 11
(1), 102.
https://doi.org/10.1186/s40795-025-01085-3

Synthesis paragraph

Nutrition is increasingly recognized as essential for healthy aging and longevity in seniors. Leitão et al. (2022) conducted a systematic review showing that diet impacts aging at a biological level, with “nutritional patterns influence inflammation, oxidative stress, and metabolic pathways that are strongly associated with aging-related biomarkers” (p. 554). This biological evidence aligns with population data. Molani-Gol et al. (2025) found that older adults who eat a varied diet, including different food groups and nutrients, generally have better functional health, less frailty, and more positive aging markers. While Leitão et al. (2022) focus on cellular mechanisms of nutrition’s effect on aging, Molani-Gol et al. (2025) show how these processes lead to tangible health benefits. Overall, these studies highlight that diet quality and diversity are crucial for biological aging at the molecular level, supporting longer life and better well-being in later years Exploratory analysis essay example.

References

Arensberg, M. B., Gahche, J., Clapes, R., Kerr, K. W., Merkel, J., & Dwyer, J. T. (2023). Research is still limited on nutrition and quality of life among older adults.
Frontiers in medicine, 10
, 1225689.
https://doi.org/10.3389/fmed.2023.1225689

Fekete, M., Szarvas, Z., Fazekas-Pongor, V., Feher, A., Csipo, T., Forrai, J., Dosa, N., Peterfi, A., Lehoczki, A., Tarantini, S., & Varga, J. T. (2022). Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases.
Nutrients, 15
(1), 47.
https://doi.org/10.3390/nu15010047

Hu F. B. (2024). Diet strategies for promoting healthy aging and longevity: An epidemiological perspective.
Journal of internal medicine, 295
(4), 508–531.
https://doi.org/10.1111/joim.13728

Leitão, C., Mignano, A., Estrela, M., Fardilha, M., Figueiras, A., Roque, F., & Herdeiro, M. T. (2022). The Effect of Nutrition on Aging-A Systematic Review Focusing on Aging-Related Biomarkers.
Nutrients, 14
(3), 554.
https://doi.org/10.3390/nu14030554

Molani-Gol, R., Rafraf, M., & Alipour, B. (2025). Association between dietary diversity and healthy aging: a systematic review.
BMC nutrition, 11
(1), 102.
https://doi.org/10.1186/s40795-025-01085-3

Zhu, Y., An, Q., & Rao, J. (2024). The effects of dietary diversity on health status among the older adults: an empirical study from China.
BMC public health, 24
(1), 674.
https://doi.org/10.1186/s12889-024-18172-y

 

Exploratory analysis essay example

– ESSAY OUTLINE:

Step 1: Write Your Inquiry Question & Working Thesis

At the top of your outline, clearly state:

Your inquiry question (the central research question your essay seeks to answer).

Your working thesis (your current argument or stance on the topic, based on your research so far).

Step 2: Draft Your Essay Outline

Using one of the outline models provided in Week 5: Lesson, structure your essay into sections. Choose the format that best suits your topic and approach. Some possible structures include:

Exploratory or argumentative models (from Week 5: Lesson)

Krause’s outline models (from Week 5: Lesson)

Purdue OWL models (Link hereLinks to an external site.)

-First two paragraphs written with Resources.

Purpose:

This activity will help you practice summary, paraphrase, citation, and weaving techniques by synthesizing two sources into a cohesive paragraph. By completing this exercise, you’ll also have a portion of your upcoming draft written!

Instructions

Step 1: Choose Two Sources

Select two sources related to your essay topic.

Make sure the ideas connect or overlap in some meaningful way.

From one source, choose a quotation.

From the other, create a paraphrase (in your own words).

Step 2: Write a Synthesis Paragraph

Your paragraph should include:

Topic Sentence – Introduce the main idea that connects your two sources.

Quotation and Paraphrase – Integrate both sources smoothly.

Signal Phrases – Introduce each source clearly (include author, year, or article title as appropriate).

Citations – Use correct APA in-text citations.

Commentary – Explain how the two sources connect and how they support your argument or idea.

Concluding Sentence – Wrap up your main point.

Tip: Focus on how the sources talk to each other—agreeing, disagreeing, or adding new insight.

Step 3: Revise Your Paragraph Exploratory analysis essay example

Use this week’s lesson strategies to blend sources smoothly.

Experiment with brackets, ellipses, or other advanced techniques.

Double-check your signal phrases and citation accuracy.

Step 4: Include a Works Cited / References List

Format your entries in APA style to match your in-text citations.

Only include the two sources used in your paragraph.

– NEXT WEEK WILL SUBMIT THE FIRST 3 PAGES, WITH REFRENCES AND ANNOTATED BIBLIOGRAPHY.

PROMPS FOR THE FINAL RESEARCH PAPER.

Purpose:

The purpose of this research paper is to develop an in-depth, college-level argument or analysis that is rooted in your Area of Study/Academic Program. Your paper should take a clear, arguable stance on a topic that is relevant to your discipline, demonstrating thoughtful engagement with credible, academic sources and synthesizing them into a cohesive argument.

Requirements:

Length:

8-10 full Exploratory analysis essay example pages, excluding the annotated bibliography.

Sources:

6-10 credible, college-level sources in an annotated bibliography

Sources must be cited and integrated into the paper effectively and ethically.

Annotations should be at least 150 words per source and summarize and evaluate the source.

Documentation Style:

Follow the disciplinary citation style ( APA format).

Thesis:

The thesis should present an arguable position or make an arguable point.

Ensure it addresses a specific, complex issue within your academic program.

Structure:

Exploratory or argumentative structured essay.

Body paragraphs that support and develop the argument.

Strong topic sentences and clear connections between claims and evidence.

Logical organization and structure throughout.

A well-supported conclusion that reinforces your thesis.

Exploratory analysis essay example

NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders

SCENARIO 2

What are the errors (6 total) in the following prescriptions? Rewrite each prescription correctly.

methylphenidate (Concerta) 5 mg BID before breakfast and lunch #60 1 refill

pegloticase (Krystexxa) 8 mg IV infusion once per month #1 0 refill

Ubrelvy 200 mg po prn onset of migraine #12 1 refill

alprazolam (Valium) 0.5 mg po TID #90 0 refill

zolpidem 10 mg qhs #30 6 refills

NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders

SCENARIO 2

The medication prescription contains the following errors: Methylphenidate (Concerta): 5 mg for BID for breakfast and lunch, 60 tabs, one refilled. The error entails the frequency of the medication. Concerta is an extended-release product and must only be taken once a day. Thus, the right prescription for Methylphenidate ER (Concerta) is 18 mg, 30 tabs, with one tab daily in the morning for ADHD (Zaric et al., 2023).

Secondly, the Pegloticase (Krystexxa) 8 mg IV infusion is administered once per month without a refill. The ambiguity of Pegloticase dosage should be taken every two weeks and not every month. For Pegloticase (Krystexxa) medication, the correct dosage is 8 mg IV infusion. Secondly, the drug should be administered where the patient has refractory gout, and the dosage will be 8 mg IV every two weeks (Man et al., 2023).

Thirdly was the prescription of a medication program of Ubrelvy 200 mg PO during the onset of migraine consisting of 12 tabs and one refill only. The reason for the medication error is overdosing. Treatment with Ubrelvy should not exceed 100 mg per dose. The recommended correct prescription of Ubrelvy would solely be 100 mg 12 tabs taken one tab PO at the onset of migraine and repeated once in 24 hours (Keenan et al., 2021).

GET A HUMAN-WRITTEN PAPER HERE

Further, the medication involving alprazolam (Valium) 0.5 mg PO TID and 90 tabs is incorrect. Firstly, a mistake in the name of the drug is Valium, which is diazepam and not alprazolam. Hence, in the case of an Alprazolam prescription, the dosage would be 0.5mg and 90 tabs, each administered orally three times a day for anxiety and no refill (Edinoff et al., 2021). Finally, there is the medication with the error Zolpidem 10 mg QID with 30 tabs and six refills. This is because of more refills on Zolpidem and would increase the likelihood of the patient developing drug dependency (Zaric et al., 2023). The correct prescription involves administering Zolpidem 10 mg, 30 tabs with a single tab taken daily before bedtime for insomnia and no refill.

References

Edinoff, A. N., Wu, N., Ghaffar, Y. T., Prejean, R., Gremillion, R., Cogburn, M., … & Kaye, A. D. (2021). Zolpidem: efficacy and side effects for insomnia. 
Health psychology research
, 
9
(1).

Keenan, R. T., Botson, J. K., Masri, K. R., Padnick-Silver, L., LaMoreaux, B., Albert, J. A., & Pillinger, M. H. (2021, April). The effect of immunomodulators on the efficacy and tolerability of pegloticase: a systematic review. In 
Seminars in Arthritis and Rheumatism
 (Vol. 51, No. 2, pp. 347-352). WB Saunders.

Man, K. K., Häge, A., Banaschewski, T., Inglis, S. K., Buitelaar, J., Carucci, S., … & Uebel-von Sandersleben, H. (2023). Long-term safety of methylphenidate in children and adolescents with ADHD: 2-year outcomes of the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study. 
The Lancet Psychiatry
, 
10
(5), 323-333.

Zaric Kontic, M., Dragic, M., Martinovic, J., Mihajlovic, K., Brkic, Z., Mitrovic, N., & Grkovic, I. (2023). Prolonged Alprazolam Treatment Alters Components of Glutamatergic Neurotransmission in the Hippocampus of Male Wistar Rats—The Neuroadaptive Changes following Long-Term Benzodiazepine (Mis) Use. 
Pharmaceuticals
, 
16
(3), 331.

 

NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders

ASSIGNMENT

Submit your Assignment by Day 7 of Week 7 (Sunday night, 11:59 pm ET)

Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.

For your Week 7 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

To Prepare:

Review assignment rubric and case studies. Be sure to thoroughly answer ALL questions.

Explain the problem and discuss how you would address the problem.

When recommending medications, write out a complete prescription for each medication. A complete prescription includes the following information: drug, dose, route, frequency, duration (if applicable), quantity, # of refills and indication for use. An example of a complete prescription is as follows: lisinopril 10mg #30 tabs, take 1 tab PO once daily for high blood pressure, refills: 2.

Answer questions using your required learning resources, clinical practice guidelines, Medscape, etc.

Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.

SCENARIO 1

Buspirone has a half-life of approximately 2 hours. If a patient takes 15 mg at 8 am, what will the blood level be at 2 pm? Can buspirone be given as an adjunct to antidepressant therapy? Name 3 antidepressants you might prescribe for patients with co-existing depression and anxiety (include
complete medication orders
) and include patient monitoring.

 

SCENARIO 2

What are the errors (6 total) in the following prescriptions? Rewrite each prescription correctly.

methylphenidate (Concerta) 5 mg BID before breakfast and lunch #60 1 refill

pegloticase (Krystexxa) 8 mg IV infusion once per month #1 0 refill

Ubrelvy 200 mg po prn onset of migraine #12 1 refill

alprazolam (Valium) 0.5 mg po TID #90 0 refill

zolpidem 10 mg qhs #30 6 refills

SCENARIO 3

Patient TL is experiencing symptoms of daily leg muscle weakness and feet cramping at night. He is currently on metformin 1000 mg po BID, Invokamet 50/500 mg BID with meals, atorvastatin 40 mg po daily and atomoxetine 40 mg po daily. Blood pressure is 118/78 and labs include: BG 90 mg/dL A1c 4.5% sCr 0.9 mg/dL eGFR 101 mL/min/1.73 m² total cholesterol 181 mg/dL LDL 95 mg/dL HDL 57 mg/dL TG 146 mg/dL B12 150 pg/mL CK 505 U/L What is your
working diagnosis
? What would you prescribe for TL and how would you improve his treatment? What would you monitor?

 

SCENARIO 4

When a person uses nicotine, it causes temporary feelings of relaxation and well-being. Nicotine binds to nicotinic receptors in the brain, augmenting the release of numerous neurotransmitters. Name at least three of these neurotransmitters. Patients may self-medicate ADHD, anxiety, and depression by smoking. Is there a medication that could treat ADHD, anxiety, depression, and provide smoking cessation? Write a complete medication order for this medication.
Does the patient need to quit smoking before starting treatment
?

 

NURS_6521_Week7_Assignment_Rubric

NURS_6521_Week7_Assignment_Rubric – NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeScenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

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

1 pts

Fair

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

0 pts

Poor

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

3 pts

This criterion is linked to a Learning OutcomeScenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

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

1 pts

Fair

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

0 pts

Poor

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

3 pts

This criterion is linked to a Learning OutcomeScenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders.

3 pts

This criterion is linked to a Learning OutcomeScenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

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

1 pts

Fair

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

0 pts

Poor

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

3 pts

This criterion is linked to a Learning OutcomeScenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection.

15 to >11.0 pts

Excellent

Medication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.

11 to >7.0 pts

Good

Medication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.

7 to >3.0 pts

Fair

Medication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.

3 to >0 pts

Poor

Medication selected is inappropriate or would not be provided based on patient unique characteristics.

15 pts

This criterion is linked to a Learning OutcomeScenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

3 pts

Complete

Written medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.

0 pts

Poor

The prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate.

3 pts

This criterion is linked to a Learning OutcomeScenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable.

4 pts

Excellent

References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.

3 pts

Good

References for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.

2 pts

Fair

References for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.

0 pts

Poor

No references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors.

4 pts

This criterion is linked to a Learning OutcomeScenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

3 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

2 pts

Good

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

1 pts

Fair

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

0 pts

Poor

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

3 pts

Total Points: 100 NURS 6521 Week7 assignment pharmacology concepts to musculoskeletal system disorders