Tag: Clinical-Nursing

Explaining cystic fibrosis (CF) to the mother would include an overview of the disease itself including its presentation and explanation of the symptomology as well as an explanation of its pathophysiology.  The explanation would include the fact that cystic fibrosis is one of the most common autosomal recessive diseases in Caucasian populations (if patient noted as Caucasian) and is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene (Davies & Aurora, 2019).  Because of the mutation in the CFTR gene, there is dysfunction of chloride ion transportation across the epithelial cells.  These epithelial cells line the respiratory and digestive tracts and exhibit defective chloride secretion and excess sodium absorption.  Both contribute to viscous mucous and promote inflammation which cause the respiratory and gastrointestinal clinical manifestations.  Additionally, impaired immune cell responses are instrumental to lung disease severity (Ideozu, Rangaraj, Abdala-Valencia, Zhang, Kandpal, Sala, Davuluri, & Levy, 2019).

The 6-month-old female presented as such because gastrointestinal manifestations often proceed pulmonary symptoms (McCance & Huether, 2019).  The baby’s colic, crying episodes after eating, and swollen belly can all be symptomology (physiologic response) related to gastroesophageal reflux, inflammation, abdominal distention, distal intestinal obstruction, bacterial overgrowth, slow transit time, or inflammatory bowel disease caused by secretory dysfunction of the malfunctioning epithelial cells of the intestines and bowel (De Freitas, Moreira, Tomio, Moreno, Daltoe, Barbosa, Neto, Buccigrossi, & Guarino, 2018).  The lack of weight gain despite good appetite could be attributable to pancreatic insufficiency which causes nutrient malabsorption and failure to thrive often present in children with CF (McCance & Huether, 2019).  The mother’s perception that the baby tastes “salty” is reflective of the CFTR ineffectively moving salt in the body.  The salt travels to the skin’s surface and is not reabsorbed.

As it pertains to the mother’s question of having more children, CF is an autosomal recessive disease.  This entails the disease often seen in siblings but not parents; equal proportions of males and females affected; and on average, one-fourth of offspring of carrier parents affected (McCance & Huether, 2019).  Given that information and recommendation for genetic counseling, the parents can make an informed decision whether or not to have more children.  Furthermore, given the son’s ongoing respiratory problems, he should be tested for CFTR mutation and genotyping as well as the measurement of sweat chloride concentration as CF occurs equally in males and females (Sosnay, Salinas, White, Ren, Farrell, Raraigh, Girodon, & Castellani, 2017).  Further gender considerations would include inquiry into her daughter’s diet as girls with CF have more difficulty meeting growth requirements.  Exclusively breastfed babies receive metabolites that provide protection against intestinal inflammation (De Freitas et al., 2018).

References

Davies, G., & Aurora, P. (2019). A simple screening test for cystic fibrosis?
Indian 

Pediatrics
, 
56
(2), 105–106.

De Freitas, M. B., Moreira, E. A. M., Tomio, C., Moreno, Y. M. F., Daltoe, F. P., Barbosa, E.,

Neto, N. L., Buccigrossi, V., & Guarino, A. (2018). Altered intestinal microbiota

composition, antibiotic therapy and intestinal inflammation in children and adolescents

with cystic fibrosis.
Plos One, 13
(6), e0198457. Retrieved form

https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pone.0198457

Ideozu, J. E., Rangaraj, V., Abdala-Valencia, H., Zhang, X., Kandpal, M., Sala, M. A., Davuluri,

R. V., & Levy, H. (2019). Transcriptional consequences of impaired immune cell

responses induced by cystic fibrosis plasma characterized via dual RNA

sequencing.
BMC Medical Genomics, 12
(1), 66. Retrieved from

https://doi-org.ezp.waldenulibrary.org/10.1186/s12920-019-0529-0

McCance, K. L. & Huether, S. E. (2019).
Pathophysiology: The biologic basis for disease in 

adults and children
(8th ed.). St. Louis, MO: Mosby/Elsevier.

Sosnay, P. R., Salinas, D. B., White, T. B., Ren, C. L., Farrell, P. M., Raraigh, K. S., Girodon, E.,

& Castellani, C. (2017). Applying cystic fibrosis transmembrane conductance

regulator genetics and CFTR2 data to facilitate diagnoses.
The Journal of

Pediatrics
, 
181S
, S27–S32.e1.  Retrieved from

https://doi-org.ezp.waldenulibrary.org/10.1016/j.jpeds.2016.09.063

 

response

Your post with very informative. I enjoyed reading the information. I didn’t get off to a great start with my posting, so this was very refreshing to read.

The thorough explanation you provided regarding the symptoms for the baby’s colic, crying episodes after eating, and swollen belly can all be symptomology (physiologic response) related to gastroesophageal reflux, inflammation, abdominal distention, distal intestinal obstruction, bacterial overgrowth, slow transit time, or inflammatory bowel disease caused by secretory dysfunction of the malfunctioning epithelial cells of the intestines and bowel was more relatable than other explanations (De Freitas, et al., 2018). It is sad that the outcome for these patients are not more optimistic with further advancement from our healthcare researchers over the years.  But despite a complex treatment, chronic airway obstruction and infection usually lead to respiratory insufficiency and premature death (De Boeck, Bulteel, & Fajac, 2016). The brother more than likely should be tested due to the respiratory symptoms that indicate concern for cystic fibrosis including persistent cough or wheeze, excessive sputum production, and recurrent or severe pneumonia (McCance & Huether, 2019).

We have a family friend with cystic fibrosis that has chosen not to have children due to her health condition. Her siblings were later tested and positive carrier, so her sister did IVF. They did genetic testing of the embryos prior to implantation.

My only suggestion in the future is to use the headings for separation of the information. It helps clarify the material being presented. Overall, your post is great and thanks for helping me get a better understanding of the application.

Best of luck this quarter!

Lindy

References

De Boeck, K., Bulteel, V., & Fajac, I. (2016). Disease-specific clinical trials networks: the example of cystic fibrosis.
European Journal of Pediatrics
. 175:817-824.

DOI:10.1007/s00431-016-2712-z

De Freitas, M. B., Moreira, E. A. M., Tomio, C., Moreno, Y. M. F., Daltoe, F. P., Barbosa, E., Neto, N. L., Buccigrossi, V., & Guarino, A. (2018). Altered intestinal microbiota

Composition, antibiotic therapy and intestinal inflammation in children and adolescents with cystic fibrosis.
Plos One
, 13(6), e0198457. Retrieved form

https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pone.0198457

McCance, K. L. & Huether, S. E. (2019).
Pathophysiology: The biologic basis for disease in adults and children
(8th ed.). St. Louis, MO: Mosby/Elsevier

Discussion: Alterations in Cellular Processes

Photo Credit: Getty Images

At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

To prepare:

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

By Day 3 of Week 1

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

The role genetics plays in the disease.

Why the patient is presenting with the specific symptoms described.

The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

The cells that are involved in this process.

How another characteristic (e.g., gender, genetics) would change your response.

Read
a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond
to
at least two
of your colleagues on
2 different days
and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not

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

NURS_6501_Discussion_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Main Posting

Points Range:
45
(45%)
– 50
(50%)

Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range:
40
(40%)
– 44
(44%)

Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range:
35
(35%)
– 39
(39%)

Responds to some of the Discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range:
0
(0%)
– 34
(34%)

Does not respond to the Discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness

Points Range:
10
(10%)
– 10
(10%)

Posts main post by Day 3.

Points Range:
0
(0%)
– 0
(0%)

N/A

Points Range:
0
(0%)
– 0
(0%)

N/A

Points Range:
0
(0%)
– 0
(0%)

Does not post main post by Day 3.

First Response

Points Range:
17
(17%)
– 18
(18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of Learning Objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range:
15
(15%)
– 16
(16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range:
13
(13%)
– 14
(14%)

Response is on topic and may have some depth.

Responses posted in the Discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range:
0
(0%)
– 12
(12%)

Response may not be on topic and lacks depth.

Responses posted in the Discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response

Points Range:
16
(16%)
– 17
(17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of Learning Objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range:
14
(14%)
– 15
(15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range:
12
(12%)
– 13
(13%)

Response is on topic and may have some depth.

Responses posted in the Discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range:
0
(0%)
– 11
(11%)

Response may not be on topic and lacks depth.

Responses posted in the Discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation

Points Range:
5
(5%)
– 5
(5%)

Meets requirements for participation by posting on 3 different days.

Points Range:
0
(0%)
– 0
(0%)

N/A

Points Range:
0
(0%)
– 0
(0%)

N/A

Points Range:
0
(0%)
– 0
(0%)

Does not meet requirements for participation by posting on 3 different days.

Total Points: 100

Cystic Fibrosis (CF) is an autosomal recessive inherited disorder arising from a defective protein called cystic fibrosis transmembrane conductance regulator (CFTR) which disrupts the normal function of epithelial cells that line the passageways of the respiratory, digestive and reproductive organs (McCance and Huether, 2019). The CF gene is passed down by both parents and is found on chromosome 7 (McCance and Huether, 2019). The CFTR regulates the concentration of sodium, chloride, and water that passes across cell membranes. Sodium and chloride regulate the amount of mucus that coats the linings of the affected organs.

In a case with CF, CFTR insufficiency results in the interference of chloride secretion, sodium reabsorption, and water transport thus causing the body to produce viscous mucus and mucociliary dysfunction (Turcios, 2020).

CF is common among European culture. According to Turcois (2020), studies show that CF is more prevalent among whites with a 1 in 2,500 chances of the child inheriting the CF gene, however, all ethnicities are not immune to it.

In the scenario, the mother is concerned that her 6-month- old has intermittent abdominal distention, cries every so often after eating and does not gain weight despite having a good appetite. The reason is that the buildup of mucus in the pancreas leads to insufficient production of pancreatic enzymes which disrupts the absorption of proteins, fats and fat-soluble vitamins (A, D, E, K) which are needed for proper growth (McCance and Huether, 2019).  It is essential to educate the mother to adhere to proper nutrition and initiate the intake of pancreatic enzyme replacement therapy to counteract the malabsorption (Kulkami, Kansra, & Karande, 2019).

Since CF also affects the sweat glands, the CFTR disrupts the balanced excretion of sodium and chloride causing the buildup of sodium and water traveling to the skin surface which is why babies tend to taste salty (Kulkami, Kansra, & Karande, 2019).

As for the 23-month-old, the insufficient CFTR in the epithelial linings of the lungs produces thick and sticky mucus trapping pathogens such as bacteria, viruses and fungi that do not clear out as it should causing patients to have recurrent lung infections and inflammation (McCance and Huether, 2019).  Respiratory symptoms are likely to appear more in older infants than newborns (Turcios, 2020). Therefore, the mother should have her child tested for possible CF.

The mother also inquired about having more children.  The chance of a family member having a hereditary disorder is called recurrence risk (McCance and Huether, 2019). CF is an autosomal recessive disorder, meaning an individual inherits 1 copy of the defected gene from each parent (Kulkami, Kansra, & Karande, 2019).  Since both parents are carriers of the defective gene, they have 1 in 4 chances that their child may inherit CF, 1 in 2 chances that the child will be a carrier and 1 in 4 chances that the child will not be a carrier.

References

Kulkarni, H., Kansra, S., & Karande, S. (2019). Cystic fibrosis revisited. 
Journal of Postgraduate Medicine
, 
65
(4), 193–196. https://doi-org.ezp.waldenulibrary.org/10.4103/jpgm.JPGM_263_18

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Turcios, N. L. (2020). Cystic Fibrosis Lung Disease: An Overview. Respiratory Care, 65(2), 233–251. https://doi-org.ezp.waldenulibrary.org/10.4187/respcare.06697

The role genetics plays in the disease.

Cystic Fibrosis (CF) is a disease that is inherited and affects the mucus and sweat production by those glands (McCance & Huether, 2018).  How it is inherited is that parents of children with CF both have to be carriers of the cystic fibrosis transmembrane regulator (CFTR) mutation gene (McCance & Huether, 2018).  Parents do not have to have CF for their children to have CF; they just have to be carriers of the mutation gene (Tabori et al., 2017).  It is very common for people of European descent to inherit CF (McCance & Huether, 2018).

 

 

Why the patient is presenting with the specific symptoms described.

The symptoms described in the case study scenario that contributed to the CF diagnosis were thought of possible colic, baby has had many episodes of crying after eating, despite having a good appetite baby is not gaining weight (failure to thrive, FTT), baby’s belly “gets all swollen sometimes,” the baby tastes “salty” when the mother kisses the baby, and sibling has had multiple episodes of “chest congestion” and was hospitalized once for pneumonia (Abid et al., 2017).

The human body is protected against bacteria by first and second lines of defense (McCance & Huether, 2018).  Physical, mechanical, biochemical, and normal flora make up the first lines of defense (McCance & Huether, 2018).  Examples of the physical and mechanical barriers are skin and mucus membranes; antibacterial properties of mucus secretions, tears, saliva, sweat, and other secretions are examples of biochemical barriers; normal flora are good bacteria that protects the human body by preventing bad bacteria from taking over in places like the gut (McCance & Huether, 2018).

CFTR protein pushes chloride ions into secretions to help draw water into these secretions (mucus) to loosen (thin) them (McCance & Huether, 2018).  CFTR protein absence leaves excess chloride ions on the skin.  The thin and slippery mucus protects the sac that lines the lungs, stomach, tissues and organs (McCance & Huether, 2018).  The missing CFTR protein does not leave a way for the body to thin out the mucus (Abid et al., 2017), leaving the body to only make thick and sticky mucus that build up, leading to blockages, frequent infections, and damages in the affected organs (McCance & Huether, 2018).

The pancreas cannot release any digestive enzymes to the small intestine when it is blocked with thick mucus making nutrients and fat not absorbable, leading to FTT (not gaining weight despite good appetite and looking malnourished (McCance & Huether, 2018).  Other gastrointestinal symptoms include fatty stools (McCance & Huether, 2018), abdominal pain after eating due to poor intestinal malabsorption (Tabori et al., 2017), abdominal bloating, constipation, and flatulence (McCance & Huether, 2018).  CFTR also helps the skin regulate sodium ions and fluid absorption; so, in someone with CF, there is less fluid absorption to dilute the sodium ions, leaving the salty taste on the skin (McCance & Huether, 2018).

The second line of defense is the body’s response to damage known as inflammation (McCance & Huether, 2018).  Symptoms are redness, swelling, pain, and heat, collection of fluid at the site, leukocytosis and fever (McCance & Huether, 2018).  In the presence of CF, inflammation causes damage to lungs and pancreas in particular, but other organs as well (McCance & Huether, 2018).  A child or young adult, or their sibling, with a history of severe and recurrent bronchitis, pneumonia, pancreatitis, and hemoptysis is suspect for further CF testing.

 

 

The
physiologic response to the stimulus presented
in the scenario and
why you think this response occurred
.

In CF, abnormally thick mucus in the airways does not have the same germ-killing properties of normal mucus leading to frequent infections that hampers attempts at treating (clearing) the infections, resulting in a loop of continuous inflammations, scarring, and death (McCance & Huether, 2018).  Viral and bacterial infections, especially culprits like Pseudomonas aeruginosa, Staphylococcus aureus, and Hemophilus influenzae, manifest inflammatory responses that are extreme (McCance & Huether, 2018).  Excessive signals are sent from cells with a defective CFTR protein, resulting in the complement system of antigen-antibody being activated (McCance & Huether, 2018); bacteria, leukocytes (white blood cells) and phagocytes (neutrophils).

 

 

The cells that are involved in this process.

The mast cell activates the inflammatory response through the release of mediators such as histamine (McCance & Huether, 2018).  Antigens of the bacteria are presented to helper T cells, who release cytokines, resulting in accumulation of neutrophils (to initiate phagocytosis of the bacteria), signaling or resulting in inflammation (McCance & Huether, 2018).

 

How another characteristic (e.g., gender, genetics) would change your response.

While some people with CF get severe symptoms or life-threatening complications, others have few signs and symptoms (Tabori et al., 2017), such as with the baby and older sibling in the case study scenario.  Siblings with only one parent in common who is a carrier will not acquire CF.  Abid et al. (2017) reported estrogen hormone elevations disrupt chloride ion and water balance (p. 2). They also measured nasal epithelial Calcium ion-activated Chloride-secretion in women with CF during their menstrual cycle with results that women with CF cannot clear build-up of airway secretions, a hallmark of CF, effectively (Abid et al., 2017).

 

 

References

 

Abid, S., Xie, S., Bose, M., Shaul, P., Terada, L., Brody, S.,…Jain, R. (2017). 17β-Estradiol Dysregulates Innate Immune Responses to Pseudomonas aeruginosa Respiratory Infection and Is Modulated by Estrogen Receptor Antagonism.
Infection and immunity
,
85
(10), e00422-17.
Https://doi.org/10.1128/IAI.00422-17
.

McCance, K. & Huether, S. (2018).
Pathophysiology: The biologic basis for disease in adults and children
(8th ed.). St. Louis, MO: Mosby/Elsevier.

Tabori, H., Arnold, C., Jaudszus, A., Mentzel, H., Renz, D., Reinsch, S.,…Mainz, J. (2017). Abdominal symptoms in cystic fibrosis and their relation to genotype, history, clinical and laboratory findings.
PloS one
,
12
(5), e0174463.
Https://doi.org/10.1371/journal.-pone.0174463
.

 

response

   I enjoyed reading your post, it was very detailed and very interesting. I like how you presented the discussion. We all know by now that Cystic fibrosis is an inherited disease and the most common life-shortening autosomal recessive disease among Caucasian populations, with a frequency of 1 in 2000 to 3000 live births. The median predicted survival for CF patients in the United States was 39.3 years (95% CI, 37.3-41.4) according to the Cystic Fibrosis Foundation 2014 Registry Report (Katkin, 2020). As in your discussion, it was common in people of European descent to inherit CF (McCance & Huether, 2018).

 

Over the years, Cystic Fibrosis (CF) has had significant improvements for early diagnoses and better management for delayed disease progression. The treatments recently are specifically seeking ways to target the genetic mutation causing the disease (Huether & McCance, 2017). Specifically, the correction of the misprocessing of the CFTR protein is helping trial new drugs. Understanding the pathophysiology of the disease can assist in the best treatment plan. For example, Ataluren is now used in research trials, which helps restore the function of mutation in the gene and aids in correcting the chloride channel transport by targeting CFTR protein (Brown, White, & Tobin, 2017).

 

I wanted also to point out in response to the mother on her 23 mos. We can also educate the mom and the husband of advanced teaching to them, we can give options regarding the CF screening and the disease itself. It will be beneficial for the mother and her husband to contemplate if they choose to have another kid. Newborn screening is universal in the US.  Ideally, when a family member has confirmed CF, other family members should be screened by the same laboratory that tested the affected relative. The screening panel should include familial mutations previously identified as well as the mutations in the standard panel. Genetic counseling should also be available to them and take also into consideration. Researchers have shown that females are more likely to succumb to this disease than men. Although this gender disparity is not researched often, it has been hypothesized that the disease is hormone mediated. This could account for the 23-month-old to not show symptoms as soon as the 6-month-old (Harness-Brumley, Elliot, Rosenbluth, Raghaven, & Jain, 2014). With mother already having two children with CF, it would be beneficial for her and her partner to undergo carrier screening, if not already performed. If considering, genetic counseling would also be of assistance. If both partners are positive for the CF mutation, there are options such as accepting the risk, adoption, and in vitro fertilization, with the use of preimplantation genetic diagnosing (The American College of Obstetricians and Gynecologists, 2017). As providers, it is our responsibility to keep the patient informed upfront regarding any future pregnancies. Again, thank you for your great post.

 

References

 

Brown, S. D., White, R., & Tobin, P. (2017). Keep them breathing: Cystic fibrosis pathophysiology, diagnosis, and treatment. Journal of the American Academy of PAs, 30(5), 23-27. doi: 10.1097/01.JAA.0000515540.36581.92

Harness-Brumley, C.L., Elliot, A.C., Rosenbluth, D.B., & Jain, R., (2014). Gender differences

In outcomes of the patient with cystic fibrosis, Journal of Women’s Health, 23(12). Pp 1012-1020

Huether, S. E., & McCance, K. L. (2019) Pathophysiology: The biologic basis for disease in adults and child ( 8th Ed.) St. Louis, Missouri: Elsevier

Katkin, J. (2019) Cystic Fibrosis: Clinical manifestation and Diagnosis. Up to Date.

Retrieve 10 October 2019 from https//:www.uptodate.com

The American College of Obstetricians and Gynecologists. (2017, June). FAQs171. Retrieved from Women’s Health Care Physicians: https://www.acog.org/Patients/FAQs/Cystic-Fibrosis-Prenatal-Screening-and-Diagnosis?IsMobileSet=false

Nursing Essays Thesis Statements

Basics of Thesis Statements

The 
thesis statement
 is the brief articulation of your paper’s central argument and purpose. You might hear it referred to as simply a “thesis.” Every scholarly paper should have a thesis statement, and strong thesis statements are concise, specific, and arguable. 
Concise
 means the thesis is short: perhaps one or two sentences for a shorter paper. 
Specific
 means the thesis deals with a narrow and focused topic, appropriate to the paper’s length. 
Arguable
 means that a scholar in your field could disagree (or perhaps already has!).

BUY PLAGIARISM-FREE PAPER HERE

Strong thesis statements address specific intellectual questions, have clear positions, and use a structure that reflects the overall structure of the paper. Read on to learn more about constructing a strong thesis statement.

Being Specific

This thesis statement has no specific argument:

Needs Improvement:
 In this essay, I will examine two scholarly articles to find similarities and differences.

This statement is concise, but it is neither specific nor arguable—a reader might wonder, “Which scholarly articles? What is the topic of this paper? What field is the author writing in?” Additionally, the purpose of the paper—to “examine…to find similarities and differences” is not of a scholarly level. Identifying similarities and differences is a good first step, but strong academic argument goes further, analyzing what those similarities and differences might mean or imply. Nursing Essays Thesis Statements

Better:
 In this essay, I will argue that Bowler’s (2003) autocratic management style, when coupled with Smith’s (2007) theory of social cognition, can reduce the expenses associated with employee turnover.

The new revision here is still concise, as well as specific and arguable.  We can see that it is specific because the writer is mentioning (a) concrete ideas and (b) exact authors.  We can also gather the field (business) and the topic (management and employee turnover). The statement is arguable because the student goes beyond merely comparing; he or she draws conclusions from that comparison (“can reduce the expenses associated with employee turnover”).

Making a Unique Argument

This thesis draft repeats the language of the writing prompt without making a unique argument:

Needs Improvement:
 The purpose of this essay is to monitor, assess, and evaluate an educational program for its strengths and weaknesses. Then, I will provide suggestions for improvement.

You can see here that the student has simply stated the paper’s assignment, without articulating specifically how he or she will address it. The student can correct this error simply by phrasing the thesis statement as a specific answer to the assignment prompt.

Better:
 Through a series of student interviews, I found that Kennedy High School’s antibullying program was ineffective. In order to address issues of conflict between students, I argue that Kennedy High School should embrace policies outlined by the California Department of Education (2010).

Words like “ineffective” and “argue” show here that the student has clearly thought through the assignment and analyzed the material; he or she is putting forth a specific and debatable position. The concrete information (“student interviews,” “antibullying”) further prepares the reader for the body of the paper and demonstrates how the student has addressed the assignment prompt without just restating that language. Nursing Essays Thesis Statements.

Creating a Debate

This thesis statement includes only obvious fact or plot summary instead of argument:

Needs Improvement:
 Leadership is an important quality in nurse educators.

A good strategy to determine if your thesis statement is too broad (and therefore, not arguable) is to ask yourself, “Would a scholar in my field disagree with this point?” Here, we can see easily that no scholar is likely to argue that leadership is an unimportant quality in nurse educators.  The student needs to come up with a more arguable claim, and probably a narrower one; remember that a short paper needs a more focused topic than a dissertation.

Better:
 Roderick’s (2009) theory of participatory leadership  is particularly appropriate to nurse educators working within the emergency medicine field, where students benefit most from collegial and kinesthetic learning.

Here, the student has identified a particular type of leadership (“participatory leadership”), narrowing the topic, and has made an arguable claim (this type of leadership is “appropriate” to a specific type of nurse educator). Conceivably, a scholar in the nursing field might disagree with this approach. The student’s paper can now proceed, providing specific pieces of evidence to support the arguable central claim. Nursing Essays Thesis Statements

Choosing the Right Words

This thesis statement uses large or scholarly-sounding words that have no real substance:

Needs Improvement:
 Scholars should work to seize metacognitive outcomes by harnessing discipline-based networks to empower collaborative infrastructures.

There are many words in this sentence that may be buzzwords in the student’s field or key terms taken from other texts, but together they do not communicate a clear, specific meaning. Sometimes students think scholarly writing means constructing complex sentences using special language, but actually it’s usually a stronger choice to write clear, simple sentences. When in doubt, remember that your ideas should be complex, not your sentence structure.

Better:
 Ecologists should work to educate the U.S. public on conservation methods by making use of local and national green organizations to create a widespread communication plan.

Notice in the revision that the field is now clear (ecology), and the language has been made much more field-specific (“conservation methods,” “green organizations”), so the reader is able to see concretely the ideas the student is communicating. Nursing Essays Thesis Statements

Leaving Room for Discussion

This thesis statement is not capable of development or advancement in the paper:

Needs Improvement:
 There are always alternatives to illegal drug use.

This sample thesis statement makes a claim, but it is not a claim that will sustain extended discussion. This claim is the type of claim that might be appropriate for the conclusion of a paper, but in the beginning of the paper, the student is left with nowhere to go. What further points can be made? If there are “always alternatives” to the problem the student is identifying, then why bother developing a paper around that claim? Ideally, a thesis statement should be complex enough to explore over the length of the entire paper.

Better:
 The most effective treatment plan for methamphetamine addiction may be a combination of pharmacological and cognitive therapy, as argued by Baker (2008), Smith (2009), and Xavier (2011).

In the revised thesis, you can see the student make a specific, debatable claim that has the potential to generate several pages’ worth of discussion. When drafting a thesis statement, think about the questions your thesis statement will generate: What follow-up inquiries might a reader have? In the first example, there are almost no additional questions implied, but the revised example allows for a good deal more exploration.

Extra Tips

Thesis Mad Libs

If you are having trouble getting started, try using the models below to generate a rough model of a thesis statement! These models are intended for drafting purposes only and should not appear in your final work.

In this essay, I argue ____, using ______ to assert _____.

While scholars have often argued ______, I argue______, because_______.

Through an analysis of ______, I argue ______, which is important because_______.

Words to Avoid and to Embrace

When drafting your thesis statement, avoid words like 
explore, investigate, learn, compile, summarize
, and 
explain
 to describe the main purpose of your paper. These words imply a paper that summarizes or “reports,” rather than synthesizing and analyzing.

Instead of the terms above, try words like 
argue, critique, question
, and 
interrogate
. These more analytical words may help you begin strongly, by articulating a specific, critical, scholarly position.

Read Kayla’s 
blog post
for tips on taking a stand in a well-crafted thesis statement. Nursing Essays Thesis Statements

NURS 6521: Advanced Pharmacology

Module 1: Foundational Concepts of Advanced Pharmacology

What’s Happening This Module?

This course is composed of eight (8) separate modules. Each module consists of an overarching topic in which each week within the module includes specific subtopics for learning. As you work through each module, you will have an opportunity to draw upon the knowledge you gain in various discussion and assignment components which will be due throughout each of the modules NURS 6521: Advanced Pharmacology.

Module 1: Basic Pharmacotherapeutic Concepts/Ethical and Legal Aspects of Prescribing is a one-week module. In Week 1 of the course, you will examine how patient factors may influence the pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. You will also examine the ethical and legal implications of prescribing drugs, as well as advanced practice nurse strategies in guiding prescription drug decision-making.

What do I have to do?

When do I have to do it?

Review your Learning Resources

Days 1-7 Week 1

Discussion: Pharmacokinetics and Pharmacodynamics

Post by
Day 3 of Week 1
, and respond to your colleagues by
Day 6 of Week 1
.

Assignment: Ethical and Legal Implications of Prescribing Drugs

Submit your Assignment by
Day 7 of Week 1
.

Go to the Week’s Content

Week 1

Week 1: Basic Pharmacotherapeutic Concepts/Ethical and Legal Aspects of Prescribing

How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?

Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat NURS 6521: Advanced Pharmacology.

This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.

Learning Objectives

Students will:

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients

Assess patient factors and history to develop personalized plans of care

Evaluate ethical and legal implications related to prescribing drugs

Analyze ethical and legal practices of prescribing drugs

NURS 6521: Advanced Pharmacology

Analyze strategies to address disclosure and nondisclosure

Justify advanced practice nurse strategies to guide prescription drug decision-making

Analyze the process of writing prescriptions to avoid medication errors

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics. NURS 6521: Advanced Pharmacology

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

Photo Credit: Getty Images/Ingram Publishing

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

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug NURS 6521: Advanced Pharmacology.

To Prepare

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

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

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

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

By Day 3 of Week 1

Post
a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples NURS 6521: Advanced Pharmacology.

By Day 6 of Week 1

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

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

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion

Assignment: Ethical and Legal Implications of Prescribing Drugs

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

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

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this NURS 6521: Advanced Pharmacology Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

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

Review the scenario assigned by your Instructor for this Assignment.

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

Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family NURS 6521: Advanced Pharmacology.

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

By Day 7 of Week 1

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

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

Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state NURS 6521: Advanced Pharmacology.

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

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

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

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK1Assgn+last name+first initial.(extension)” as the name.

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

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

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK1Assgn+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 1 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 1 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 1

To participate in this Assignment:

Week 1 Assignment

What’s Coming Up in Module 2?

Photo Credit: Getty Images/iStockphoto

In the next module,
you will examine the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders and the types of drugs prescribed to patients with respiratory disorders NURS 6521: Advanced Pharmacology.

Looking Ahead: Week 2 Assignment

In Week 2, your Instructor will assign you a case study related to Assignment 1 by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and Learning Resources in order to complete your Assignment on time.

Photo Credit: Getty Images/iStockphoto

Next Week

To go to the next week:

Module 2

Module 2: Cardiovascular and Respiratory Systems

What’s Happening This Module?

Module 2: Cardiovascular and Respiratory Systemsis a 2-week module, Weeks 2 and 3 of the course. In this module, you will examine how patient factors may influence pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics used in the treatment of cardiovascular and respiratory disorders. You will also explore and suggest drug therapy plans for asthma and analyze the stepwise approach for asthma treatment and management.

What do I have to do?

When do I have to do it?

Review your Learning Resources

Days 1-7, Weeks 2 and 3

Assignment 1: Pharmacotherapy for Cardiovascular Disorders

Submit your Assignment by
Day 7 of Week 2
.

Assignment 2: Asthma and Stepwise Management. NURS 6521: Advanced Pharmacology

Submit your Assignment by
Day 7 of Week 3
.

Go to the Week’s Content

Week 2

Week 2: Cardiovascular System

Alterations of the cardiovascular system can cause serious adverse events and may lead to death when not treated in a timely and safe manner. Unfortunately, many patients with cardiovascular disorders are unaware until complications appear. In clinical settings, patients often present with symptoms of several cardiovascular disorders, making it essential for you, as the advanced practice nurse, to be able to recognize these symptoms and recommend appropriate drug treatment options.

This week, you examine the impact of patient factors that may lead to changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.

Learning Objectives

Students will:

Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes

Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapies

Evaluate drug therapy plans for cardiovascular disorders NURS 6521: Advanced Pharmacology

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Assignment: Pharmacotherapy for Cardiovascular Disorders

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

—Murphy et al., 2018

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

Photo Credit: Getty Images/Science Photo Library RF

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

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

To Prepare

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

Review the case study assigned by your Instructor for this Assignment.

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

Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes NURS 6521: Advanced Pharmacology.

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

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

By Day 7 of Week 2

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

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

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

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

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

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 2 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 2 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 2 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 2 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 2

To participate in this Assignment:

Week 2 Assignment

What’s Coming Up in Week 3?

Photo Credit: Getty Images/iStockphoto

Next week,
you will examine strategies for the treatment and management of respiratory disorders, including asthma. You will analyze asthma and stepwise management and consider the impact of this approach for patient health.

Next Week

To go to the next week:

Week 3

Week 3: Respiratory System

Asthma and chronic obstructive pulmonary disease (COPD) are significant public health burdens. Currently, more than 25 million people in the United States have asthma (HealthyPeople.gov, 2019). As an advanced practice nurse, you will likely encounter patients who will present with respiratory disorders, including asthma or COPD. Understanding specific treatment protocols as well as the types of pharmacotherapeutics used to treat respiratory disorders is important to ensure the effective and safe delivery of advanced nursing practice.

This week, you will evaluate drug therapy plans for patients who present with asthma and analyze the stepwise approach to asthma treatment and management from a patient in your professional practice.

Reference: HealthyPeople.gov. (2019). Respiratory diseases. Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/respiratory-diseases

Learning Objectives

Students will:

Evaluate drug therapy plans for asthma

Assess the impact of asthma treatments on patients

Analyze the stepwise approach to asthma treatment and management

NURS 6521: Advanced Pharmacology

Learning Resources

Required Readings
(click to expand/reduce)

Optional Resources
(click to expand/reduce)

Assignment: Asthma and Stepwise Management

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

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

To Prepare

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

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

Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. NURS 6521: Advanced Pharmacology.

By Day 7 of Week 3

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

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

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

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

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.

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

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

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

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

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 3 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 3 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 3

To participate in this Assignment:

Week 3 Assignment

What’s Coming Up in Module 3?

Photo Credit: Getty Images/iStockphoto

In the next module,
you will examine diagnoses for patients with potential GI and hepatobiliary disorders. You will also develop a drug therapy plan based on patient history and diagnosis.

Next Week

To go to the next week:

Module 3

Module 3: Gastrointestinal and Hepatobiliary Systems

Symptoms of various gastrointestinal (GI) and hepatobiliary disorders often overlap, making diagnosis and treatment challenging. For example, symptoms such as vomiting, constipation, and bloating are non-specific and could also be the result of underlying medical history or current prescription drug use. As an advanced practice nurse, you could be potentially responsible for providing care to a patient who may present with non-specific symptoms related to the gastrointestinal and hepatobiliary systems.

How would you proceed to care for this patient? What type of drug therapy might you recommend, not knowing current medical history or prescription drug use? Are there certain drugs you should avoid in ensuring a drug-drug interaction does not occur? These are the types of questions that may guide you in your role as an advanced practice nurse.

What’s Happening This Module?

Module 3: Gastrointestinal and Hepatobiliary Systemsis a 1-week module, Week 4 of the course. In this module, you will examine diagnoses for patients with potential GI and hepatobiliary disorders. You also develop a drug therapy plan based on patient history and diagnosis.

What do I have to do?

When do I have to do it?

Review your Learning Resources.
NURS 6521: Advanced Pharmacology

Days 1-7, Week 4

Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Submit your Assignment by
Day 7 of Week 4
.

Go to the Week’s Content

Week 4

Week 4: Gastrointestinal and Hepatobiliary Disorders

As an advanced practice nurse, you will likely encounter patients who will present with symptoms affecting the gastrointestinal (GI) tract. Of special note, is the consideration that most symptoms concerning the GI tract are non-specific and therefore, diagnosing diagnoses of the GI tract require thoughtful and careful investigation. Similarly, hepatobiliary disorders may also mirror many of the signs and symptoms that patients present when suffering from GI disorders.

How might you tease out the specific signs and symptoms between these potential disorders and body systems? What drug therapy plans will best address these disorders for your patients?

This week, you examine GI and hepatobiliary disorders. You will review a patient case study and consider those factors in recommending and prescribing a drug therapy plan fo your patient.

Learning Objectives

Students will:

Evaluate diagnoses for patients with gastrointestinal and hepatobiliary disorders

Justify drug therapy plans based on patient history and diagnosis

Learning Resources

Required Readings
(click to expand/reduce)

Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Photo Credit: Getty Images/iStockphoto

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.

Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

To Prepare

Review the case study assigned by your Instructor for this Assignment

Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.

Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.

Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. NURS 6521: Advanced Pharmacology

By Day 7 of Week 4

Write
a 1-page paper that addresses the following:

Explain your diagnosis for the patient, including your rationale for the diagnosis.

Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Reminder:
The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at
http://writingcenter.waldenu.edu/57.htm
). All papers submitted must use this formatting.

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.

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

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

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 4 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 4

To participate in this Assignment:

Week 4 Assignment

What’s Coming Up in Module 4?

Photo Credit: Getty Images/iStockphoto

In the next module,
you will examine types of drugs prescribed to patients with endocrine disorders, such as diabetes, and you will consider the impact of patient factors on the effects of these drugs.

Next Week

To go to the next week:

Module 4

Module 4: Endocrine System

The endocrine system plays an important role in the regulation and coordination of activities throughout the body. When alterations of these systems occur, many patients require long-term drug therapies. In addition to drugs prescribed by their health care providers, patients with these disorders also often take herbal and dietary supplements. This may impact the effects of prescribed drugs, as well as pose a concern of adverse drug reactions in patients. When treating patients with endocrine disorders, it is important to educate them on associated risks. As an advanced practice nurse prescribing drugs, you must carefully consider all drug, herbal, and dietary therapies prior to finalizing treatment plans.

What’s Happening This Module?

Module 4: Endocrine System

is a 1-week module, Week 5 of the course. In this module, you examine types of drugs prescribed to patients with endocrine disorders, as well as consider the impact of patient factors on the effects of drugs. You also examine types of diabetes and the impact of diabetes drugs on patients.

What do I have to do?

When do I have to do it?

Review your Learning Resources

Days 1-7, Week 5

Discussion: Diabetes and Drug Treatments

Post by
Day 3 of Week 5
, and respond to your colleagues by
Day 6 of Week 5
.

Go to the Week’s Content

Week 5

Week 5: Endocrine System Disorders and the Treatment of Diabetes

The endocrine system includes eight major glands throughout the body which affect such things as growth and development, metabolism, sexual function, and mood (National Institutes of Health). Some of the most commonly diagnosed endocrine disorders include hypothyroidism, diabetes, and Hashimoto’s disease. Not surprisingly, treating any one endocrine disorder may have effects on other body systems or their functions. As an advanced practice nurse, treating patients who may suffer from endocrine disorders requires an acute understanding of the structure and function of the endocrine system. Additionally, a solid understanding of patient factors and behaviors will assist in developing the best drug therapy plans possible to treat your patients. Some of most commonly diagnosed endocrine disorders include NURS 6521: Advanced Pharmacology

This week, you differentiate the types of diabetes and examine the impact of diabetes drugs on patients. You also evaluate alternative drug treatments and patient education strategies for diabetes management.

Reference: National Institutes of Health. (n. d.). National Institute of Diabetes and Digestive and Kidney Disorders. Endocrine diseases. Retrieved July 3, 2019 from
https://www.niddk.nih.gov/health-information/endocrine-diseases

Learning Objectives

Students will:

Differentiate types of diabetes

Evaluate the impact of diabetes drugs on patients

Evaluate alternative drug treatments and patient education strategies for diabetes management

Learning Resources

Required Readings
(click to expand/reduce)

Discussion: Diabetes and Drug Treatments

Photo Credit: [Mark Hatfield]/[iStock / Getty Images Plus]/Getty Images

Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations.

For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/ NURS 6521: Advanced Pharmacology

To Prepare

Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.

Select one type of diabetes to focus on for this Discussion.

Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.

Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.

By Day 3 of Week 5

Post
a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples NURS 6521: Advanced Pharmacology.

By Day 6 of Week 5

Read
a selection of your colleagues’ responses and
respond
to
at least two
of your colleagues on
two different days
who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

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

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 5 Discussion Rubric

Post by Day 3 of Week 5 and Respond by Day 6 of Week 5

To Participate in this Discussion:

Week 5 Discussion

What’s Coming Up in Module 5?

Photo Credit: Getty Images/iStockphoto

In the next module,
you will examine diagnoses for patients with neurologic and musculoskeletal disorders, and you will complete your Midterm Exam.

Looking Ahead: Midterm Exam

Please review the Resources and content in the previous modules in preparation for your Midterm Exam in Module 5.

Next Week

To go to the next week:

Module 5

Module 5: Neurologic and Musculoskeletal Systems

What’s Happening This Module?

Module 5: Neurologic and Musculoskeletal Systems

is a 2-week module, Weeks 6 and 7 of the course. In this module, you will analyze drugs prescribed to treat neurological and musculoskeletal disorders and explore patient education strategies for treatment and management of these disorders. You will also evaluate the impact of patient factors on the effects of prescribed drugs and drug therapy plans for neurologic and musculoskeletal disorders. You will also complete your Midterm Exam.

What do I have to do?

When do I have to do it?

Review your Learning Resources

Days 1-7, Weeks 6 and 7

Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders

You are encouraged to begin your Assignment in Week 6 and continue working on it in Week 7. However, this Assignment is not due until
Day 7 of Week 8
in Module 6. NURS 6521: Advanced Pharmacology

Midterm Exam

Complete by
Day 7 of Week 7
.

Go to the Week’s Content

Week 6

Week 6: Neurologic and Musculoskeletal Disorders

Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.

Learning Objectives

Students will:

Evaluate patients for treatment of neurologic and musculoskeletal disorders

Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Photo Credit: Getty Images/Science Photo Library RF

To Prepare

Review the interactive media piece assigned by your Instructor.

Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.

Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.

You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

By Day 7 of Week 8

Write a 1- to 2-page summary NURS 6521: Advanced Pharmacology paper that addresses the following:

Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.

Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.

What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.

Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

You will submit this Assignment in Week 8.

Submission and Grading Information

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

Please save your NURS 6521: Advanced Pharmacology Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 8 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 8 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 8 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 8 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 8

To participate in this Assignment:

Week 8 Assignment

What’s Coming Up in Week 7?

Photo Credit: Getty Images/iStockphoto

Next week,
you will continue working on your Assignment started in Week 6, and you will complete your Midterm Exam.

Next Week

To go to the next week:

Week 7

Midterm Exam

The Exam covers the content you have explored throughout the first 6 weeks of this course.

This exam is a test of your knowledge in preparation for your certification exam. 
No outside resources
—including books, notes, websites, or any other type of resource—are to be used to complete this quiz. You are not allowed to take screenshots or record the exam questions in any other format while taking the exam. You are expected to 
comply with Walden University’s Code of Conduct
.

Photo Credit: Getty Images/Hero Images

By Day 7 of Week 7

Complete
the Midterm Exam. You have 120 minutes to complete the exam. You may only attempt this exam once.

Submission and Grading Information

Complete the Exam by Day 7 of Week 7

To Complete this Exam:

Week 7 Exam

What’s Coming Up in Module 6?

Photo Credit: Getty Images/iStockphoto

In the next module,
you will examine types of drugs prescribed to patients who present with psychological disorders.

In the next module,
you will examine types of drugs prescribed to patients who present with psychological disorders.

Next Week

To go to the next week:

Week 6: Neurologic and Musculoskeletal Disorders

Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems NURS 6521: Advanced Pharmacology. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.

Learning Objectives

Students will:

Evaluate patients for treatment of neurologic and musculoskeletal disorders

Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Learning Resources

Required Readings
(click to expand/reduce)

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

Chapter 10, “Basic Principles of Neuropharmacology” (pp. 73–77)

Chapter 11, “Physiology of the Peripheral Nervous System” (pp. 79–90)

Chapter 12, “Muscarinic Agonists and Antagonists” (pp. 91–107)

Chapter 13, “Adrenergic Agonists” (pp. 109–119)

Chapter 14, “Adrenergic Antagonists” (pp. 121–132)

Chapter 15, “Indirect-Acting Antiadrenergic Agents” (pp. 133–137)

Chapter 16, “Introduction to Nervous System Pharmacology” (pp. 139–141)

Chapter 17, “Drugs for Parkinson Disease” (pp. 143–158)

Chapter 18, “Drugs for Alzheimer Disease” (pp. 159–166)

Chapter 19, “Drugs for Epilepsy” (pp. 167–189)

Chapter 20, “Drugs for Muscle Spasm and Spasticity” (pp. 191–201)

Chapter 57, “Drug Therapy of Rheumatoid Arthritis” (pp. 629–641)

Chapter 58, “Drug Therapy of Gout” (pp. 643–651)

Chapter 59, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 653–672)

American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5

 

This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia.

Document:
Mid-Term Summary & Study Guide (PDF)

Required Media
(click to expand/reduce)

Laureate Education (Producer). (2019b).
Alzheimer’s disease
[Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.

Laureate Education (Producer). (2019e).
Complex regional pain disorder
[Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat complex regional pain disorders.

Disorders of The Nervous System

Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m)

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Photo Credit: Getty Images/Science Photo Library RF

To Prepare

Review the interactive media piece assigned by your Instructor.

Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece NURS 6521: Advanced Pharmacology.

Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.

You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

By Day 7 of Week 8

Write a 1- to 2-page summary NURS 6521: Advanced Pharmacology paper that addresses the following:

Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.

Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.

What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.

Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

You will submit this Assignment in Week 8.

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 8 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 8 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 8 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 8 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 8

To participate in this Assignment:

Week 8 Assignment

What’s Coming Up in Week 7?

Photo Credit: Getty Images/iStockphoto

Next week,
you will continue working on your Assignment started in Week 6, and you will complete your Midterm Exam.

Next Week

To go to the next week:

Module 6: Psychological Disorders

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act…mental health is important at every stage of life, from childhood and adolescence through adulthood.

—Centers for Disease Control and Prevention, 2018

As an advanced practice nurse, treating patients who may present with psychological disorders requires critical clinical decision making. It is your expertise in clinical decision making that will ensure that the pharmacotherapeutics and other suggested treatments prescribed to your patients will not only promote positive patient health outcomes but will lead to sustained health and well-being NURS 6521: Advanced Pharmacology.

Reference: Centers for Disease Control and Prevention. (2018). Mental health. Retrieved from https://www.cdc.gov/mentalhealth/index.htm

What’s Happening This Module?

Module 6: Psychological Disorders

is a 1-week module, Week 8 of the course. In this module, you will examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

What do I have to do?

When do I have to do it?

Review your Learning Resources

Days 1-7, Week 8

Discussion: Decision Making When Treating Psychological Disorders

Post by
Day 3 of Week 8
, and respond to your colleagues by
Day 6 of Week 8
.

Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders

Submit your Assignment by
Day 7 of Week 8
.

Go to the Week’s Content

Week 8

Week 8: Pharmacology for Psychological Disorders

How does an advanced practice nurse determine the best treatment option or pharmacotherapeutic to recommend for patients with psychological disorders?

Much like assessing or recommending pharmacotherapeutics for other conditions or disorders, as an advanced practice nurse, you may encounter a patient who presents with a psychological disorder. Understanding the guiding principles related to treating patients with psychological disorders as well as the effects of pharmacotherapeutics on a patient’s overall health and well-being is critical for the safe and effective delivery of care NURS 6521: Advanced Pharmacology.

This week, you examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

Learning Objectives

Students will:

Evaluate patients for treatment of psychological disorders

Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders

Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology

Evaluate patients for treatment of neurological and musculoskeletal disorders

Analyze decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders

Justify decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Discussion: Decision Making When Treating Psychological Disorders

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders NURS 6521: Advanced Pharmacology.

Photo Credit: Getty Images/iStockphoto

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

Review this week’s interactive media pieces and select one to focus on for this NURS 6521: Advanced Pharmacology Discussion.

Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

By Day 3 of Week 8

Post
a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

By Day 6 of Week 8

Read
a selection of your colleagues’ responses and
respond
to
at least two
of your colleagues on
two different days
who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

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

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 8 Discussion Rubric

Post by Day 3 of Week 8 and Respond by Day 6 of Week 8

To Participate in this Discussion:

Week 8 Discussion

Assignment: Decision Tree for Neurological and Musculoskeletal

By Day 7 of Week 8

Submit
your Assignment, started in Week 6.

Reminder:
The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at
http://writingcenter.waldenu.edu/57.htm
). All papers submitted must use this formatting.

Photo Credit: Getty Images/Science Photo Library RF

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 8 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 8 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 8 NURS 6521: Advanced Pharmacology Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 8 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 8

To participate in this Assignment:

Week 8 Assignment

What’s Coming Up in Module 7?

Photo Credit: Getty Images/iStockphoto

In the next module,
you will examine types of drugs prescribed to address women’s and men’s health, infections, and disorders of the hematologic system.

Next Week

To go to the next week:

Module 7

Week 8: Pharmacology for Psychological Disorders

How does an advanced practice nurse determine the best treatment option or pharmacotherapeutic to recommend for patients with psychological disorders?

Much like assessing or recommending pharmacotherapeutics for other conditions or disorders, as an advanced practice nurse, you may encounter a patient who presents with a psychological disorder. Understanding the guiding principles related to treating patients with psychological disorders as well as the effects of pharmacotherapeutics on a patient’s overall health and well-being is critical for the safe and effective delivery of care.

This week, you examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

Learning Objectives

Students will:

Evaluate patients for treatment of psychological disorders

Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders

Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology

Evaluate patients for treatment of neurological and musculoskeletal disorders

Analyze decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders

Justify decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Discussion: Decision Making When Treating Psychological Disorders

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders NURS 6521: Advanced Pharmacology.

Photo Credit: Getty Images/iStockphoto

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

Review this week’s interactive media pieces and select one to focus on for this Discussion.

Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

By Day 3 of Week 8

Post
a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

By Day 6 of Week 8

Read
a selection of your colleagues’ responses and
respond
to
at least two
of your colleagues on
two different days
who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

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

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 8 Discussion Rubric

Post by Day 3 of Week 8 and Respond by Day 6 of Week 8

To Participate in this Discussion:

Week 8 Discussion

Assignment: Decision Tree for Neurological and Musculoskeletal

By Day 7 of Week 8

Submit
your Assignment, started in Week 6.

Reminder:
The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at
http://writingcenter.waldenu.edu/57.htm
). All papers submitted must use this formatting.

Photo Credit: Getty Images/Science Photo Library RF

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 8 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 8 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 8 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 8 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 8

To participate in this Assignment:

Week 8 NURS 6521: Advanced Pharmacology Assignment

What’s Coming Up in Module 7?

Photo Credit: Getty Images/iStockphoto

In the next module,
you will examine types of drugs prescribed to address women’s and men’s health, infections, and disorders of the hematologic system.

Next Week

To go to the next week:

Module 7

 

Week 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part I

As an advanced practice nurse, you will likely encounter many disorders associated with women’s and men’s health, such as hormone deficiencies, cancers, and other functional and structural abnormalities. Disorders such as these not only result in physiological consequences but also psychological consequences, such as embarrassment, guilt, or profound disappointment for patients. For these reasons, the provider-patient relationship must be carefully managed. During evaluations, patients must feel comfortable answering questions so that you, as a key health-care provider, will be able to diagnose and recommend appropriate treatment options. Advanced practice nurses must be able to educate patients on these disorders and help relieve associated stigmas and concerns.

This week, you examine women’s and men’s health concerns as well as the types of drugs used to treat disorders that affect women’s and men’s health. You also explore how to treat aspects of these disorders on other health systems.

Learning Objectives

Students will:

Evaluate patients for treatment of complex health issues

Evaluate patients for treatment of infections

Evaluate patients for treatment of hematologic disorders

Analyze patient education strategies for the management and treatment of complex comorbidities

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? NURS 6521: Advanced Pharmacology What education strategies might you recommend for ensuring positive patient health outcomes?

For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.

Photo Credit: Getty Images

To Prepare

Review the Resources for this module and reflect on the different health needs and body systems presented.

Your Instructor will assign you a complex case study to focus on for this Discussion.

Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

By Day 3 of Week 9

Post
a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

You will respond to your colleagues’ posts in Week 10.

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

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 9 Discussion Rubric

Post by Day 3 of Week 9 and Respond by Day 6 of Week 10

To Participate in this Discussion:

Week 9 Discussion

What’s Coming Up in Week 10?

Photo Credit: Getty Images/iStockphoto

Next week,
you will continue working on your NURS 6521: Advanced Pharmacology Discussion assigned in Week 9, as you examine the types of drugs used to treat infections and disorders of the hematologic system.

Next Week

To go to the next week:

Week 10

Week 10: Women’s and Men’s Health/Infections and Hematologic Systems, Part II

Bacterial and viral infections may spread through the direct contact of bodily fluids such as blood or through vectors, who help to spread infections via the blood. When you think of infections and the hematologic system, what comes to mind?

Infectious diseases, such as malaria, dengue, or other hemorrhagic fevers are some examples of infections that impact the hematologic system. However, disorders of the hematologic system, such as anemia or blood clotting factor disorders, can also have a deleterious effect on a patient’s health and well-being. As an advanced practice nurse, you will need to understand the different types of pharmacotherapeutics used to treat infections and disorders of the hematologic system as you work to enhance patient-centered approaches for safe, quality, and effective care.

This week, you will examine infections and hematologic disorders, as well as the types of drugs used to treat aspects of these disorders or health systems.

Learning Objectives

Students will:

Evaluate patients for treatment of complex health issues

Evaluate patients for treatment of infections

Evaluate patients for treatment of hematologic disorders

Analyze patient education strategies for the management and treatment of complex comorbidities

Learning Resources

Required Readings
(click to expand/reduce)

Required Media
(click to expand/reduce)

Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

To Prepare

Review the resources for this module and reflect on the different health needs and body systems presented.

Review your peers case studies from Week 9.

Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

Photo Credit: Getty Images

By Day 6 of Week 10

Read
a selection of your colleagues’ responses from Week 9 and
respond
to
at least two
of your colleagues on
two different days
who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide NURS 6521: Advanced Pharmacology examples.

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

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 9 Discussion Rubric

Post by Day 3 of Week 9 and Respond by Day 6 of Week 10

To Participate in this Discussion:

Week 9 Discussion

What’s Coming Up in Module 8?

Photo Credit: Getty Images/iStockphoto

In the next module,
you will examine prescribing drugs and the off-label use of drugs to treat pediatric patients. You will also complete your Final Exam.

Looking Ahead: NURS 6521: Advanced Pharmacology Final Exam

Please review the Resources and content in the previous modules in preparation for your Final Exam in Module 8.

 

Next Week

To go to the next week:

Module 8

Nursing Essay Writing Punctuation: Commas

Comma Basics

Commas are punctuation marks with a variety of uses. The following constructions require commas:

Serialized lists
.
 In a list with three or more elements, use commas to separate each element of the series.

Example
: 
This KAM consists of Breadth, Depth, and Application.

This punctuation rule is also followed for 
parallel construction in a series
.

Nonessential clauses.
 Use commas to set off clauses that contain information that is nonessential to the sentence’s meaning.

Example:
 Walden University, established in 1970, offers many degree programs.

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Note that without the middle clause (“established in 1970”), the sentence still makes sense (“Walden University offers many degree programs”). Therefore, the clause is nonessential. For more information, view the page on 
relative, restrictive, and nonrestrictive clauses
.

Compound sentences.
 Use a comma to separate two 
independent clauses
 connected by a coordinating conjunction. A 
coordinating conjunction
 is a connecting word such as “and,” “but,” or “or
.” 
For more information, view the page on 
sentence structure and types of sentences
.

Example
: Smith (2001) conducted the research, and Heller (2008) commented on the results. Nursing Essay Writing Punctuation: Commas

After a dependent introductory clause, phrase, or word
. Use a comma after a 
dependent
 introductory clause, phrase, or word.

Example of introductory clause: 
If you are using this sentence structure, place a comma after the dependent clause.
 
Example of introductory phrase:
 Before completing the interviews, I must obtain Walden University approval.
 
Example of introductory word
: 
Therefore, I created three research questions.
 
Example of introductory word
:
 However, further research is needed.

Dates.
 Use a comma to set off the year in exact dates.

Example:
 The hospital’s pursuit of Magnet status was successful (R. Jones, personal communication, September 18, 2009).

Citations.
 Use commas to set off the elements of a 
citation
.

Example:
 The research was “inconclusive in its implications” (Sanders, 2009, p. 45).

Introducing quotations (not seamless). 
Use a comma when an independent clause introduces a quotation but is not seamlessly integrated into it.

Example:
 Freud (1900) 
claimed,
 “the dreamer…assumes that the dream–even if it does not come from another world–has at all events transported the dreamer into another world” (p. 5).

Visit 
varying sentence structures
 for more information on comma usage.

For more practice, take our 
Grammar Diagnostic Quiz
.

Also watch the 
Mastering the Mechanics 1, 2, and 3 webinars
. Comma usage is frequently discussed throughout this webinar series.

In addition, refer to APA 7, Section 6.3 for more about commas. Nursing Essay Writing Punctuation: Commas

Common Comma Errors

The following constructions do not require commas:

Months.
 Do not use a comma when referring to a month within a particular year.

Example:
 I conducted the study in June 2003.

Complex sentences
.
 Do not use a comma in a sentence that joins an independent clause and a dependent clause.

Example:
 Smith (2001) found that the results were consistent although some details in the approaches differed.

Introducing quotations (seamless).
 Do not use a comma when an independent clause seamlessly introduces a quotation.

Example:
 Freud (1900) claimed 
that “the 
dreamer…assumes that the dream–even if it does not come from another world–has at all events transported the dreamer into another world” (p. 5).

Comma splices.
A comma splice occurs when two independent clauses (complete sentences) are separated by just a comma. Nursing Essay Writing Punctuation: Commas

Example:
 Jessica and I went to the movies, we had a good time.

There are many ways to correct the sentence above. Review the information on 
run-on sentences
for examples of correctly joining independent clauses. Nursing Essay Writing Punctuation: Commas

Pediatrics

Prescription of medication to children is an area that should be approached systematically due to the diverse factors affecting this demographic. The aim of off label drug use for children is to attain maximum benefit for the patient in the challenges that he or she is facing. This is a decision based on professional judgment, and decision-making should be guided by the presentation of the patient and evidence supporting the use and efficacy of the drugs in helping this particular individual (Pratico et al., 2017). One way that the use of off-label drugs can be made safer includes considering the risk and benefit ratio of medication, and disclosing such information. For instance, in the case there is an option to begin the use of Zoloft, an SSRI, in a child that is suffering from depression. In a trial that evaluated the efficacy of Zoloft in comparison to a placebo, the findings showed that after 12 weeks 55 percent of children in the study group improved in comparison to 24 percent that received the placebo (Cardy et al., 2017). Furthermore, side effects have been associated with the drug that include drowsiness, fatigue, insomnia, nausea, and dizziness. Children have also been reported to experience changes in their mental state.

Therefore, in the case presentation the first approach will be to attempt a non-pharmaceutical intervention such as cognitive behavioral therapy, which has been found to be effective in children that have depression (Yang et al., 2017). The judgment and insight of the patient are appropriate and there is no suicide ideation. Hence, CBT will help identify the source of the problem and aid in the introduction of the appropriate behavioral interventions for positive outcomes in the child.

 

 

 

 

References

Cardy, R., Dhaliwal, S., & Reddy, P. S. (2017). Antidepressant drug treatment in Child and

adolescent Psychiatry. 
Madridge J Intern Emerg Med
, 
1
(1), 31-39.

Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles,

CA: Western Psychological Services

Pratico, A. D., Longo, L., Mansueto, S., Gozzo, L., Barberi, I., Tiralongo, V., … & Leonardi,

(2018). Off-label use of drugs and adverse drug reactions in pediatric units: a prospective, multicenter study. 
Current drug safety
, 
13
(3), 200-207.

Yang, L., Zhou, X., Zhou, C., Zhang, Y., Pu, J., Liu, L., … & Xie, P. (2017). Efficacy and

acceptability of cognitive behavioral therapy for depression in children: A systematic review and meta-analysis. 
Academic pediatrics
, 
17
(1), 9-16.

Assignment: Off-Label Drug Use in Pediatrics

The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.

Photo Credit: Getty Images

Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

To Prepare

Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.

Reflect on situations in which children should be prescribed drugs for off-label use.

Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

By Day 5 of Week 11

Write
a 1-page narrative in APA format that addresses the following:

Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.

Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

Reminder:
The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at
http://writingcenter.waldenu.edu/57.htm
). All papers submitted must use this formatting.

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK11Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 11 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 11 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK11Assgn+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

NURS_6521_Week11_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.

Points Range:
36
(36%)
– 40
(40%)

The response accurately and thoroughly explains in detail the circumstances under which children should be prescribed drugs for off-label use.

The response includes accurate and specific examples that fully support the explanation provided.

Points Range:
32
(32%)
– 35
(35%)

The response accurately explains the circumstances under which children should be prescribed drugs for off-label use.

The response includes accurate examples that support the explanation provided.

Points Range:
28
(28%)
– 31
(31%)

The response inaccurately or vaguely explains the circumstances under which children should be prescribed drugs for off-label use.

The response includes inaccurate or vague examples that may or may not support the explanation provided.

Points Range:
0
(0%)
– 27
(27%)

The response inaccurately and vaguely explains the circumstances under which children should be prescribed drugs for off-label use, or is missing.

The response includes inaccurate and vague examples that do not support the explanation provided, or is missing.

Explain strategies to making off-label use and dosage of drugs safer for children from infancy to adolescence and descriptions and names of off-label drugs that require extra care and attention when used in pediatrics. Be specific.

Points Range:
41
(41%)
– 45
(45%)

The response accurately and clearly describes in detail strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence.

The response includes accurate, complete, and detailed descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

Points Range:
36
(36%)
– 40
(40%)

The response accurately describes strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence.

The response includes accurate descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

Points Range:
32
(32%)
– 35
(35%)

The response inaccurately or vaguely describes strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence.

The response includes inaccurate or vague descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

Points Range:
0
(0%)
– 31
(31%)

The response inaccurately and vaguely describes strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence, or is missing.

The response includes inaccurate and vague or incomplete descriptions and names of off-label drugs that require extra care and attention when used in pediatrics, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:

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

Points Range:
5
(5%)
– 5
(5%)

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

Points Range:
4
(4%)
– 4
(4%)

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

Points Range:
3.5
(3.5%)
– 3.5
(3.5%)

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

Points Range:
0
(0%)
– 3
(3%)

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

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

Points Range:
5
(5%)
– 5
(5%)

Uses correct grammar, spelling, and punctuation with no errors

Points Range:
4
(4%)
– 4
(4%)

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

Points Range:
3.5
(3.5%)
– 3.5
(3.5%)

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

Points Range:
0
(0%)
– 3
(3%)

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

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

Points Range:
5
(5%)
– 5
(5%)

Uses correct APA format with no errors

Points Range:
4
(4%)
– 4
(4%)

Contains a few (1–2) APA format errors

Points Range:
3.5
(3.5%)
– 3.5
(3.5%)

Contains several (3–4) APA format errors

Points Range:
0
(0%)
– 3
(3%)

Contains many (≥ 5) APA format errors

Total Points: 100

Nursing Essay Writing Grammar: Noun–Pronoun Agreement

Noun-Pronoun Agreement Basics

The purpose of a 
pronoun
 is to take the place or refer back to a noun in a 
sentence
. Just like subjects and verbs, nouns and pronouns should agree in number within a sentence.

Singular Noun, Singular Pronoun

When writing a sentence, using the same word more than once can get repetitive.

Example:
 Francine edited her
 
paper
 because her
 paper
 was full of errors.

Rather than repeating “paper”
 
twice, it is possible to use a pronoun.

Revision:
 Francine edited her 
paper
 because 
it
was full of errors. Nursing Essay Writing Grammar: Noun–Pronoun Agreement

Since “paper” is singular (there is only one), use a singular pronoun (“it”) to replace it.

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Remember to find the true subject of the sentence to determine if the pronoun should be singular or plural. See our webpage on 
subject–verb agreement
 for more on singular and plural subjects.

Example
: 
Each
 student must find 
his or her
 own note-taking strategy.

Since the subject is singular (“each
“
), the pronoun (“his or her”) must also be singular.

Example:
 
Neither
 Bob nor Alex believed 
he
 would receive the award.

Since the subject is singular (“neither”), the pronoun (“he”) must also be singular.

Example
: 
A community group
 of teachers is meeting tonight to see if 
it 
can find a way to help students improve their SAT scores.

Since the subject is singular (“a community group”), the pronoun (“it”) must also be singular.

Singular “They”

Recently, many academic and popular publications have started accepting the use of the pronoun “they” as a singular pronoun, meaning writers use “they” to correspond to singular subjects in an effort to avoid gendered pronouns. Although the pronoun “they” is only a plural pronoun in some style guides, APA encourages writers to use “they” as a singular or plural pronoun with the specific intention of embracing gender diversity. Nursing Essay Writing Grammar: Noun–Pronoun Agreement

According to the 
APA Style blog
, “when transgender and gender nonconforming people (including agender, genderqueer, and other communities) use the singular “they” as their pronoun, writers should likewise use the singular “they” when writing about them” (para. 1).

With this understanding in mind, when writers are specifically writing about a person or group of people who prefer the singular “they,” writers should also use the singular “they.” Where relevant, we recommend writers explicitly explain that they are using the singular “they” to follow the self-identifications of the people they are discussing.

Additionally, writers can often avoid the issue of gender-neutral singular pronouns by revising a sentence to make the subject plural:

Original sentence: 
A teacher
 should carefully choose professional development opportunities that address
 
her
gaps in knowledge. Nursing Essay Writing Grammar: Noun–Pronoun Agreement

Revised sentence: 
Teachers
 should carefully choose professional development opportunities that address 
their
 gaps in knowledge.

Plural Noun, Plural Pronoun

When the subject of the sentence is plural, the pronoun in the sentence becomes plural as well.

Example
:
 When
 
students
 arrive on the first day of school, 
students
 need help finding the right classroom.

Since “students” is plural, use a plural pronoun to replace it.

Revision: 
When 
students
 arrive on the first day of school, 
they
 need help finding the right classroom.

Remember to find the true subject of the sentence to determine if the pronoun should be singular or plural. See our webpage on 
subject–verb agreement
 for more on singular and plural subjects.

Example:
 When 
a supervisor and an employee
 disagree, 
they 
should discuss the situation.

Since the subject is plural (“a supervisor and an employee”), the pronoun (“they”) must also be plural.

Example
: The professor hoped that the 
students
 had reviewed 
their
 notes carefully.

Since the subject is plural (“students”), the pronoun (“their”) must also be plural.

Example
: 
Both
 Smith (2016) and Taylor (2017) believed 
their 
results would lead to social change.

Since the subject is plural (“both”), the pronoun (“their”) must also be plural. Nursing Essay Writing Grammar: Noun–Pronoun Agreement

Pronoun Ambiguity

Although pronouns are useful to help writers avoid repetition, they should be used sparingly to keep the meaning of the sentence clear. Take a look at this sentence:

Example:
 When Jeff and Brian joined the team members, 
they
 were scared.

The pronoun here (“they”) is unclear–to whom does it refer? Was the team scared? Were Jeff and Brian scared? In this example, because the pronoun “they
” 
is ambiguous, choosing a noun rather than a pronoun will help with clarity.

Revision:
 When Jeff and Brian joined the team members, 
the team members
 were scared.

Gender-Neutral Pronouns Policy

Walden University prides itself as an inclusive institution that serves a diverse population of students. Committed to broadening the university’s understanding of inclusivity and diversity, Walden will now accept gender-neutral pronouns in student writing. This practice acknowledges APA’s recent endorsement of the singular “they” and also embraces alternative pronouns currently in circulation (e.g., the nominatives xe, ve, ze/zir, ey, and zhe and their associated derivations). Walden recognizes that discussion around gender identity is ongoing. As such, the university will accept any pronoun in student writing so long as evidence can be provided that it is accepted as a respectful term by the community it represents. Nursing Essay Writing Grammar: Noun–Pronoun Agreement

http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html

Alzheimer’s Disease

76-year-old Iranian Male

 

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

RESOURCES

§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Decision Point One

Select what you should do:

Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

: Begin Aricept (donepezil) 5 mg orally at BEDTIME

Begin Razadyne (galantamine) 4 mg orally BID

http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html

The case study is on a 76-year-old Iranian male patient that is suspected to have Alzheimer’s disease. The conclusion is based on the reports provided by his eldest son and there were no organic disease processes that were identified during the examination. The behavioral changes started two years ago, and included personality changes, apathy, which was followed by memory loss and challenges in finding the appropriate words during conversation. Confabulation is also noticed during the clinical interview, speech, and self-reported euthymic mood. The patient also has an impairment in his judgment and insight as well as absence of impulse control. There is no suicide ideation reported and the patient is diagnosed with neurocognitive disorder as a result of Alzheimer’s disease.

The first approach that will be taken will include Donepezil 5mg at bedtime. The use of donepezil among patients that have Alzheimer’s disease has been examined for decades. The medication is an acetylcholinesterase inhibitor, which increases the acetylcholine levels in the brain and compensates the reduced function of cholinergic neurons (Birks and Harvey, 2018). An assessment of randomized clinical trials analyzed the impact that donepezil has on patients with Alzheimer’s using randomized control trials. The findings showed that there is strong evidence that donepezil is effective in three major areas in the management of this condition, which include behavior, functional ability, and cognition (Li et al., 2018). These are the major areas that were affected in the patient and the goal was to limit their impact on his quality of life. As indicated in the case, he had significant personality changes that negatively impacted his engagement in activities of interest. However, there is a need to state that the National Institute of Aging has noted that there is still a poor comparison between different agents that are used as the first line of treatment for the patient (NIH, 2020).

The outcomes from donepezil differ as there can be development of complications along with limited clinical benefits. The patient complained of side effects such as loss of weight and appetite, vomiting, nausea, and diarrhea, which have been reported among patients using this medication (Kumar and Sharma, 2019).

The second decision was the use of cognitive behavioral treatment, which has been found studies to have a positive impact among patients with early stages of Alzheimer’s disease. Evidence supporting psychosocial interventions for patients with dementia has been identified in isolated cases (Forstmeier et al., 2015). However, there is still limited empirical data on these approaches. Some scholars have labelled behavioral interventions as appropriate among patients that have neuropsychiatric symptoms. Therefore, these will be used on the patient to improve behavior, and particularly targeted at reducing apathy and improving the self-control by the patient. Improvement of mood will positively impact the quality of life and the ability for the patient to engage in activities that will improve his cognitive status.

The third decision will be to include family members in the therapeutic process as this will help reinforce behaviors that will assist the patient. Studies illustrate that there is a high lack of adherence to care among elderly patients (Smith et al., 2017). This reduces the ability to evaluate the effectiveness of the interventions, as outcomes may be due to poor drug use. The goal is to increase the support system of the patient, and daily interactions as this has been found to positively impact the cognitive and emotional well-being of patients with dementia.

 

 

 

 

 

 

References

Birks, J. S., & Harvey, R. J. (2018). Donepezil for dementia due to Alzheimer’s

disease. 
Cochrane Database of systematic reviews
, (6).

Forstmeier, S., Maercker, A., Savaskan, E., & Roth, T. (2015). Cognitive behavioural

treatment for mild Alzheimer’s patients and their caregivers (CBTAC): study protocol for a randomized controlled trial. 
Trials
, 
16
(1), 526.

How is Alzheimer’s Disease Treated? (2020). NIH

Kumar, A., & Sharma, S. (2019). Donepezil. In 
StatPearls [Internet]
. StatPearls Publishing.

Li, Q., He, S., Chen, Y., Feng, F., Qu, W., & Sun, H. (2018). Donepezil-based multi

functional cholinesterase inhibitors for treatment of Alzheimer’s disease. 
European journal of medicinal chemistry
, 
158
, 463-477.

Smith, D., Lovell, J., Weller, C., Kennedy, B., Winbolt, M., Young, C., & Ibrahim, J. (2017).

A systematic review of medication non-adherence in persons with dementia or cognitive impairment. 
PloS one
, 
12
(2).

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Photo Credit: Getty Images/Science Photo Library RF

To Prepare

Review the interactive media piece assigned by your Instructor.

Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.

Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.

You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

By Day 7 of Week 8

Write a 1- to 2-page summary paper that addresses the following:

Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.

Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.

What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.

Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

You will submit this Assignment in Week 8.

Submission and Grading Information

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

Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 8 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 8 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click 
Open
.

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

Click on the 
Submit
 button to complete your submission.

NURS_6521_Week8_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific.

Points Range:
18
(18%)
– 20
(20%)

The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made for the patient presented.

Points Range:
16
(16%)
– 17
(17%)

The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.

Points Range:
14
(14%)
– 15
(15%)

The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.

Points Range:
0
(0%)
– 13
(13%)

The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing.

Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.

Points Range:
23
(23%)
– 25
(25%)

The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes specific and relevant outside reference examples that fully support the explanation provided.

Points Range:
20
(20%)
– 22
(22%)

The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.

Points Range:
18
(18%)
– 19
(19%)

The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.

Points Range:
0
(0%)
– 17
(17%)

The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing.

The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.

What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.

Points Range:
18
(18%)
– 20
(20%)

The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned.

The response includes specific and relevant outside reference examples that fully support the explanation provided.

Points Range:
16
(16%)
– 17
(17%)

The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.

The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.

Points Range:
14
(14%)
– 15
(15%)

The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.

The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.

Points Range:
0
(0%)
– 13
(13%)

The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing.

The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.

Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples.

Points Range:
18
(18%)
– 20
(20%)

The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise.

Points Range:
16
(16%)
– 17
(17%)

The response accurately explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise.

Points Range:
14
(14%)
– 15
(15%)

The response inaccurately or vaguely explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise.

Points Range:
0
(0%)
– 13
(13%)

vaguely explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise, or is missing.

The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:

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

Points Range:
5
(5%)
– 5
(5%)

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

Points Range:
4
(4%)
– 4
(4%)

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

Points Range:
3.5
(3.5%)
– 3.5
(3.5%)

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

Points Range:
0
(0%)
– 3
(3%)

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

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

Points Range:
5
(5%)
– 5
(5%)

Uses correct grammar, spelling, and punctuation with no errors

Points Range:
4
(4%)
– 4
(4%)

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

Points Range:
3.5
(3.5%)
– 3.5
(3.5%)

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

Points Range:
0
(0%)
– 3
(3%)

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

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

Points Range:
5
(5%)
– 5
(5%)

Uses correct APA format with no errors

Points Range:
4
(4%)
– 4
(4%)

Contains a few (1–2) APA format errors

Points Range:
3.5
(3.5%)
– 3.5
(3.5%)

Contains several (3–4) APA format errors

Points Range:
0
(0%)
– 3
(3%)

Contains many (≥ 5) APA format errors

Total Points: 100

Nursing Essay Writing Proofreading

Introduction

Proofreading
 involves reading your document to correct the smaller typographical, grammatical, and spelling errors. Proofreading is usually the very last step you take before sending off the final draft of your work for evaluation or publication. It comes after you have addressed larger matters such as style, content, citations, and organization during revising. Like revising, proofreading demands a close and careful reading of the text. Although quite tedious, it is a necessary and worthwhile exercise that ensures that your reader is not distracted by careless mistakes.

Tips for Proofreading

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Distance yourself from your work.

Set aside the document for a few hours or even a few days before proofreading. Taking a bit of time off enables you to see the document anew. A document that might have seemed well written one day may not look the same when you review it a few days later. Taking a step back provides you with a fresh (and possibly more constructive) perspective.

Proofread at a specific time of day.

Make a conscious effort to proofread at a specific time of day (or night!) when you are most alert to spotting errors. If you are a morning person, try proofreading then. If you are a night owl, try proofreading at this time. Nursing Essay Writing Proofreading

Print a hard copy of the text.

Reviewing the document in a different format and having the ability to manually circle and underline errors can help you take the perspective of the reader, identifying issues that you might ordinarily miss. Additionally, a hard copy gives you a different visual format (away from your computer screen) to see the words anew.

Do not rely exclusively on grammar and spelling checkers.

Although useful, programs like 
Word’s spell-checker
 and 
Grammarly
 can misidentify or not catch errors. Although grammar checkers give relevant tips and recommendations, they are only helpful if you know how to apply the feedback they provide. Similarly, MS Word’s spell checker may not catch words that are spelled correctly but used in the wrong context (e.g., differentiating between 
their, they’re
, and 
there
). Beyond that, sometimes a spell checker may mark a correct word as wrong simply because the word is not found in the spell checker’s dictionary. To supplement tools such as these, be sure to use dictionaries and other 
grammar resources
 to check your work. You can also make 
appointments
 with our writing instructors for feedback concerning grammar and word choice, as well as other areas of your writing!

Read your text aloud and slowly.

Reading a text aloud allows you to identify errors that you might gloss over when reading silently. This technique is particularly useful for identifying run-on and other types of awkward sentences. If you can, read for an audience. Ask a friend or family member to listen to your work and provide feedback, checking for comprehension, organization, and flow.

Have someone else read aloud to you.

Hearing someone else read your work allows you to simply listen without having to focus on the written words yourself. You can be a more critical listener when you are engaged in only the audible words. Nursing Essay Writing Proofreading

Go through the paper backwards.

By reading the document backwards, sentence by sentence, you are able to focus only on the words and sentences without paying attention to the context or content.

Use a ruler or blank piece of paper.

Placing a ruler or a blank sheet of paper under each line as you read it will give your eyes a manageable amount of text to read.

Check for familiar errors.

If you can identify one type of error that you struggle with (perhaps something that a faculty member has commented on in your previous work), go through the document and look specifically for these types of errors. Learn from your mistakes, too, by mastering the problem concept so that it does not appear in subsequent drafts.

Proofread for one type of error at a time.

Related to the previous strategy of checking for familiar errors, you can proofread by focusing on one error at a time. For instance, if commas are your most frequent problem, go through the paper checking just that one problem. Then proofread again for the next most frequent problem.

Ask someone else to look over the document.

After you have finished making corrections, have someone else scan the document for errors. A different set of eyes and a mind that is detached from the writing can identify errors that you may have overlooked. Nursing Essay Writing Proofreading

Proofreading is not just about errors.

Remember that proofreading is not just about errors. You want to polish your sentences, making them smooth, interesting, and clear. Watch for very long sentences, since they may be less clear than shorter, more direct sentences. Pay attention to the rhythm of your writing; try to use sentences of varying lengths and patterns. Look for unnecessary phrases, repetition, and awkward spots. Nursing Essay Writing Proofreading

Diabetes and Drug Treatments

Diabetes mellitus (DM) is a disorder in the body’s metabolism characterized by altered glucose conversion into energy for cell use, defects in insulin secretion, or increased insulin resistance (Antonioli, Blandizzi, Csoka, Pacher, & Hasko, 2015). DM can occur in children and adults and is diagnosed by measuring glycosylated hemoglobin (HbA1C) levels, fasting plasma blood sugar (FPG) levels, 2-hour plasma blood sugar levels during oral glucose tolerance testing, or random blood sugar level; however HbA1C provides a more accurate and long-term measure of blood sugar control (Huether & McCance, 2017).

Types of Diabetes

Type 1 diabetes mellitus (T1DM), presents during childhood approximately before age 10, with a classic clinical onset of high blood sugar, excessive thirst, excessive urination, and weight loss resulting from an autoimmune dysfunction activating the CD4, CD8 T cell, and macrophages infiltrating the pancreas leading to chronic inflammation, pancreatic B-cell dysfunction, destruction, and death (Antonioli et al., 2015). Genetic susceptibility increases the risk of close relatives to a T1DM patient as a result of gene polymorphisms, whereas environmental exposure can trigger an immune response to genetically susceptible individuals destroying the insulin-producing B-cells in the pancreas (Levitsky & Misra, 2019).

Type 2 diabetes mellitus (T2DM) develops in genetically predisposed individuals as a result of advancing age, inactivity, and obesity resulting in high levels of blood sugar due to the body’s inability to produce insulin, use enough insulin, or use glucose for energy with signs and symptoms of fatigue, weight gain, slow healing wounds, frequent infections, visual changes, and altered sensation (Blair, 2016). Chronic-low grade inflammation, immune system activation, and infiltration in the pancreas results in B-cell dysfunction and progressively increased insulin resistance (Antonioli et al., 2015).

Gestational diabetes mellitus is high blood sugar levels with the onset or first detected during pregnancy; however according to the American Diabetes Association (ADA) (as cited by

Heather & McCance, 2017), women with gestational diabetes may have had undiagnosed pre-existing diabetes, so the ADA recommends that these women should receive a  T1DM or T2DM diagnosis instead of gestational diabetes.

Metformin Administration in Type 2 Diabetes

Biguanides such as Metformin is the first line of therapy for T2DM unless contraindicated because it inhibits the liver’s glucose production and increases muscle tissue insulin sensitivity (Blair, 2016).  Metformin comes in two oral preparations: a)  initial adult dose for the immediate-release tablet is 500 mg orally once or twice daily or 850 mg daily; should be administered with a meal to decrease gastrointestinal (GI)  upset; and gradual dosage increases usually every seven days to minimize adverse GI effects; and b) initial adult dose for the extended-release Metformin is 500 mg to 1 gram once daily with the evening meal and gradual dose titration to minimize adverse GI effects (UpToDate, n.d.). Contraindications to Metformin use are hypersensitivity to Metformin or any of its components, patients with eGFR < 30 mL/minute as it can result in lactic acidosis, acute, or chronic metabolic acidosis, and death  (UpToDate, n.d.). Short-Term and Long-Term Impact of Type 2 Diabetes and Effects of Drug Treatment             Short-term impact of T2DM are : a) hypoglycemia in individuals taking secretagogues such as sulfonylurea agents or exogenous insulin that requires immediate glucose replacement by mouth or intravenously; b) hyperosmolar hyperglycemic nonketotic syndrome (HHNKS), is less common but can result in high mortality rate particularly in the elderly who have comorbidities such as infections, cardiovascular, or renal disease which is characterized by very high blood sugar level resulting in severe dehydration, electrolyte imbalance, and neurologic impairment (Huether & McCance, 2017). The long-term impact of T2DM are categorized into: a) microvascular complications which are damages to small blood vessels leading to renal failure, retinopathy leading to blindness, and neuropathy leading to impotence and foot disorders; and b) macrovascular complications are damage to larger blood vessels leading to cardiovascular diseases (Blair, 2016). Monitoring recommendation for Metformin use are : a) Vitamin B12 levels  every two to three years especially in individuals with peripheral neuropathy or anemia because long-term Metformin use can result in Vitamin B12 deficiency; b) initial and yearly hematologic and renal function studies; and c) Bi-annual urine glucose, fasting blood sugar, and hemoglobin A1C in patients with stable glucose control and every four months for individuals not meeting glycemic control (UpToDate, n.d.). References Antonioli, L., Blandizzi, C., Csoka, B., Pacher, P., & Hasko, G. (2015). Adenosine signaling in diabetes mellitus—Pathophysiology and therapeutic considerations. Nature Reviews Endocrinology , 11 (4), 228-. Gale OneFile: Science. Blair, M. (2016). Diabetes mellitus review. Urologic Nursing , 1 , 27. https://doi.org/10.7257/1053-816X.2016.36.1.27 Huether, S. E., & McCance, K. L. (2017).  Understanding pathophysiology  (6th ed.). St. Louis, MO: Mosby Levitsky, L.L., & Misra, M. (2019, June 27). Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. In A.G. Hoppin (Ed.), UpToDate. Retrieved March 25, 2020, from https://www.uptodate.com/ Metformin: Drug information—UpToDate . (n.d.). Retrieved March 25, 2020, from https://www.uptodate.com/   Discussion: Diabetes and Drug Treatments Photo Credit: [Mark Hatfield]/[iStock / Getty Images Plus]/Getty Images Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations. For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes. Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/ To Prepare Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Select one type of diabetes to focus on for this Discussion. Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment. Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments. By Day 3 of Week 5 Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples. By Day 6 of Week 5 Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS_6521_Week5_Discussion_Rubric Grid View List View Excellent Good Fair Poor Main Posting Points Range: 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Points Range: 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Points Range: 35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors. Points Range: 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Main Post: Timeliness Points Range: 10 (10%) – 10 (10%) Posts main post by day 3 Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Does not post by day 3 First Response Points Range: 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Points Range: 15 (15%) – 16 (16%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Points Range: 13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Points Range: 0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. Second Response Points Range: 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Points Range: 14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. Points Range: 12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. . Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Points Range: 0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. Participation Points Range: 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days. Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days Total Points: 100 Type 1 Diabetes Type 1 diabetes generally develops during childhood or adolescence, however type 1 can develop during adulthood (Rosenthal & Burchum, 2018). Previously called insulin dependent or juvenile diabetes, type 1 diabetes is caused by an autoimmune reaction that destroys pancreatic beta cells, which are the cells responsible for insulin synthesis and release into bloodstream. Type 2 Diabetes Type 2 diabetes accounts for 90-95% of diagnosed diabetes cases and approximately 22 million Americans have this disease (Rosenthal & Burchum, 2018).  Type 2 diabetes is non-insulin dependent diabetes or also known as adult-onset diabetes mellitus.  Insulin is still produced for patients with Type 2, the secretion is no longer tightly coupled to plasma glucose, which makes the release of insulin delayed and peak output is subnormal. A patient will have fasting labs and also check a hemoglobin A1C. Juvenile Diabetes An autoimmune disease where the pancreas stops producing insulin. Also, known as type 1 diabetes or insulin dependent. This is not related to lifestyle or diet. Early signs to watch for, include thirst and urination.  If having symptoms, the provider will test blood levels. Gestational Diabetes Diabetes that appears during pregnancy and then subsides after delivery is gestational diabetes (Rosenthal & Burchum, 2018). You want to monitor blood glucose and make sure it is well controlled with diet and insulin if prescribed. Gestational diabetes usually shows up in the middle of pregnancy, and providers test between 24-28 weeks of pregnancy (CDC, n.d.). The medication I chose is Metformin (Glucophage). Metformin is an oral agent that decreases glucose production by the liver and increases tissue response to insulin (Rosenthal & Burchum, 2018). Metformin is started once diagnosis of type 2 diabetes is made unless contraindicated.  Metformin is safe and has beneficial effects on A1C, weight management, and cardiovascular mortality (American Diabetes Association, 2018). Metformin can be used as monotherapy, unless A1C is greater than 9%, then consider dual therapy.  Keeping a healthy weight is important along with diet and lifestyle changes. Drug Class: Biguanides           Pharmacokinetics: Metformin is slowly absorbed from the small intestine and is not metabolized, but excreted unchanged by the kidneys (Rosenthal & Burchum, 2018). Metformin can accumulate to toxic levels.  Metformin can be used in patients with mild impairment in kidney function and in some patients with moderate kidney impairment (U.S. Food  & Drug, 2017).  Before started, obtain patients eGFR. Not recommended in patients with a eGFR <30. Side effects: decreased appetite, nausea, and diarrhea. Severe metabolic acidosis can occur with accumulation of Metformin and patients with significant renal impairment.  If a patient had any recent infection or illness they need to be aware to let the provider know and the medication might have to be stopped until feeling better.  Patients admitted in the hospital are usually stopped on their Metformin and resumed after discharge. Caution patients if drink alcohol, whether its acute or chronic, because alcohol potentiates the effects of Metformin on lactate metabolism.  Metformin can cause low blood sugar if patients do not eat enough, if they drink alcohol or if they take other medications that can lower blood sugar (U.S. Food & Drug, 2017).  Monitoring blood glucose levels are very important when  educating patients. Sarah References American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes-2018. Diabetes Care, 41(supplement 1), S73-S85. Retrieved from: https://care.diabetesjournals.org/content/diacare/41/Supplement_1/S73.full.pdf Centers for Disease Control and Prevention. (n.d.). Gestational Diabetes and Pregnancy.Retrieved from: https://www.cdc.gov/pregnancy/diabetes-gestational.html Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier U.S. Food & Drug. (2017). FDA Drug Safety Communication: FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function. Retrieved from: https://www.fda.gov/drugs/drug- safety- and-availability/fda-drug-safety-communication-fda-revises-warnings-regarding-use-diabetes-medicine-metformin-certain   response Great job on your discussion regarding Metformin and diabetes management! I did some additional research on Metformin so I could contribute and bring additional information to your chosen topic. I did my discussion post on sulfonylureas which is also an oral agent medication that can be used in the treatment of Type II Diabetes. Biguanides mechanism of action and potential side effects are different from those of sulfonylureas in that they do not usually result in hypoglycemia (when used alone) nor dot hey promote hyperinosemia or weight gain. Biguanides can be used as a first line of treatment in addition to diet and exercise or they can be combined with other oral agents or insulin. It is imperative that providers start patient’s out with a lose dose and gradually increase the dose every 1-2 weeks depending upon therapeutic goals. Metformin should be started at 500mg or 850mg daily or twice daily with a maximum dose of 2550mg. Dosing is most effective when taken before meals in the mornings and evenings (Arcangelo, Peterson, Wilbur & Reinhold, 2017, p. 792). In review of dietary recommendations and the use of Metformin I was unable to find any solid evidence on whether any dietary intakes affect the use of Metformin. It is noted that while taking the medication one should refrain from high fat diets and those that include a lot of sugar as a diet that consists of high fat and sugar are defeating the purpose of the medication being taken. Metformin taken with cimetidine increases the risk for hypoglycemic events and combination therapy with the use of metformin and glucocorticoids or alcohol can increase the risk of lactic acidosis. Studies have shown that metformin treatment when combined with healthy lifestyles has a long-term effect on the management of diabetes. According to Rojas & Gomes (2013), “Diabetes incidence 10 years since DPP randomization was reduced by 34% and 18% in the lifestyle and metformin group, respectively (Rojas & Gomes, 2013). Arcangelo, V. P. (2017). Pharmacotherapeutics for Advanced Practice. Philadelphia: Wolters Kluwer. Rojas, L. &. (2013). Metformin: an old but still the best treatment for type 2 diabetes. Diabetology & Metabolic Syndrome .