Tag: Clinical-Nursing

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.’

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?

 

SCENARIO 4

Nicotine acts upon nicotinic receptors in the brain, thereby causing the discharge of dopamine, norepinephrine, and serotonin. This mechanism can help justify why people provide nicotine to treat diseases like ADHD, anxiety, and depression, among others. These conditions and smoking cessation can be treated with the help of bupropion, which is sold under the name of Wellbutrin SR (Zhang et al., 2023).

A complete prescription for this purpose would be as follows, Bupropion sustained release of 150mg in the pack of 60 tablets. One tablet should be taken orally for the first three days, while one tablet should be taken two times daily for smoking relief, ADHD, and depression and with a single refill (Naguy & Badr, 2022).

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There is no requirement for the patient to stop smoking before they begin the program and take bupropion. In most cases, the second party wishes to quit dates before the two weeks the medication is administered. Supervision during treatment is quite an elaborate process and entails the following. The status of the phenomenon of interest, such as the patient’s mood, anxiety levels, and whether they are smoking, should be assessed frequently (Picciotto & Kenny, 2021). One also has to consider the side effects; for example, one may develop insomnia or agitated feelings during treatment. Also, compliance with the suggested regimen and the drug’s effectiveness should be revisited after 4-6 weeks if the best results are required.

References

Naguy, A., & Badr, B. H. (2022). Bupropion—myth-busting!. 
CNS spectrums
, 
27
(5), 545-546.

Picciotto, M. R., & Kenny, P. J. (2021). Mechanisms of nicotine addiction. 
Cold Spring Harbor perspectives in medicine
, 
11
(5), a039610.

Zhang, H., Gilbert, E., Hussain, S., Veldhuizen, S., Le Foll, B., Selby, P., & Zawertailo, L. (2023). Effectiveness of bupropion and varenicline for smokers with baseline depressive symptoms. 
Nicotine and Tobacco Research
, 
25
(5), 937-944. 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.

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?

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 1

Antidepressants and other psychotic disorders need close medication monitoring so that high medication efficacy is achieved. Quite frequently, the half-life of a particular drug and distribution volume determines how well the given medication will perform and the result expected from patients. The half-life of constipation is about 2 hours, and buspirone is a non-benzodiazepine anxiolytic (Shin et al., 2024). Should a patient decide to take 15 mg at 8 a.m., the concentration of the drug in his body will halve every 2 hours. Hence, at 2.00 p.m., the drug will have been cleared of six half-lives (15 mg-7.5 mg-3.75 mg-1.875 mg-0.9375 mg-?0.46875 mg-?0.234375 mg). Therefore, the drug’s level in the blood will be (0.234375 mg) minuscule by 2 p.m.

Nevertheless, it should be noted that buspirone is being used as an adjunct drug, which means that it has antidepressant activity and can be prescribed for patients with signs of depression accompanied by anxiety. Other three antidepressants that can be used in the treatment of depression accompanied by anxiety include other drugs such as sertraline, venlafaxine, and escitalopram (Du et al., 2024).

Below are complete prescriptions for each:

Sertraline 50 mg; 30 tabs: Take one tab PO daily for depression and anxiety.

Refills: twice

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Venlafaxine XR 75 mg; 30 tabs: Take one cap PO daily with food for depression and anxiety.

Refills: twice.

Escitalopram 10 mg; 30 tabs

Take one tab of PO daily for depression and anxiety.

Refills: 2.

Depression patients under medication should be monitored regularly to assess for drug side effects and medication outcomes. Patient symptoms would include mood changes and anxiety symptoms. Secondly, the patient should be on close monitoring for Blood pressure levels when under venlafaxine medication due to the increased risk of hypertension. Finally, the patient should be on serotonin syndrome (Browne et al., 2021) 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?

 

 
References

Browne, P. D., Bolte, A. C., Besseling-van der Vaart, I., Claassen, E., & de Weerth, C. (2021). Probiotics as a treatment for prenatal maternal anxiety and depression: a double-blind randomized pilot trial. 
Scientific reports
, 
11
(1), 3051.

Du, Y., Li, Q., Dou, Y., Wang, M., Wang, Y., Yan, Y., … & Ma, X. (2024). Side effects and cognitive benefits of buspirone: A systematic review and meta-analysis. 
Heliyon
.

Shin, E., Renzi, D., Canales, C., Ravichandran, C., McDougle, C. J., & Thom, R. P. (2024). Buspirone for the treatment of anxiety in Williams syndrome: a retrospective chart review study. 
Expert Opinion on Pharmacotherapy
, 
25
(1), 113-120.

 

NURS_6521_Week7_Assignment_Rubric

NURS_6521_Week7_Assignment_Rubric

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.

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?

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.

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 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?

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.

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 3

Patient TL reported complaining of daily leg muscle weakness and night foot cramping. Blood tests reveal Vitamin B12 at 150 pg/mL and creatine kinase at 505 U/L. Thus, tentative differential diagnosis includes Vitamin B12 deficiency-related neuropathy and at least suspicion of statin-induced myopathy due to atorvastatin intake (Ruscica et al., 2022).

The Treatment Plan would start with the cessation of atorvastatin for a while to determine its contribution to the development of myopathy. This will be followed with laboratory patient follow-up. Secondly, it’s the introduction of a Vitamin B12 supplementation program. For example, take Cyanocobalamin 1000 mcg/mLm and give 10 vials (Botha, 2022). The doses should be 1 mL IM weekly for 4 weeks, then the continuation of once-monthly injections.

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The patient’s management should entail assessing the CK levels and muscle complaints after discontinuing atorvastatin. Secondly, Vitamin B12 and neuropathy symptoms should be evaluated at least every three months. Lastly, review the patient’s cholesterol and consider challenging with atorvastatin at a lower dose or putting the patient on another statin (Pulipati & Davidson, 2021).

References

Botha, I. (2022). Cyanocobalaminum: Cyanocobalamin, Cobalamin, Vitamin B12, Anti-pernicious anemia factor, Crystamine. In 
Materia Medica of New and Old Homeopathic Medicines
 (pp. 99-102). Cham: Springer International Publishing.

Pulipati, V. P., & Davidson, M. H. (2021). How I treat statin-associated side effects in an outpatient setting. 
Future Cardiology
, 
17
(7), 1249-1260.

Ruscica, M., Ferri, N., Banach, M., Sirtori, C. R., & Corsini, A. (2022). Side effects of statins: from pathophysiology and epidemiology to diagnostic and therapeutic implications. 
Cardiovascular Research
, 
118
(17), 3288-3304. 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.

NURS 6521 Week 4 Assignment pharmacology concepts to the gastrointestinal and hepatobiliary systems

SCENARIO 3

AT is a 63-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease. What would you prescribe? Consider her labs and provide an updated drug therapy plan. Include complete medication orders. How would you monitor drug therapy? Labs: TSH 3.9 mU/L, vitamin D 24 ng/mL, B12 450 pg/mL, Hb 12.5 g/dL, blood glucose = 100 mg/dL, HgA1C = 5.4% Medications include: insulin glargine 20 units once daily qhs, insulin lispro 6 units before each meal (adjusting based on carbohydrate intake)

NURS 6521 Week 4 Assignment pharmacology concepts to the gastrointestinal and hepatobiliary systems

SCENARIO 3

AT is a patient who presents with features of early-onset Alzheimer’s disease (AD). The first therapy plan is the use of cholinesterase inhibitors that include donepezil and other treatments for deficiencies, including low vitamins, which have been proven to affect cognitive functioning. Donepezil 5 mg is taken orally at night to treat Alzheimer’s symptoms; there is a desire to halt this progression. In addition, Vitamin D3 supplement administration at 2000 IU has started to address deficiency and fulfill health needs (Blackman et al., 2021). Both medications are prescribed in quantity of thirty days and three refluxes.

The patient gets to be educated on the kind of treatment they are bound to receive next. The patient is read the purpose of donepezil in the management, and they are told that it slows the worsening of AD; the patient is prescribed to take donepezil at night to help minimize gastrointestinal side effects. Significance is also therefore laid on the compliance to the vitamin D program (Blackman et al., 2021). The cognitive function and the laboratory results are checked six weeks later with a clinic appointment.

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It includes neuropsychological tests which are administered semestrial, one of which is called the Mini-Mental State Examination. Serum Vitamin D will be assessed frequently to ascertain that the patient serum Vitamin D will be more than 30ng/ML (Wang et al., 2020). This would also include symptoms of nausea and bradycardia which could be precipitated by donepezil.

Similar to most of the drugs used in the treatment of Alzheimer’s disease, donepezil is an antagonist of acetylcholinesterase that increases the concentration of acetylcholine in cerebral cortex. Again, intervention or prevention of Vitamin D deficiency is relevant because it arguably defines the overall health experience for patients diagnosed with Alzheimer’s disease (Kumar et al., 2022).

 

References

Blackman, J., Swirski, M., Clynes, J., Harding, S., Leng, Y., & Coulthard, E. (2021). Pharmacological and non‐pharmacological interventions to enhance sleep in mild cognitive impairment and mild Alzheimer’s disease: A systematic review. 
Journal of sleep research
, 
30
(4), e13229.

Kumar, V., Kim, S. H., & Bishayee, K. (2022). Dysfunctional glucose metabolism in Alzheimer’s disease onset and potential pharmacological interventions. 
International Journal of Molecular Sciences
, 
23
(17), 9540.

Wang, L. Y., Pei, J., Zhan, Y. J., & Cai, Y. W. (2020). Overview of meta-analyses of five non-pharmacological interventions for Alzheimer’s disease. 
Frontiers in aging neuroscience
, 
12
, 594432.

 

ASSIGNMENT

Submit your Assignment by Day 7 of Week 4 (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 4 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.

To Prepare:

Review NURS 6521 Week 4 Assignment pharmacology concepts to the gastrointestinal and hepatobiliary systems AT is a 63-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease 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

JG is a 37-year-old male presenting with wheezing and shortness of breath. During his visit today, he reports having to use his albuterol 3 days per week over the past month. He reports being awakened by a cough six nights during the last month. His current medications include: salmeterol 50 mcg inhaler BID, albuterol MDI two puffs q4-6 hr PRN shortness of breath, prednisone 20mg qam, loratadine 10 mg daily, diphenhydramine 50 mg qhs prn. How would you step up asthma therapy for this patient (include complete medication order)? What medication changes would you make? What drug classification is salmeterol? Can it be used as monotherapy? What patient teaching and monitoring would you provide regarding the
updated drug therapy plan
?

 

SCENARIO 2

KH is a 48-year-old male diagnosed with type II diabetes 1 year ago. He has controlled his blood glucose through dietary changes. He has hypertension and is currently on lisinopril 10 mg po daily. He has no known allergies. His lab work today includes: fasting BG is 175 mg/dL; HgA1C = 7.5%. Basic Metabolic Profile (BMP) is normal except for Cr 1.8 and eGRF 28. What treatment plan would you implement for KH (include complete medication order)? What education would you provide regarding his treatment plan?
How would you monitor the effectiveness of this plan
? What is the goal A1C?

 

SCENARIO 3

AT is a 63-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease. What would you prescribe? Consider her labs and provide an updated drug therapy plan. Include complete medication orders. How would you monitor drug therapy? Labs: TSH 3.9 mU/L, vitamin D 24 ng/mL, B12 450 pg/mL, Hb 12.5 g/dL, blood glucose = 100 mg/dL, HgA1C = 5.4% Medications include: insulin glargine 20 units once daily qhs, insulin lispro 6 units before each meal (adjusting based on carbohydrate intake)

 

SCENARIO 4

HM is a 42 year-year-old female seeking evaluation for feelings of fullness, bloating and acid reflux with symptoms worse at night. HM eats fast food once a day and consumes 2 cups of coffee a day. She drinks alcohol socially on weekends. PMH includes asthma, diabetes and hypertension. Her blood pressure today is 142/85. Current medications include prn famotidine, prn albuterol, Pulmicort Flexhaler 90 mcg 2 inhalations twice daily, cetirizine 10 mg daily, bisoprolol 5 mg po daily and metformin 1000 mg po daily with food. How would you improve her drug therapy plan? What changes would you make (include complete medication orders)? What information would you provide to the patient at her visit?
Can a patient take a H2 blocker and PPI at the same time
? NURS 6521 Week 4 Assignment pharmacology concepts to the gastrointestinal and hepatobiliary systems AT is a 63-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease.

 

NURS_6521_Week4_Assignment_Rubric

NURS_6521_Week4_Assignment_Rubric

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.

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 Week 4 Assignment
pharmacology concepts to the gastrointestinal and hepatobiliary systems AT is a 63-year-old female that presents to the clinic today with early-onset Alzheimer’s Disease.

HM is a 42-year-old female seeking evaluation for feelings of fullness, bloating and acid reflux with symptoms worse at night

SCENARIO 4

HM is a 42 year-year-old female seeking evaluation for feelings of fullness, bloating and acid reflux with symptoms worse at night. HM eats fast food once a day and consumes 2 cups of coffee a day. She drinks alcohol socially on weekends. PMH includes asthma, diabetes and hypertension. Her blood pressure today is 142/85. Current medications include prn famotidine, prn albuterol, Pulmicort Flexhaler 90 mcg 2 inhalations twice daily, cetirizine 10 mg daily, bisoprolol 5 mg po daily and metformin 1000 mg po daily with food. How would you improve her drug therapy plan? What changes would you make (include complete medication orders)? What information would you provide to the patient at her visit? Can a patient take a H2 blocker and PPI at the same time? NURS 6521 Week 4 Assignment pharmacology concepts to the gastrointestinal and hepatobiliary systems

 

SCENARIO 4 

HM has signs consistent with a serious condition known as gastroesophageal reflux disease (GERD). To obtain the best treatment outcomes, going from H2 blockers to PPI is possible because the latter includes more effective acid inhibition agents (Scarpignato et al., 2020). Change in behavior is also important; this also reveals another aspect that is important in the management of the symptoms.

For medication changes, medication includes Pantoprazole 40 mg for a daily dose in case of a GERD treatment plan. The current use of famotidine will be stopped so that unnecessary combination of drugs is not encouraged (Scarpignato et al., 2020). Pantoprazole has been recommended in a pack of 30 tablets to be taken orally, one tablet daily before breakfast, with three refill packs.

Patient education emphasizes that, for the best effect, pantoprazole must be taken 30 min before meals. It is therefore important that diets taken should be Governments, and ADDS should advise that the consumption of caffeine, alcohol, and fast foods be minimized. Lifestyle measures include weight loss and head-of-the-bed elevation during sleep (Savarino et al., 2021).

Evaluation of monitored aspects includes evaluating symptom relief after 4 to 6 weeks of therapy. Also, evaluating the risks related to PPIs for long-term usage include osteoporosis (Mukhtar et al., 2022). Patients who continue having their symptoms or experience certain alert signs like weight loss or difficulty swallowing may require endoscopy.

Owing to the fact that H2 blockers and PPIs have similar methods of action, there is usually no need for the two medications to be used at the same time. PPIs have a better efficacy profile in terms of symptom relief and mucosal healing (Mukhtar et al., 2022)

 

References

Mukhtar, M., Alzubaidee, M. J., Dwarampudi, R. S., Mathew, S., Bichenapally, S., Khachatryan, V., … & Khan, S. (2022). Role of non-pharmacological interventions and weight loss in the management of gastroesophageal reflux disease in obese individuals: a systematic review. 
Cureus
, 
14
(8).

Savarino, V., Marabotto, E., Zentilin, P., Demarzo, M. G., de Bortoli, N., & Savarino, E. (2021). Pharmacological management of gastro-esophageal reflux disease: an update of the state-of-the-art. 
Drug design, development and therapy
, 1609-1621.

Scarpignato, C., Sloan, J. A., Wang, D. H., & Hunt, R. H. (2020). Gastrointestinal pharmacology: practical tips for the esophagologist. 
Annals of the New York Academy of Sciences
, 
1481
(1), 90-107.

population, intervention, comparison, outcome, and timeframe (PICOT) question Planning for the Dissemination of Research Findings PowerPoint

Using the population, intervention, comparison, outcome, and timeframe (PICOT) question developed in Week 2 and the research study you selected for the Week 3 or Week 4 discussion, select a method to plan the dissemination of research findings through a PowerPoint. This assignment encompasses the planning for dissemination through the completion of the selected template but does not require an oral presentation. (Template Uploaded)

-Answer each question in your own words on the selected Planning for the Dissemination of Research Findings template.

-Do not copy and paste information from the research study into the template.

-Correctly cite and reference the research study when paraphrasing it to answer questions on the Planning for the Dissemination of Research Findings template.

-Follow rules of grammar, spelling, word usage, and punctuation consistent with formal, scientific writing.

**Article Link attached at bottom of Quantitative Research Essay**

Section 1: PICOT Question

Explain the clinical nursing practice problem you selected in Week 2.

State the PICOT question you developed.

Discuss the search strategy used to find research evidence.

Section 2: Research Evidence Design

Introduce your selected research study and discuss how it supports the PICOT question.

Explain the research design and methodology used in the study.

Discuss the participants, data collection methods, and data analysis.

Section 3: Research Evidence Results and Discussion

Explain the research results.

Display the results using a visual aid such as a graph, chart, or table.

Discuss how the results from this study answer the PICOT question.

Section 4: Critique of Evidence

Discuss your overall critique of the evidence.

What were the strengths of the study?

What were the weaknesses or limitations of the study?

Section 5: Application to Practice

Explain how the study contributes to the existing body of knowledge.

Discuss any potential challenges or barriers to implementing these findings.

Propose recommendations for integrating the evidence into clinical practice.

 

population, intervention, comparison, outcome, and timeframe (PICOT) question Planning for the Dissemination of Research Findings PowerPoint

Directions:

1.Using the PICOT question developed in Week 2 and the research study you selected for the Week 3 or Week 4 discussion, complete each section of the Planning for the Dissemination of Research Findings PowerPoint template.

2.This assignment encompasses the completion of the template but does not require an oral presentation.

3.Click into the box to the right to add your name and date.

4.Click on the next slide.

5.Find and click the word Notes at the bottom right of your PowerPoint screen.

6.On each side, in the Notes section, add speaker notes by answering each section with explanation and detail.

7.On the PowerPoint slide, click where it says [TYPE HERE], remove the words [TYPE HERE], and provide the key information for each section.

8.The PowerPoint slides should contain highlighted information from the speaker notes.

 

population, intervention, comparison, outcome, and timeframe (PICOT) question Planning for the Dissemination of Research Findings PowerPoint

PICOT Question

Selected clinical nursing practice problem

The Efficacy of CGM on glycemic control and diabetes management

PICOT question

In adults with uncontrolled diabetes (P), how does the implementation of a CGM (I) compared to the standard of care related to measuring blood sugar (C) affect glycemic control, as measured by HbA1c levels (O) over a 6-month period (T)?

Search strategy used to find research evidence.
Selecting the specific search terms

Using Boolean operators

Using subject headings

Using keywords

The selected clinical practice problem was about the efficacy of using CGM on glycemic control and in managing diabetes patients. The PICOT question was perfectly established in evaluating the use of CGM in measuring blood sugar over a period of 6 months. The search strategy that helped in coming up with the right articles for the study included identifying the exact phrases and trams from the PICOT question. In addition, the use of Boolean operators including ‘AND’, and ‘OR’ was effective in connecting important keywords into meaningful search terms.

 

Research Evidence Design

Research the study

The importance of continuous glucose monitoring (CGM) in managing diabetes mellitus

Design and methodology

The study used retrospective study design

The target of this analysis was to assess the clients’ insulin regimens

25 participants were used in this study

PLACE YOUR ORDER HERE

P
articipants
, data collection methods, and data analysis.

The data was collected using the: Clinic’s electronic health records

Real-time Dexocom clarity database

The patient with an Android and iPhone were given a share code

Patients without smartphones, the data was retrieved from the clinical records

The research study aims to explore the importance of continuous glucose monitoring (CGM) in managing diabetes mellitus. The study used retrospective study design. The study design used patients who were using the CGM systems and examined them every month. The study used a cohort of 25 patients with uncontrolled diabetes receiving treatment at the clinic. The target of this analysis was to assess the clients’ insulin regimens that were adjusted with regard to rea-time blood glucose readings. The data was collected using the clinic’s electronic health records and the real-time Dexocom clarity database. The patient with an Android and iPhone were given a share code that helped in tracking their blood glucose. For patients without smartphones, the data was retrieved from the clinical records.

Research Evidence Results and Discussion

Research results.

Results show SMBG to CGM devices brought about improved glycemic control Before CGM, the levels of HbAIc were 11.21%

7.04% while using CGM.

Findings about glycemic control rates while using SMBG and CGM

SMBG

11.21%

CGM

7.04%

Results to PICOT question

Positive impacts of using CGM devices towards enhancing glycemic Improved outcomes for patients with diabetes

Results show that the change from SMBG to CGM devices brought about improved glycemic control. For example, before the use of CGM, the levels of HbAIc were at 11.21% which drastically improved to about 7.04% while using CGM. The results highlight and answer the PICOT question since there were positive impacts of using CGM devices towards enhancing glycemic control hence its importance on improving the outcomes for patients with diabetes over the six months period.

 

Critique of Evidence

Critique of the evidence

The evidence can be generalized to other clinical practices The outcomes show the need for CGM to decide on monitoring blood sugar levels

The importance of smartphones and digital technologies health

Strengths of the study

Patients during this study were able to eliminate their reliance on insulin therapy

Limitations of the study

Lacked a control group

Limited sample size

Short duration for the follow-up

The evidence provided across the study is credible and valid and can be generalized to other clinical practices. The outcomes were significant and brought to light the need for CGM to decide on monitoring blood sugar levels over traditional methods. The importance of smartphones and digital technologies are becoming an important tool in helping improve the outcomes of patients suffering from diabetes. The strengths of the study included the fact that three patients during this study were able to eliminate their reliance on insulin therapy. The outcome of the study also brings into focuses the importance of CGM in controlling blood sugar levels. The limitations of this study are that it lacked a control group, had a limited sample size and also there was only a short duration for the follow-up.

Application to Practice

Study contributes to the existing body of knowledge

Highlights the efficacy of CGM on glycemic control Real-world application to clinical practices

Challenges to implementing these findings

Difficult to generalize of the results

Disadvantage to persons without smartphones

R
ecommendations

Need for better training and education of clinicians and the patients

The findings of this study perfectly add to the assisting body of knowledge by highlighting the efficacy of CGM in capitalizing on glycemic control and its usefulness in the real world across every clinical practice. The barriers to this study that might affect its implementation is the generalizable of the results to patients suffering from diabetes with regard to age, gender, and socioeconomic status. This is because, in most instances, persons without smartphones and advanced technologies might be disadvantaged during implementation. There is a need for better training and education of both the clinicians and the patients suffering from diabetes about the importance of CGM in improving the overall outcomes and its ability to control the blood glucose levels.

 

Reference

Manov, A. E., Chauhan, S., Dhillon, G., Dhaliwal, A., Antonio, S., Donepudi, A., Jalal, Y. N., Nazha, J., Banal, M., & House, J. (2023). The effectiveness of continuous glucose monitoring devices in managing uncontrolled diabetes mellitus: A retrospective study. 
Cureus
.
https://doi.org/10.7759/cureus.42545

 

population, intervention, comparison, outcome, and timeframe (PICOT) question Planning for the Dissemination of Research Findings PowerPoint

The PICOT question developed to answer the clinical inquiry on the efficacy of CGM on glycemic control and diabetes management is; In adults with uncontrolled diabetes (P), how does the implementation of a CGM (I) compared to the standard of care related to measuring blood sugar (C) affect glycemic control, as measured by HbA1c levels (O) over a 6-month period (T)?

A quantitative study by was identified to help address the PICOT question.  The article “The Effectiveness of Continuous Glucose Monitoring Devices in Managing Uncontrolled Diabetes Mellitus” aims to evaluate the effect of CGM in diabetes management by evaluating for differences in glycemic control levels such as (HbA1c) levels, and glucose level (Manov et al., 2023). The study is quantitative as it utilized a retrospective study design where numerical data will be analyzed in establishing the effectiveness of CGM through improvement in glycemic level and related health outcomes.  “Quantitative evidence provides statistical data that can be used to inform nursing practice, proving the effectiveness of nursing interventions.” (Chamberlain, 2025)

The researchers used the retrospective cohort study method, investigating electronic health records of patients who applied continuous glucose monitoring devices. The data was extracted from medical charts, with special attention to glycemic control indicators such as HbA1c (Manov et al., 2023). This approach is sufficient in assessing the efficiency of CGM devices since it makes it possible to analyze previously obtained data. The sample consisted of adults with uncontrolled diabetes; this is appropriate given the objective of the study-that is, investigating the impact of CGM on this very population.  One thing that would be interesting to explore would be to differentiate Type 1 & Type 2.  There isn’t a ton of available research on the efficacy of CGM with patients with Type 2.

This study demonstrated that CGM significantly improved glycemic control, as reflected by lower HbA1c levels and more stable glucose readings compared to self-monitoring. The findings established with the research is important in nursing as it demonstrates the effect of these devices in diabetes management (Manov et al., 2023). This has the potential to improve patient outcomes and decrease complications associated with diabetes. Nurses can incorporate the use of CGM when developing care plans to better manage the disease. Recommendation is to have studies that are larger, with more diverse groups, longer follow-up, and evaluation of cost-effectiveness.

 

References

Chamberlain University College of Nursing. (2025) 
NR-439
 
Week 4: Quantitative Research [
Online lesson]. (n.d.). 
https://chamberlain.instructure.com/courses/164135/pages/week-4-quantitative-research?module_item_id=23440921

Manov, A. E., Chauhan, S., Dhillon, G., Dhaliwal, A., Antonio, S., Donepudi, A., Jalal, Y. N., Nazha, J., Banal, M., & House, J. (2023). The effectiveness of continuous glucose monitoring devices in managing uncontrolled diabetes mellitus: A retrospective study. 
Cureus
.
https://doi.org/10.7759/cureus.42545

population, intervention, comparison, outcome, and timeframe (PICOT) question Planning for the Dissemination of Research Findings PowerPoint

Self-Implicit Bias and Health Equity in Nursing

Disclaimer:

These results are not a definitive assessment of your automatic associations. The results may be influenced by variables related to the test (e.g., the category labels or particular items used to represent the categories on the ST-IAT) or the person (e.g., how tired you are). The results are provided for educational purposes only.

How Does The ST-IAT Work?

The ST-IAT measures the strength of associations between concepts (e.g., an individual from the Roskipps group) and attributes (e.g., Plesant, Unpleasant). The main idea is that making a response is easier when closely related items share the same response key. We would say that one has an implicit association of an individual group member and Plesant if they are faster to categorize words when the individual group member and Plesant share a response key relative to when the individual group member and Unpleasant share a response key. Any single ST-IAT is unlikely to predict behavior well for a specific individual. In the aggregate, the IAT can predict behavior such as discrimination in hiring and promotion, medical treatment, and decisions related to criminal justice.

 

What Was This Study About?

In this study, we told you about two fictitious social groups. We tested whether the information that we provided you about the typical behaviors of each group member would influence your implicit associations formed about these group members. There is some evidence that even very little information can influence people’s implicit associations. We are testing whether that is indeed the case.

 

Self-Implicit Bias and Health Equity in Nursing

(STRATEGY CHOSEN FOR #2: Deploy specific strategies to address the multiple determinants of health on which health care organization can have a direct impact)

Part 1. Self-awareness assignment. Follow this link to the Implicit-bias test. (RESULTS ATTACHED)

https://www.americanbar.org/groups/litigation/initiatives/task-force-implicit-bias/implicit-bias-test/Links to an external site.

Registration is free. Select the test called Implicit Association Test (IAT) and on the page that opens, click the link PROJECT IMPLICIT SOCIAL ATTITUDES. This is a collaborative research effort between Harvard, Univ of VA, and the Univ of WA. Upon completion of Part 1, write a short (half page) summary of your reaction to the results of the test and how they could impact your practice as an APRN (25 points) then move on to Part 2.

Part 2. After completing the assigned reading for this week (IHI White Paper: Achieving Health Equity) go to pages 32-36. Complete the assessment tool on your work place, or if not currently working, on a past workplace, preferably a healthcare organization of some kind. If you have never worked in a healthcare system, contact your instructor for suggestions. Fill in the columns depending on where your organization is at with interventions to meet that domain (ie Level 2? Level 4?) and also answer the questions that are in the framework tool. Self-Implicit Bias and Health Equity in Nursing Once you complete the assessment, select at least ONE deficient domain/subdomain that you identified from within the assessment tool (see domains below) and describe a strategy you would implement to improve that domain. For example, if you selected the domain “Deploy Specific Strategies to Address the Multiple Determinants of Health on Which Health Care Organizations Can Have a Direct Impact”, you would then select a sub-domain, such as “Healthy Behaviors” and describe strategies you and a team of co-workers could implement to improve progress in that subdomain. (75 points)

Make health equity a strategic priority

Develop structures and processes to support health equity work

Deploy specific strategies to address the multiple determinants of health on which health care organization can have a direct impact

Decrease institutional racism within the organization

Develop partnerships with community organizations to improve health and equity

 

Self-Implicit Bias and Health Equity in Nursing

Achieving Health Equity: A Comprehensive Approach for Health Care Organizations

Healthcare organizations need to tackle health equity because they must provide equal and fair healthcare service access to every individual. The document presents survey results from an implicit bias test and facility assessment data from a military healthcare organization alongside recommendations for developing a particular weak domain.

Part 1: Reflection on Implicit Bias Test Results

Through the Implicit Association Test (IAT), people can discover their unconscious biases because it examines the strength of the relationship between ideas and characteristics. The Implicit Association Test demonstrated implicit social group preferences in this research study. The test results provide important information about unconscious biases that affect professional decisions, even though they do not establish definitive proof. The unexpected outcomes from the test led me to question my own beliefs about social groups. Healthcare professionals need to understand their unconscious biases because these biases create potential negative effects on patient care treatment choices and clinical practice delivery.

Healthcare delivery shows systematic inequalities because implicit biases affect how healthcare professionals treat minority patients. The research demonstrates that healthcare providers who possess implicit biases deliver unequal medical care to minority patients, which leads to inferior health results (Green et al., 2007). APRNs must recognize and address these biases to provide equitable care because they work in their role as Advanced Practice Registered Nurses. Better health outcomes emerge from patient trust, which develops when healthcare providers become more culturally competent because of their awareness. The Implicit Association Test enables healthcare providers to become more self-aware about their biases, which allows them to regularly assess and reduce these biases to create an inclusive healthcare setting.

ORDER A PLAGIARISM-FREE PAPER HERE

Part 2: Health Equity Assessment and Improvement Strategy

The evaluation of a military healthcare facility used the IHI Health Equity Self-Assessment Tool to analyze five critical elements, which included making health equity strategic, developing organizational systems for health equity work, deploying targeted health determinants strategies while reducing institutional racism, and building community partnerships. The assessment underlined the necessity of improvement within specific strategy deployment aimed at handling multiple health determinants.

The facility maintains a Level 2 rating in the “Healthy Behaviors” sub-domain under this domain because it operates with few programs to support healthy conduct among employees and the community. The upcoming strategy will enhance this sub-domain through the development of a culture of health and well-being.

Health promotion programs require the facility to build full-scale wellness initiatives that serve employees and residents. The facility should offer wellness workshops, fitness challenges, and healthy lifestyle seminars as part of its wellness programs. Last year, Baicker et al. (2010) demonstrated through their research that workplace wellness programs delivered solid outcomes in employee health transformation alongside healthcare cost reduction. The facility creates a health-oriented supportive environment through the active promotion of these programs.

The facility should establish partnerships with organizations in the community to implement this strategy. Health organizations within the local area enable organizations to work together on initiatives that enhance health behaviors. Health fairs, nutrition education, and physical activity campaigns, alongside other community partnerships, represent successful efforts that improve the health of residents within the community. The facility benefits from partnerships that build its reputation while developing trust among its surrounding community members.

Additional incentives aimed at employees will help them adopt healthier behaviors. Employees will be more likely to embrace healthier behaviors when the facility provides discounts for gym memberships and healthy eating vouchers along with wellness days. Success studies show that wellness programs with incentives enhance employee participation in health activities and achieve better health results (Horstmann, 2018). The facility can build both a wellness culture and better employee satisfaction and retention rates through health-focused rewards for its staff members.

Health screenings that happen regularly help people discover medical problems before they become severe, which enables them to prevent health challenges from worsening. Through scheduled health screening programs, both employees and community members can find early health risks so that appropriate interventions can be provided. Health screenings that happen before diseases develop have proven effective at improving medical outcomes while minimizing healthcare expenses because they allow doctors to detect illnesses when they are simpler to treat (Brennan et al., 2014). The facility enhances population health through its focus on preventive care because it maintains long-term wellness benefits for everyone Self-Implicit Bias and Health Equity in Nursing.

Mental health is equally important to the development of healthy behaviors. Healthcare facilities should establish mental health support systems, which include stress management workshops, counseling services, and employee assistance programs, to address psychological health needs. Mental health promotion leads to better overall health and increased productivity, according to Goetzel et al. (2019). The facility will establish a complete wellness framework through its mental health service provision.

The path to health equity needs a detailed and diverse strategy for its realization. The implicit bias test outcomes demonstrate the necessity of developing self-awareness to handle biases that affect healthcare delivery. The assessment process of the military healthcare facility reveals particular areas that require improvement regarding healthy behavior promotion.  Self-Implicit Bias and Health Equity in Nursing The facility can move forward with its health equity initiatives through the implementation of health promotion programs, community partnerships, employee wellness rewards, regular health checks, and mental health care support. Such programs enrich both employee health and community welfare as they establish an inclusive healthcare system that promotes equity.

 
 

References

Baicker, K., Cutler, D., & Song, Z. (2010). Workplace wellness programs can generate savings. 
Health Affairs
, 
29
(2), 304–311.

Brennan, T. A., Spettell, C. M., Fernandes, J., Lantiere, M., & Hiatt, S. (2014). Disease management to promote prevention. The American Journal of Managed Care, 20(5), e153-e160.

Goetzel, R. Z., Anderson, D. R., Whitmer, R. W., Ozminkowski, R. J., Dunn, R. L., Wasserman, J., & Health Enhancement Research Organization (HERO) Research Committee. (2019). The relationship between modifiable health risks and health care expenditures: an analysis of the multi-employer HERO health risk and cost database. 
Journal of Occupational and Environmental Medicine
, 
40
(10), 843–854.

Green, A. R., Carney, D. R., Pallin, D. J., Ngo, L. H., Raymond, K. L., Iezzoni, L. I., & Banaji, M. R. (2007). Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. 
Journal of General Internal Medicine
, 
22
, 1231-1238.

Horstmann, D. J. (2018). 
Health-specific leadership and employee health: The influence of contextual and individual factors in a healthcare setting
(Doctoral dissertation, by Medien-und Informationszentrum, Leuphana Universität Lüneburg Files in This Item: File Size Format Dissertation_David_Horstmann_2018. Pdf MD5: da1cbb4a81a6f1b5535e4fbec1a7b4b9 License: Nutzung nach Urheberrecht open-access 1.45 MB Adobe PDF View/Open Items in PubData are protected by copyright, with all rights reserved, unless otherwise indicated. Views Show full item record) Self-Implicit Bias and Health Equity in Nursing

PSYCHOPHARMACOLOGY SCAVENGER HUNT CONCEPT MAP ANSWERS

PSYCHOPHARMACOLOGY SCAVENGER HUNT CONCEPT MAP ANSWERS

Agonists

Definition:
Fully activates a receptor, producing a maximal biological response.

Pharmacological Agents:
Oxycodone, Amphetamine

Mode of Action:

Oxycodone:
Binds to µ-opioid receptors (MOR), inhibiting pain signaling.

Amphetamine: Reverses dopamine transporter (DAT), increasing dopamine release.

Role of Cytochrome Enzymes:

Oxycodone: Metabolized by CYP3A4, CYP2D6, affecting drug clearance.

Amphetamine: Primarily metabolized by CYP2D6, affecting duration of action.

Therapeutic Uses

Oxycodone: Pain management.

Amphetamine: ADHD, narcolepsy treatment.

Expected Side Effects:

Oxycodone: Respiratory depression, addiction, constipation.

Amphetamine: Insomnia, hypertension, tachycardia (Rosenthal & Burchum, 2021).

 

Partial Agonist

Definition:
Binds to a receptor but only partially activates it, leading to a submaximal response.

Pharmacological Agents:
Brexpiprazole, Aripiprazole

Mode of Action:

Brexpiprazole & Aripiprazole: Partial D2 dopamine receptor agonists, balancing dopamine activity; also act on 5-HT1A (serotonin) receptors.

Role of Cytochrome Enzymes:

Metabolized primarily by CYP3A4 & CYP2D6, affecting plasma levels and drug efficacy (Siwek et al., 2023)..

Therapeutic Uses

Schizophrenia, bipolar disorder, adjunct in major depressive disorder (MDD).

Expected Side Effects:

Weight gain, akathisia, sedation, gastrointestinal issues (Siwek et al., 2023).

 

Antagonist

Definition:
Blocks receptor activation without stimulating a biological response.

Pharmacological Agents:
Haloperidol, Risperidone

Mode of Action:

Haloperidol: Blocks dopamine D2 receptors, reducing dopaminergic activity.

Risperidone: Blocks dopamine D2 and serotonin 5-HT2A receptors, reducing psychotic symptoms.

Role of Cytochrome Enzymes:

Haloperidol: Metabolized by CYP3A4 & CYP2D6, influencing drug clearance.

Risperidone: Primarily metabolized by CYP2D6, with some CYP3A4 involvement.

Therapeutic Uses

Haloperidol: Schizophrenia, Tourette’s syndrome, acute psychosis.

Risperidone: Schizophrenia, bipolar disorder, autism-related irritability.

Expected Side Effects:

Extrapyramidal symptoms (EPS), sedation, weight gain, metabolic changes (Rosenthal & Burchum, 2021).

 

Inverse Agonist

Definition:
Binds to a receptor and induces an opposite effect by reducing baseline receptor activity.

Pharmacological Agents: Naloxone, Pimavanserin

Mode of Action:

Naloxone: Inverse agonist at µ-opioid receptors (MOR), reversing opioid effects.

Pimavanserin: Inverse agonist at serotonin 5-HT2A receptors, modulating psychotic symptoms in Parkinson’s disease (Rosenthal & Burchum, 2021).

Role of Cytochrome Enzymes:

Naloxone: Metabolized by CYP3A4 & CYP2D6, with rapid hepatic clearance.

Pimavanserin: Metabolized by CYP3A4, affecting bioavailability.

Therapeutic Uses:

Naloxone: Opioid overdose reversal.

Pimavanserin: Parkinson’s disease psychosis.

Expected Side Effects:

Naloxone: Withdrawal symptoms (nausea, sweating, agitation).

Pimavanserin: QT prolongation, confusion, peripheral edema (Rosenthal & Burchum, 2021)

 

PSYCHOPHARMACOLOGY SCAVENGER HUNT CONCEPT MAP ANSWERS

Agonist (Oxycodone, Amphetamine)

Agonists fully activate their target receptors to the maximal biological effect. The µ-opioid receptor agonist oxycodone is a drug for the treatment of moderate-to-severe pain, but its use may result in respiratory depression and dependence (Rosenthal & Burchum, 2021). Oxycodone is metabolized in part by the CYP3A4 and CYP2D6 enzymes, which can affect its plasma concentration and analgesic efficacy (Barrett et al., 2023). Amphetamine, a dopamine transporter (DAT) agonist, increases synaptic dopamine levels and, as a result, has a positive effect on focus in ADHD patients. The rest is mainly by CYP2D6, hence duration and individual response. Hypertension, tachycardia, and insomnia are adverse effects.

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Partial Agonist (Brexpiprazole, Aripiprazole)

Partial agonists affect a submaximal receptor response by helping to balance neurotransmitter activity. Brexpiprazole and aripiprazole partially stimulate dopamine D2 and serotonin 5HT1A receptors, leading to a decrease in psychotic symptoms with decreased side effects involving dopamine blockade (Siwek et al., 2023). The bioavailability and drug interactions of both drugs are, in part, affected by their metabolism by CYP3A4 and CYP2D6 (Rosenthal & Burchum, 2021). They are effective in schizophrenia and major depressive disorder (MDD) while having fewer extrapyramidal symptoms, according to studies. They can cause akathisia, weight gain, and sedation; however. Part of their activity regulates dopamine flux fluctuations, thereby making treatment more tolerable.

 

Antagonist (Haloperidol, Risperidone)

They prevent neurotransmitters from having effects by blocking receptor activation. The dopamine D2 antagonist, haloperidol, is widely used in schizophrenia and acute psychosis but is associated with a high risk of extrapyramidal symptoms (EPS) (Sampogna et al., 2023). D2 and serotonin 5-HT2A antagonist Risperidone, with a lower risk of EPS, is used to treat schizophrenia and bipolar disorder and has the potential for weight gain and metabolic disturbances (Rosenthal & Burchum, 2021). Drug clearance and interaction profile with both drugs are dependent on CYP2D6 metabolism. They have antagonistic properties which can effectively reduce hallucinations, delusions and agitation.

Inverse Agonist (Naloxone, Pimavanserin)

Unlike other agonists, inverse agonists can decrease baseline receptor activity. µ-opioid receptor inverse agonist naloxone rapidly reverses opioid overdose by displacing opioids from their receptors (Pagan et al., 2024). CYP3A4 and CYP2D6 metabolize it, inducing rapid hepatic clearance and requiring frequent dosing (Rosenthal & Burchum, 2021). The serotonin 5-HT2A inverse agonist pimavanserin reduces Parkinson’s disease psychosis without worsening motor symptoms. It is metabolized through CYP3A4 and has a long half-life but carries a risk of QT prolongation, peripheral edema, and confusion.

References

Barrett, J. E., Shekarabi, A., & Inan, S. (2023).
Oxycodone: A current perspective on its pharmacology, abuse and pharmacotherapeutic developments
. PHARMREV-000506.
https://doi.org/10.1124/pharmrev.121.000506

Pagan, F. L., Schulz, P. E., Torres-Yaghi, Y., & Pontone, G. M. (2024). On the
optimal diagnosis
and the evolving role of pimavanserin in parkinson’s disease psychosis.
CNS Drugs
,
38
(5), 333–347.
https://doi.org/10.1007/s40263-024-01084-1

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

Sampogna, G., Di Vincenzo, M., Giuliani, L., Menculini, G., Mancuso, E., Arsenio, E., Cipolla, S., Rocca, B. D., Martiadis, V., Signorelli, M. S., & Fiorillo, A. (2023). A systematic review on the effectiveness of antipsychotic drugs on the quality of life of patients with schizophrenia.
Brain Sciences
,
13
(11), 1577–1577.
https://doi.org/10.3390/brainsci13111577

Siwek, M., Wojtasik-Bakalarz, K., Krupa, A. J., & Chrobak, A. A. (2023). Brexpiprazole pharmacologic properties and use in schizophrenia and mood disorders.
Brain Sciences
,
13
(3), 397–397.
https://doi.org/10.3390/brainsci13030397 
 PSYCHOPHARMACOLOGY SCAVENGER HUNT CONCEPT MAP ANSWERS

Norma James is a 73-year-old Black female that comes to the office for her 3 month follow up visit for Type 2 Diabetes Mellitus (T2DM)

Norma James: Introduction 

 
CC: “I am here for a 3 month follow up visit for my diabetes.”

HPI: Norma James is a 73-year-old Black female that comes to the office for her 3 month follow up visit for Type 2 Diabetes Mellitus (T2DM).  The patient was diagnosed 8 years ago.  Since her last visit 3 months ago, she has been more compliant with her diet and has started the higher dose of Trulicity prescribed. She denies weight loss, polyuria, polydipsia, or polyphagia.

Timing/Context: Blood sugars are worse if diabetic diet is not followed. But she has no choice but to eat what the assisted living feeds her. Patient notices her glucose is worse after eating pasta, bread, and cereal. She reports she is only about 50% compliant with diabetic diet. She performs a morning blood glucose level using a portable glucose monitor. She reports morning fasting glucose is 128. So, she cannot understand why her glycated hemoglobin (HbA1C) is 7.2. She reports she once checked her glucose 2 hour post prandial after eating spaghetti for dinner and her glucose was 252.

Modifying Factors: Medications, change in Trulicity dose has improved glucose by 20-30. Patient reports she is compliant with medications. She walks in her apartment but denies any physical exercise. Her family has an appointment to speak to the dietician at the assisted living facility to discuss a diabetic diet.

Complications: (-)hospitalizations for diabetic decompensations, (+)
diabetic nephropathy
, seen by nephrologist every 6 months, lasty visit 3 months ago and kidney function stable with creatinine 1.8,  (+)
diabetic retinopathy
worse in the dark. Last eye exam 6 months ago, (+)
diabetic neuropathy
 with B/L LE
numbness and tingling in feet
worse with exercise or in heat, (+) new wound right ankle, (-) sexual dysfunction, (+)depression stable with medications.

PMHx: Hypertension, Atrial Fibrillation, Hyperlipidemia, Depression

Family Hx: Father: Type 2 Diabetes Mellitus, Obesity, Hyperlipidemia, Hypertension, CVA

Mother: Hypothyroidism, Hypertension

Is Ms. James’s pancreas still producing insulin? Describe the pathophysiology of T2DM. (2 points)

Explain the patient’s risk factors, hereditary traits, and diversity concerns that may contribute to her uncontrolled T2DM.

(1 point)

What comorbidities does Ms. James have? Explain how the pathophysiology of T2DM is linked to these comorbidities. (1 point)

What complications are related to a long duration of T2DM in older adult patients?

Explain the pathophysiology involved. (Refer to the guideline link in question 10 OR click directly on these links from the guidelines:
Prevention or Delay of Diabetes and Associated Comorbidities: 
Standards of Care in Diabetes—2023

 AND
4. Comprehensive Medical Evaluation and Assessment of Comorbidities: 
Standards of Care in Diabetes—2023
) (2 points)

Application: Link the pathophysiology of T2DM to clinical manifestations

Ms. James has bilateral peripheral neuropathy that affects her lower extremities. Although it had initially caused severe pain, the neuropathy has now progressed to numbness in both lower extremities. Ms. James reported noticing a small skin ulcer on her right ankle. She reports she initially scraped her ankle on the corner of the dresser 2 weeks ago. But the wound became open within the last 3 days. She reports she has been using “wound butter” she received from a cashier at a convenience store about a year ago on the ulcer. The ulcer is now draining pus, is inflamed and has erythema borders.

Explain the link between all of Ms. James’ clinical manifestations and the pathophysiology of disease. (3 points)

Based on the information provided within the entire case study – What contributed to the worsening symptom of Ms. James’s right ankle wound? List the pathophysiologic basis for the contributing factors. (2 points)

What pertinent education should Ms. James receive regarding peripheral neuropathy and wounds? (1 point)

Application:
Link the pathophysiology of T2DM to the treatment plan

Ms. James’ T2DM is treated with Glipizide an oral sulfonylurea glucose-lowering medication and Trulicity a once-a-week injectable GLP-1 receptor agonist. She is taught how to test her blood glucose level more frequently using a Freestyle Libre continuous glucose monitoring system and educated on the importance of glycemic control, dietary modifications, incorporating physical activity into daily routine, exercise. She is provided with a list of classes on nutrition and on integrating exercise into her daily schedule. She is also educated on the importance of maintaining adequate control over her comorbid conditions (i.e., hypertension and hyperlipidemia).

Relate the mechanism of action oral sulfonylureas to the pathophysiology of T2DM? How does this treatment help to control Ms. James’s hyperglycemia by creating a homeostatic environment? (2 points)

Relate the mechanism of action of injectable Trulicity to the pathophysiology of T2DM? How does this treatment help to control Ms. James’s hyperglycemia by creating a homeostatic environment? (2 points)

After reading the most recent clinical practice guidelines for diabetes, compare and contrast the two guidelines. Which one will you use in practice? Why? (2 points)

Links to guidelines:
https://www.endocrinepractice.org/article/S1530-891X(23)00034-4/fulltext

https://diabetesjournals.org/clinical/article/41/1/4/148029/Standards-of-Care-in-Diabetes-2023-Abridged-for

Evaluate the intersectionality of age, race, gender, and socioeconomic status in Ms. James’ diabetes management journey. (1 point)

Identify potential barriers to preventive care she may have experienced before entering assisted living. (1 point)

Propose evidence-based, culturally appropriate interventions that address: Access to diabetes education and preventive services. (1 point)

Use of references and citations (at minimum 3) in appropriate APA format and appropriate grammar. (4 points) Click here for
Link to APA 7-quick-reference-guide.pdf

Norma James is a 73-year-old Black female that comes to the office for her 3 month follow up visit for Type 2 Diabetes Mellitus (T2DM)

Norma James: Case Study Analysis

Is Ms. James’s pancreas still producing insulin? Describe the pathophysiology of T2DM.

Type 2 diabetes mellitus (T2DM) consists of insulin resistance together with simultaneous beta-cell pancreatic dysfunction that progressively worsens over time. The available insulin production from Ms. James’s pancreas remains inadequate despite showing limited ability to counter the insulin resistance. Receptor cells inside the body of someone with T2DM do not respond properly to insulin which results in elevated blood sugar levels. This condition develops because of genetic predisposition and bad lifestyle habits which facilitates decrease in insulin-releasing beta cells throughout time. Exacerbated hyperglycemia results from elevated hepatic glucose production and insufficient peripheral glucose uptake.

Explain the patient’s risk factors, hereditary traits, and diversity concerns that may contribute to her uncontrolled T2DM.

The patient possesses three main risk factors encompassing her older age alongside racial background and family history of diabetes and hypertension. T2DM becomes more prevalent among elderly and Black race populations due to genetic predisposition combine with systemic barriers to diabetes care. The assisted living facility dietary regulations prevent her from properly following an appropriate diabetes management eating plan. Each socioeconomic barrier and lack of personal diabetes education exacerbates her health condition requiring culturally appropriate healthcare to succeed.

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What comorbidities does Ms. James has? Explain how the pathophysiology of T2DM is linked to these comorbidities.

Ms. James has multiple medical conditions which include hypertension alongside atrial fibrillation, hyperlipidemia, depression, diabetic nephropathy retinopathy and neuropathy. Chronic hyperglycemia causes oxidative stress leading to endothelial dysfunction while creating inflammatory pathways and establishes intricate connections between diabetes and these comorbidities. Blood vessel damage occurs through these mechanisms leading to nephropathy and retinopathy and neuropathy. The metabolic effects of insulin resistance lead Dyslipidemia and hypertension toward co-aggregation with T2DM.

What complications are related to a long duration of T2DM in older adult patients? Explain the pathophysiology involved.

Older adults who live with prolonged T2DM face complications that comprise macrovascular and microvascular complications together with cognitive decline and enhanced infection vulnerabilities. Prolonged high blood sugar levels cause proteins and lipids to become glycated into advanced glycation end products (AGEs) that harm the endothelial cells while impeding blood circulation (Powers et al., 2021). The combination between neuropathy with vascular insufficiency results in reduced wound healing and increased vulnerability to infection. T2DM that persists over time produces marked neurodegeneration which increases the risk for dementia development.

Explain the link between all of Ms. James’s clinical manifestations and the pathophysiology of disease.

The nerve ischemia and demyelination stemming from persistently elevated glucose levels has resulted in Ms. James’s bilateral peripheral neuropathy. The wound demonstrates impaired healing because inadequate blood flow and reduced immune function originate from microvascular disfunction (Powers et al., 2021). The ulcer’s transition to infection which shows erythematous borders and purulent drainage proves that hyperglycemia has weakened local immunity and made healing more difficult.

Based on the information provided within the entire case study – What contributed to the worsening symptom of Ms. James’s right ankle wound? List the pathophysiologic basis for the contributing factors.

Several factors contributed to the wound’s progression:

Peripheral neuropathy
: His reduced sensation caused him to detect injuries later than normal.

Impaired immune function
: The immune system performance of leukocytes becomes low when blood sugar levels are elevated which enables infections to take root.

Vascular damage
: Low blood circulation prevents oxygen and essential nutrients from reaching the healing area.

Improper wound care
: The application of “wound butter” to the injury seemed to bring contaminants that worsened the infection process.

What pertinent education should Ms. James receive regarding peripheral neuropathy and wounds?

Ms. James requires education to understand how to do critical daily foot checks, proper footwear selection and timely reporting of wounds (Garber et al., 2023). Acceptable wound care practice includes the usage of sterile materials and she should avoid on using physically unverified treatments like “wound butter.” She should seek medical attention without delay whenever symptoms of infection develop such as redness and swelling with discharge from the wound area.

Relate the mechanism of action of oral sulfonylureas to the pathophysiology of T2DM.

The mechanism of sulfonylureas like glipizide includes a potassium channel-blocking effect that stimulates pancreatic beta cells to produce insulin. The cell membrane becomes depolarized through this process which allows calcium to enter while insulin is released (Powers et al., 2021). The insulin-producing capacity of sulfonylureas improves naturally occurring insulin output thus fighting insulin resistance and controlling blood glucose levels that achieve better glycemic results.

Relate the mechanism of action of injectable Trulicity to the pathophysiology of T2DM.

Trulicity which is a GLP-1 receptor agonist acts by imitating incretin hormone GLP-1 directly stimulating receptor actions which enables insulin production and inhibits glucagon release especially after carbohydrate consumption and additionally delaying digestive emptying. Glycemic control benefits from these effects because they control post-meal glucose spikes together with beta-cell function support that matches T2DM’s pathophysiological basis of impaired insulin secretion and insulin resistance.

Compare and contrast the two diabetes guidelines. Which one will you use in practice? Why?

Standards of Care published by the American Diabetes Association (ADA) concentrate on custom-designed treatment accompanied by lifestyle adjustments with team-based medical care (American Diabetes Association, 2023). The American Association of Clinical Endocrinology (AACE) establishes intensive glycemic goals with recommendations to deploy complex therapeutic approaches (Garber et al., 2023). The ADA guidelines would serve best because their holistic framework matches patient-focused practices while accounting for social and economic barriers affecting Ms. James.

Evaluate the intersectionality of age, race, gender, and socioeconomic status in Ms. James’s diabetes management journey.

Multiple barriers exist in Ms. James’s treatment path because of her age as well as her racial background and her socioeconomic status. Being an older Black woman renders her at greater risk for experiencing health inequalities because of inadequate access to appropriate cultural healthcare and systemic discrimination (American Diabetes Association, 2023). The combined influence of these factors results in constraints on Ms. James’s dietary options as she lives in an assisted living facility. This way these multiple factors combine to influence her diabetes management outcomes Norma James is a 73-year-old Black female that comes to the office for her 3 month follow up visit for Type 2 Diabetes Mellitus (T2DM).

Identify potential barriers to preventive care she may have experienced before entering assisted living.

Healthcare barriers include restricted facility access and expensive healthcare costs alongside lack of transportation and minimal health knowledge (American Diabetes Association, 2023). The patient delay in seeking proper medical attention and lifestyle modifications may have aroused due to cultural stigma surrounding diabetes.

Propose evidence-based, culturally appropriate interventions that address access to diabetes education and preventive services.

Diabetes education programs targeting Black senior citizens should deliver culturally appropriate dietary education information. Community partnerships could expand accessibility to preventive medical care and implementation of telehealth solutions to eliminate transportation limitations. Authentic multilingual materials combined with family participation will help older black adults both understand their care plans and follow them.

 

References

American Diabetes Association. (2023). Standards of Medical Care in Diabetes—2023. Retrieved from
https://diabetesjournals.org/clinical/article/41/1/4/148029/Standards-of-Care-in-Diabetes-2023-Abridged-for

Garber, A. J., et al. (2023). AACE Guidelines for Comprehensive Management of Type 2 Diabetes. Retrieved from
https://www.endocrinepractice.org/article/S1530-891X(23)00034-4/fulltext

Powers, A. C., et al. (2021). Diabetes Mellitus: Pathophysiology and Management.
Harrison’s Principles of Internal Medicine. 
Norma James is a 73-year-old Black female that comes to the office for her 3 month follow up visit for Type 2 Diabetes Mellitus (T2DM)

Individual Assignment EBP Implementation Project Plan on your PICOT Question

Module #4: Individual Assignment

EBP Implementation Project Plan on your PICOT Question

INSTRUCTIONS

Complete
the assignment, using this
Word file
as a worksheet.
Type
your answers directly on this sheet. Use APA style for the reference list and include citations to support your work ideas or plans for each question.

QUESTIONS

The objective of this assignment is to guide you in creating a plan to implement an evidence-based practice (EBP) quality improvement (QI) project based on your PICOT questions.

Instructions:

State your PICOT question (this should be the revised version of your question after incorporating feedback from previous assignments).

Answer the following questions (limit your answers to 250-300 words per question):

What initial steps can be implemented to garner support from the administration and other key stakeholders regarding the need for practice change proposed by your PICOT question?

Describe how you would engage leadership, interdisciplinary teams, and other stakeholders.

Identify potential barriers and describe ways to address them.

What steps can be performed prior to implementing the practice change? (20 pts)

Identify preparatory actions such as conducting a needs assessment, reviewing current policies, securing resources, education/training needs, pilot/small scale testing.

How will you incorporate patient preferences and clinical expertise in your project?

How does your proposed QI project (for your PICOT question) address the Quadruple Aim of Healthcare?

How can the practice change be sustained over time? Individual Assignment EBP Implementation Project Plan on your PICOT Question

Discuss methods to ensure long-term success, such as ongoing training, integrating the change into policies and procedures, and monitoring outcomes.

Consider strategies for continuous quality improvement (CQI), stakeholder feedback, and period evaluation.

 
References

SUBMITTING YOUR ASSIGNMENT

SAVE THIS WORD FILE

with your responses as a PDF

SUBMIT
the completed document via Canvas, under the Assignments tab

 

GRADES

Submissions will be graded according to the specific assignment rubric.

In addition, the following point deductions will apply: five points for each day after the submission deadline. No work will be accepted beyond one week after the original due date.

 

Individual Assignment EBP Implementation Project Plan on your PICOT Question 

Module #4: Individual Assignment

The Revised PICOT Question

The revised PICOT question is; “In adult patients diagnosed with hypertension (P), how does implementing a combination of patient education and home blood pressure monitoring (I) compared to standard hypertension management without these interventions (C) improve blood pressure control and reduce complications (O) over 6 months (T)”

Question Two

Initial Steps for Acquiring Administration’s Support, Engagement Strategies, and Potential Barriers

Implementing some initial can trigger key stakeholders to support practice change recommended by the PICOT question. The first step involves identifying the clinical issue of priority. A clear explanation of the problem being addressed with the proposed PICOT question and its potential adverse outcomes should be presented to the key stakeholders, including the administration. In this case, stakeholders should be informed about current ineffective measures for managing blood pressure among individuals diagnosed with hypertension and potential health complications. Research shows that ineffective management of hypertension exposes patients to potential health complications, including cardiovascular diseases (Lak et al., 2024). The second step is developing a clear evidence-based (EB) rationale supporting the recommended practice change. Research shows that a multi-approach combining patient education and home blood pressure monitoring enhances hypertension management, resulting in a desired blood pressure level (Heshmat-Ghahdarijani et al., 2022) Individual Assignment EBP Implementation Project Plan on your PICOT Question . Therefore, incorporating patient education and home blood pressure monitoring into patient hypertension management care would lower blood pressure and reduce the risk of potential health complications. Consequently, stakeholders would support recommended practice change to enhance hypertension management; thereby preventing potential adverse treatment outcomes.

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Engaging stakeholders would enhance the implementation of the proposed change. First, one can engage leadership by identifying relevant top leaders, including heads of departments affected by ineffective hypertension management care. These top leaders will provide significant inputs needed during change implementation. Moreover, interdisciplinary teams, including physicians, registered nurses, specialists, pharmacists, and nurse practitioners can be engaged by fostering collaboration. Organizing workshops, meetings, or focus groups would enable interdisciplinary teams to discuss the impact of the proposed change in hypertension management on their day-to-day operations. The last group of stakeholders who should be engaged during the implementation of practice change are patients and their families. These stakeholders are at the center of the practice change since they will actively participate in patient education and monitoring blood pressure at home.

           
The first barrier to successful implementation of practice change is resistance to change. Staff members are usually resistant to change due to discomfort associated with new practices, including additional training. This issue can be addressed by informing staff members about the benefits of the recommended change in open communication, making them willing to implement new hypertension management measures. Another potential barrier is communication gaps. Effective communication with key stakeholders leads to the successful implementation of practice change within clinical settings (Metz & Bartley, 2020). Communication gaps can be resolved by introducing multiple communication channels, including newsletters, memos, and regular meetings; thereby informing stakeholders about the progress.

Pre-Implementation Steps

           
The first pre-implementation step is conducting a needs assessment. It involves identifying the clinical issue being addressed by implementing practice change. A gap in the current hypertension management care can be identified by gathering baseline data through stakeholder feedback, interviews, data analysis, or surveys. In this case, the number of hypertension-related hospital admissions or health complications can be used as the baseline data that will be used to evaluate the current state of hypertension management. The second step reviewing current practices. Current procedures and protocols related to hypertension management will be reviewed in this second step. Besides, inconsistencies or gaps that might compromise the implementation of the new hypertension management protocol are identified. Step three involves securing all necessary resources. For instance, financial resources needed for the practice change are gathered in this phase. Besides, this step involves ensuring the availability of all human resources that would contribute to a successful practice change and their willingness to participate in the change implementation Individual Assignment EBP Implementation Project Plan on your PICOT Question .

Additionally, the fourth pre-implementation step involves evaluating education and training needs. Staff members’ knowledge gap that might hinder the change implementation is identified and addressed through training sessions. Step five involves communicating with all key stakeholders regularly throughout the preparatory phase via multiple forums. Regular communication keeps them updated about the change project’s objectives, progress, and expected outcomes. A detailed implementation timeline is developed in step six. It should include significant milestones and deadlines for every activity. The last pre-implementation step involves establishing a clear evaluation criterion. The incidence of hypertension-related complications can be used as the outcome measure for assessing the effectiveness of the practice change.

Incorporating clinical expertise and patient preferences in the EBP project

Incorporating clinical expertise and patient preferences into the proposed practice change for enhancing hypertension management care would result in desired patient/clinical treatment outcomes.

Patient preferences would lead to better treatment outcomes by creating personalized care plans, which would encourage patients to actively participate in blood pressure management and adhere to the recommended treatment plan. The first step of incorporating patient preferences into the practice change project involves assessing patient preferences. This vital information would be collected by administering surveys or questionnaires to patients, conducting patient interviews, and adopting a shared decision-making model that allows patients to influence decisions regarding their treatment interventions. The second step involves developing patient-tailored treatment plans. Research shows that designing personalized medication plans based on patients’ preferences enhanced medication adherence in individuals receiving long-term treatments for chronic illnesses (Menditto et al., 2020). Thus, patients would adhere to the treatment regimens if their preferences were incorporated into their patient-centric plans. The last step involves collecting feedback regarding patients’ side effects, progress, and satisfaction with the current treatment plan regularly.

Additionally, integrating clinical expertise with practice change projects would optimize patient treatment outcomes through the utilization of current clinical guidelines for hypertension management. For instance, utilizing guidelines recommended by the “American Heart Association” (AHA) would ensure that the patient’s hypertension management care plan is designed based on the latest clinical protocols (Abdalla et al., 2023). Consequently, desired blood pressure levels would be achieved, lowering the risk of potential health complications. Moreover, considering clinical expertise would improve treatment through interdisciplinary collaboration. Clinical experts from multiple disciplines, including nurses, dietitians, pharmacists, and exercise physiologists would work together in developing a comprehensive hypertension management plan, lowering blood pressure levels.

The Connection Between Hypertension Management Care Plan and the Quadruple Aim of Healthcare

The Quadruple Aim targets four significant objectives, including patient experience, cost-effectiveness, population health, and healthcare provider well-being. The recommended EB hypertension management care plan addressed these four objectives.

First, the care plan focuses on improving patient experience. A better patient experience is achieved by designing patient-centered care that incorporates patient preferences. Hence, patients feel valued, respected, and understood once the recommended treatment intervention incorporates their preferences, values, and cultural factors. Besides, designing a personalized treatment intervention based on patient input and clinical evidence makes individual patients feel empowered to actively participate in their recovery journey, thereby boosting their overall experience.

Secondly, the hypertension management care plan can improve population health. This goal is achieved by designing a patient-centered care plan that would effectively lower an individual’s blood pressure level, thereby preventing hypertension-related health complications, such as heart disease, kidney failure, and stroke (Alrashed et al., 2024). Lowering the risk of these comorbidities leads to better population health outcomes. Additionally, the hypertension management care plan includes an education program, which would create awareness among community members. Consequently, individuals would check their blood pressure regularly and adopt healthy lifestyles, which would lower hypertension risk; thereby improving population health.

Moreover, the recommended care plan can enhance cost-effectiveness by reducing healthcare costs. The management of hypertension-related health complications, such as stroke, kidney disease, and heart attack is associated with relatively high treatment costs (Zhou et al., 2021).  The proposed care plan focuses on enhancing hypertension management to lower blood pressure, thereby preventing potential complications, including heart attack, stroke, and kidney disease. Consequently, the expensive long-term treatment for these medical conditions is eliminated, enhancing cost-effectiveness.

Lastly, the proposed care plan boosts healthcare provider well-being. The plan focuses on enhancing blood management to prevent comorbidities among hypertension patients. As a result, high workloads caused by hypertension-related medical conditions would be reduced. Thereby lowering providers’ burnout and improving their mental health and overall well-being Individual Assignment EBP Implementation Project Plan on your PICOT Question .

Strategies for making practice change sustainable over time

Various methods can be adopted to enhance the success of the practice change in the long term. The first approach is ongoing staff training and education programs. Conducting training sessions regularly will keep healthcare professionals updated on the latest evidence-based (EB) hypertension management guidelines, techniques, and resources, thereby achieving better patient outcomes through their hypertension management efforts. Moreover, the change can be sustained by incorporating the recommended hypertension management measures into current policies and procedures. Therefore, the proposed hypertension plan would become the new care protocol for managing blood pressure upon being integrated into healthcare organization’s policies and procedures. The last strategy for making the new hypertension management protocol sustainable involves monitoring outcomes. The new intervention would be embraced as the new clinical guideline for managing hypertension upon demonstrating effectiveness in lowering blood pressure.

Additionally, different strategies should be adopted to support continuous quality improvement (QI), period evaluation, and stakeholders’ feedback. First, the PDSA model can be adopted due to its efficacy in facilitating continuous QI in clinical settings (Burke & Marang-Van De Mheen, 2021) Individual Assignment EBP Implementation Project Plan on your PICOT Question . This model will allow changes in hypertension care to be tested in manageable and small steps in a cyclic approach. Moreover, feedback on the efficacy of the new care plan will be obtained by engaging various stakeholders, including healthcare providers, administrators, and patients throughout the change project implementation process. Lastly, conducting periodic evaluations will provide feedback that will be used to determine the efficacy of the new care plan in achieving operational and clinical goals.

References

Abdalla, M., Bolen, S. D., Brettler, J., Egan, B. M., Ferdinand, K. C., Ford, C. D., … & American Heart Association and American Medical Association. (2023). Implementation strategies to improve blood pressure control in the United States: a scientific statement from the American Heart Association and American Medical Association. 
Hypertension
, 
80
(10), e143-e157.
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