Tag: Clinical-Nursing

Assignment 1

Using peer-reviewed journal articles or evidence-based practice websites locate policy or regulatory position statements or campaigns that support changes in APRN prescribing practices at the state or national level.

In a paper not to exceed six double-spaced pages, excluding title and reference pages, analyze these statements by assessing their alignment with the American Association of Nurse Practitioners (AANP)’s Nurse Practitioner Prescriptive Privilege statement (see 
AANP Position Statement & Papers
). Use the Assignment 1 Rubric below to guide you in completing this assignment.

Assignment 1 Rubric

Competency

30 points

27 points

25 points

0 points

Points Earned

Policies, regulator position statements, campaigns

Locates multiple policies or regulator position statements or campaigns that support changes in APRN prescribing practices at state and at national level

Locates several state or national level policy or regulator position statement, but not both

Locates only one policy or position statement

Does not locate policies or position statements

/30

peer reviewed journals and evidence-based practice

Applies multiple peer reviewed journals and evidence-based practice websites to the assignment

Applies several peer reviewed journals or evidence-based practice websites to the assignment, but not both

Applies one peer reviewed journals or evidence-based practice websites to the assignment

Does not use  peer reviewed journals or evidence-based practice websites in the assignment

/30

Analyzes regulatory position statements by assessing their alignment with the American Association of Nurse Practitioners (AANP)’s Nurse Practitioner Prescriptive Privilege statement. Discusses teamwork and collaboration as it relates to regulatory requirements

Evidence of analysis of regulatory statements and alignment of AANP statements. Discusses teamwork and collaboration as it relates to regulatory requirements

Evidence of analysis of regulatory statements and alignment of AANP statements. Discusses teamwork and collaboration as it relates to regulatory requirements

Minimal evidence of analysis of regulatory statements and alignment of AANP statements. Discusses teamwork and collaboration as it relates to regulatory requirements

No evidence of analysis of regulatory statements and alignment of AANP statements. No discussion of teamwork and collaboration as it relates to regulatory requirements

/30

Competency

5 points

4 points

3 points

0 points

Points Earned

Grammar, spelling, and punctuation

There are no errors in grammar, spelling, and punctuation

There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning

There are major errors in grammar, spelling, and punctuation that do not reflect scholarly writing

NA

/5

APA Compliance

The paper meets APA format guidelines

There are minor APA format errors

There are significant errors in format

NA

/5

Total Points

/100

AANP’s Positions and Papers

See Where Your Nurse Practitioner (NP) Community Stands

You instinctively advocate for your patients, but legislative and political advocacy is no less important to advancing your role as an NP and ensuring excellence in patient care. Position statements and papers are designed to guide and amplify the views of NPs while educating consumers and decision-makers. The American Association of Nurse Practitioners
®
 (AANP) has outlined a number of positions on issues of importance for NPs nationwide.

For further information, AANP discussion papers offer pros and cons to enhance understanding and encourage continued discussion. AANP also offers a number of members-only clinical practice briefs, which are designed to offer evidence-based guidelines and to support NPs in clinical practice.

Position Statements

APRN Compact Licensure

The APRN Compact for multistate licensure was adopted by the National Council of State Boards of Nursing (NCSBN) in August 2020. Review AANP’s position on the the revised compact.

View APRN Compact Licensure Position

Mandated Residency and Fellowship Training

All NPs must complete a master’s or doctoral degree program and have advanced clinical training beyond their initial professional registered nurse (RN) preparation. They undergo rigorous national certification, periodic peer review, clinical outcome evaluations and adhere to a code for ethical practices. View AANP’s position on mandated residencies and fellowships for NPs.

View Mandated Residency and Fellowship Training Position

NP Education

The cornerstone of NP practice is robust academic and clinical preparation. To that end, AANP believes and affirms that quality of NP preparation is comprised and grounded by these requirements.

View NP Education Position

Personal Protective Equipment (PPE)

Adequate access to proper PPE is essential to protecting patients and all health care providers. Learn more about why AANP supports equipping health care providers with proper PPE.

View PPE Position

Prescriptive Authority

Prescribing medications, devices, treatments and modalities is a central component of NP practice. Discover why AANP advocates that NPs have unlimited prescriptive authority in their scope of practice.

View Prescriptive Authority Position

Team-based Care

Team-based care is a systems approach to health care delivery. See AANP’s position on the implementation of integrated, multidisciplinary team-based approaches to health care.

View Team-based Care Position

Telehealth

Technology has advanced substantially in recent decades, leading to an increase in health tech services such a telehealth. Take a look at AANP’s position on the use of the term telehealth and NPs’ use of this important technology.

View Telehealth Position

Therapeutic Use of Marijuana

NPs are the health care provider of choice for millions of patients, many of whom are interested in the therapeutic use of marijuana and related compounds. Learn AANP’s stance on marijuana in health care.

View Therapeutic Use of Marijuana Position

Position Papers

Clinical Outcomes: The Yardstick of Educational Effectiveness

Educational preparation for NPs differs from that of other health care professionals. Discover why outcomes are the best way to evaluate clinician education and measure clinical success and patient safety.

View Educational Effectiveness Position

Commitment to Addressing Health Care Disparities During COVID-19

As a professional home for NPs, AANP is committed to empowering all NPs to advance high-quality, equitable care while addressing health care disparities through practice, education, advocacy, research and leadership (PEARL).

View Health Care Disparities Paper

Nurse Practitioner Cost Effectiveness

A solid body of evidence demonstrates that NPs have consistently proven to be cost-effective providers of high-quality care for almost 50 years. Explore the many different examples of NP cost effectiveness in this position statement.

View Cost Effectiveness Position

Nurse Practitioners in Primary Care

NPs are committed to providing primary care. Gain insight into how NPs are vital to primary care delivery and the role they play in making high-quality, patient-centered health care available to the broadest possible range of consumers.

View NPs in Primary Care Position

Standards for Nurse Practitioner Practice in Retail-based Clinics

Health care is moving to make care more convenient and local to where patients live and work, and retail-based clinics are playing a larger role. See a discussion of the standards AANP recommends for retail-based clinics.

View Retail-based Clinics Standards Position

Use of Terms Such as Mid-level Provider and Physician Extender

Getting terminology right is key to getting health care right. Some terms, such as mid-level provider or physician extender, are inaccurate and misleading to the public when referring to NPs. Gain an understanding of why AANP endorses clear title use for NPs.

View Use of Terms Position

 

Discussion Papers

Doctor of Nursing Practice (DNP)

The evolution of existing master’s programs to doctoral programs can strengthen programs and NP practice. Read AANP’s position on the shift in the academic preparation of nurses in advanced practice.

View DNP Paper

Nurse Practitioner Curriculum

NPs must complete an accredited graduate program and achieve advanced clinical training beyond their initial professional registered nurse preparation. Read AANP’s affirmation of core elements in NP curriculum.

View NP Curriculum Paper

Quality of Nurse Practitioner Practice

The body of literature supports the position that NPs provide safe, effective, patient-centered, timely, efficient, equitable and evidenced-based care. Review the summary of research supporting the value NPs bring to their patients.

View NP Quality Paper

Scope of Practice for Nurse Practitioners

As licensed, independent clinicians, NPs practice autonomously and in coordination with health care professionals and other individuals. Learn more with this overview of the role, education, accountability, and responsibility of NPs.

View Scope of Practice Position

Standards of Practice for Nurse Practitioners

Whether you are just starting your path to becoming an NP, have been practicing for decades or are simply interested in NP practice, gain valuable information about NPs with this overview of AANP-developed Standards of Practice.

View Standards of Practice Paper

Clinical Practice Briefs

2013 American Heart Association/American College of Cardiology Guideline on Lifestyle Management to Reduce Cardiovascular Risk

The American Heart Association (AHA) and the American College of Cardiology (ACC) recently released several guidelines to prevent cardiovascular diseases and improve the management of these diseases.

View the Practice Brief

American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for the Management of Patients With Atrial Fibrillation

These 2014 recommendations from the American Heart Association (AHA), American College of Cardiology (ACC) and Heart Rhythm Society (HRS) explore atrial fibrillation (AF), a supraventricular tachycardia characterized by uncoordinated atrial activation and ineffective contraction.

View the Practice Brief

Breast Cancer Screening Guidelines Summary

Among the multiple published professional breast cancer screening guidelines, three commonly used guidelines are summarized here: the American Cancer Society (ACS), American College of Obstetricians and Gynecologists (ACOG) and United States Preventive Services Task Force (USPSTF) guidelines.

View the Practice Brief

Clinical Practice Guideline: Allergic Rhinitis

The purpose of the guideline, developed by the American Academy of Otolaryngology – Head and Neck Surgery Foundation, is to discuss quality improvement for all clinicians and to promote accurate diagnosis and appropriate treatment.

View the Practice Brief

Colorectal Cancer Screening Guidelines Summary

Among the multiple published professional colorectal cancer screening guidelines, two widely used guidelines are summarized here: the American Cancer Society (ACS) and United States Preventive Services Task Force (USPSTF) guidelines.

View the Practice Brief

Genetic Counseling and Testing by Advanced Practice Providers

In an online search through the National Guideline Clearinghouse, only two general non-disease-specific guidelines out of more than 100 different clinical guidelines address genetic counseling and testing.

View the Practice Brief

Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020

The original Global Initiative for Chronic Obstructive Lung Disease* (GOLD) was released in 2001 and was revised in 2013, 2014, 2015, 2016, 2017, 2019 and 2020, based on scientific literature. The 2020 report follows the same model as previous reports.

View the Practice Brief

Management of High Blood Pressure in Adults

This long-awaited updated guideline on the management of hypertension in adults differs from its predecessor (Seventh Joint National Committee [JNC 7]) in a number of ways.

View the Practice Brief

Measles: Recommendations for Assessment, Treatment and Prevention

The Centers for Disease Control and Prevention (CDC) provides guidance for health care providers on the assessment, treatment and prevention of measles in Measles for Healthcare Professionals.

View the Practice Brief

Menopausal Symptoms: Comparative Effectiveness of Therapies

The Agency for Quality Healthcare Research and Quality (AHRQ) published a report from 2015 comparing effectiveness of therapies for menopausal symptoms.

View the Practice Brief

Opioids for Chronic, Non-cancer Pain: A Position Paper of the American Academy of Neurology

AAN has reviewed the literature and issued a position paper regarding long-term use of opioids in the treatment of non-cancer pain. This review summarizes the position paper as it has direct application for advanced nursing practice.

View the Practice Brief

Pharmacological Management of Obesity: Obesity Management Association (OMA) 2020 Obesity Algorithm

The OMA 2020 Obesity Algorithm discusses the management of obesity and includes pharmacologic guidance as an adjunct in the foundational treatment of obesity: diet, activity and behavioral interventions.

View the Practice Brief

Practice Guideline Update: Acute Treatment of Migraine in Children and Adolescents

The American Academy of Neurology (AAN) provides multidisciplinary clinical practice guidelines based on evidence-based practice, including these on counseling, diagnosis, evaluation, management and treatment for acute migraine in children and adolescents.

View the Practice Brief

Practice Guideline Update: Preventive Treatment of Migraine in Children and Adolescents

AAN provides multidisciplinary clinical practice guidelines based on evidence-based practice, including these best practices on counseling, diagnosis, evaluation, management and treatment for preventive migraine in children and adolescents.

View the Practice Brief

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Autism Spectrum Disorder

A recently updated practice parameter from the American Academy of Child and Adolescent Psychiatry (AACAP) offers revised guidelines for assessing and treating children and adolescents (at or younger than 17 years of age) with Autism Spectrum Disorder (ASD).

View the Practice Brief

Primary Care Diagnosis and Management of Adults With Depression

The 2014 updated guideline was compiled by the Michigan Quality improvement Consortium. The recommendations were drawn from a synthesis of published studies, existing protocols and national guidelines.

View the Practice Brief

Primary Care Management of Headaches in Adults

Toward Optimized Practice (TOP) of Alberta, Canada, provides multidisciplinary clinical practice guidelines that are based on evidence-based practice.

View the Practice Brief

Sleep Disorder Management Diagnostic Treatment Guidelines Summary

AIM Specialty Health
®
 (AIM) issued updated guidelines on polysomnography and home sleep testing in 2019. AIM promotes safe, cost-effective and appropriate specialty services. Guidelines are devised based on grading of evidence.

View the Practice Brief

Strategies to Prevent Clostridium Difficile Infections in Acute Care Hospitals: 2014 Update

The Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) along with the American Hospital Association and the Association for Professionals in Infection Control and Epidemiology (APIC) have collaborated in updating these guidelines.

View the Practice Brief

Definitions

Discussion Paper: Doctor of Nursing Practice

The concept of a practice or clinical doctorate has been under discussion within the nurse practitioner (NP) community since before 2001, when the National Organization of NP Faculties (NONPF) established a task force to examine the issues from the NP educational perspective. In October 2004, the American Association of Colleges of Nursing (AACN) published a position paper focusing on the issue of converting the terminal degree for advanced practice nursing from the master’s to the Doctor of Nursing Practice (DNP) by the year 2015. The American Academy of Nurse Practitioners (the Academy, now the American Association of Nurse Practitioners
®
) and the American Academy of Nurse Practitioners Certification Program participated in these activities as they unfolded. In 2008, the Academy facilitated the Nurse Practitioner Roundtable, a coalition of NP organizations, to consider the current issues surrounding the DNP movement. The coalition published “Nurse Practitioner DNP Education, Certification and Titling: A Unified Statement” in June 2008. In July 2008, the APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee published the “Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education,” a document that establishes a framework for the processes identified in the title and which continues to broadly define APRN at the graduate level.

The rationale for the shift in the academic preparation of nurses in advanced practice focuses on several issues, including the observation that advanced practice nursing is currently one of only a few health care disciplines that prepare its practitioners at the master’s rather than the doctoral level. Most licensed independent practitioners (LIPs) such as podiatrists, psychologists, optometrists, pharmacists, osteopaths, medical doctors and dentists are prepared at the clinical doctoral level. Current master’s and higher degree NP programs fully prepare NPs to be accountable for health promotion, as well as the management of patients with undifferentiated problems and those with acute, complex chronic and/or critical illness. However, it is clear that the coursework currently required in NP master’s programs is equivalent to that of other clinical doctoral programs. It is important, however, that the transition to clinical doctoral preparation for NPs continues to be conducted so that master’s-prepared NPs will not be disenfranchised in any way.

The following issues, therefore, will need to be addressed to ensure that the preparation of NPs at the clinical doctoral level further develops in a logical and equitable fashion.

The quality of the preparation of current master’s and post-master’s NP programs must not be compromised. NPs have demonstrated skills in providing high-quality care to their patients regardless of gender, age or socioeconomic status. The evolution of NP programs to offer a doctorate in nursing practice does not change that fact. NPs provide safe, high-quality care in all specialties and practice sites in which they are involved.

The transition to the new title must be handled smoothly and seamlessly to avoid negative impact on NP practice and sound patient care and to maintain parity.

Additional requirements, if any, made in the DNP programs should reflect areas where evidence supports need for increased depth to enhance NP practice.

Skilled clinical practice must be maintained as the foundation of all NP educational programs.

Issues related to parity must be addressed to include providing reasonable methods for currently prepared NPs to obtain the DNP, if desired, and to prevent discrimination in reimbursement.

Programs must be developed based upon agreed upon standards and guidelines.

Accreditation standards must be maintained to ensure the preparation of safe, highly qualified clinicians who can be certified and recognized in the regulatory arena.

Programs should remain accessible and affordable to qualified applicants in order to maintain an adequate number of highly qualified NP clinicians to contribute to the health of their communities.

The evolution of existing master’s programs to practice doctoral programs can add strength to programs and NP practice and can increase recognition in the health care arena. The development of such programs must be conducted in a manner that allows for smooth transitioning.

The American Association of Nurse Practitioners (AANP) is dedicated to and continues to address these issues as steps are taken to implement activities that would lead to the further development of DNP NP educational programs in the future.

References:

APRN Consensus Work Group & National Council of State Boards of Nursing (2008). 
APRN Advisory Committee. Consensus model for APRN regulation: Licensure, accreditation, certification & education.
 Retrieved May 2013.

American Association of Colleges of Nursing (2004). AACN position statement on the practice doctorate in nursing. Washington, D.C.: Author.

American Association of Colleges of Nursing (2006). 
The Essentials of Doctoral Education for Advanced Practice Nurses.
 Retrieved May 2013.

American Association of Colleges of Nursing (2006). 
DNP roadmap task force report. 
Retrieved May 2013.

NONPF (2006). 
Practice doctorate nurse practitioner entry-level competencies.
 Retrieved May 2013.

Nurse Practitioner Roundtable (2008). 
Nurse practitioner DNP education, certification, and titling: A unified statement.
 Retrieved May 2013.

Commitment to Addressing Health Care Disparities During COVID-19

The American Association of Nurse Practitioners
® 
(AANP) is uniquely positioned to meet the health care demands of the nation during the COVID-19 pandemic. As a professional home for nurse practitioners (NPs), AANP is committed to empowering all NPs to advance high-quality, equitable care, while addressing health care disparities through practice, education, advocacy, research and leadership (PEARL).

The COVID-19 pandemic has highlighted long-standing vulnerabilities in the social and structural fabric of the American economic system, which has disadvantaged citizens of color and members of marginalized populations for centuries. The articulation of the health disparities associated with COVID-19 and the promise to do better, without a well-defined action plan, is simply inadequate and unacceptable in a civilized society.

Through PEARL, AANP will address the systemic causes of health disparities among vulnerable populations and encompass a holistic approach to address the issues in marginalized communities. As NPs, we have an intricate knowledge of the intersection of social determinants of health and health care outcomes.

Our commitment to humanity is as evident today as it was to Dr. Martin Luther King, Jr., in 1967 when he stated, “It really boils down to this: that all life is interrelated. We are all caught in an inescapable network of mutuality, tied into a single garment of destiny. Whatever affects one destiny, affects all indirectly.”

APRN Compact Licensure

The American Association of Nurse Practitioners
®
 (AANP) Opposes the Revised APRN Compact

AANP does not endorse the APRN Compact for multistate licensure, which was adopted by the National Council of State Boards of Nursing (NCSBN) in August 2020.

AANP strongly opposes the inclusion of practice hours as a prerequisite for a multistate advanced practice registered nurse (APRN) license. The inclusion of practice hours is inconsistent with the evidence and is in direct conflict with the Consensus Model for APRN Regulation: licensure, accreditation, certification and education.

The evidence is clear. APRNs are prepared for safe entry to practice at the point of graduation from an accredited graduate program and after the successful passage of a national certification board examination. The inclusion of minimum practice hours as a requirement for a multistate APRN license creates unnecessary and costly regulations for all states and new challenges for the states currently working to retire similar barriers.

AANP additionally reaffirms the position that an APRN Compact must include an APRN advisory committee. Incorporating an APRN advisory committee would ensure that there are readily available resources and needed expertise to address the complexity and variety of practice issues.

AANP has played an instrumental role in securing Full Practice Authority across the country and finalizing more than 100 state statutes that benefit nurse practitioners (NPs) and their patients, including laws that adopt the APRN title, role and educational requirements. In the past, the association has supported the concept of a multistate licensure compact for APRNs. AANP knows that ending the current patchwork of licensure and practice authorization is necessary to improve health outcomes for patients and address health care workforce needs. It is unfortunate, but necessary, that AANP not endorse or work toward implementing NCSBN’s revised APRN Compact

N521-Stage 1 Hypertension Discussion Essay – 65-year-old African-American man Discussion 4

R. S., a 65-year-old African-American man, was referred to the CNP in the hypertension clinic for evaluation of high BP noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year. Past medical history: Appendectomy 30 years ago, Peptic ulcer disease 10 years ago, Type 2 diabetes mellitus for 10 years; Family history: Father had hypertension; died of myocardial infarction at age 55, Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60; Physical examination: Height 69 in, weight 108 kg; BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm); Pulse: 84 beats/min, regular; Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages; Laboratory findings: Blood urea nitrogen: 24 mg/dL, Serum creatinine: 1.5 mg/dL, Glucose: 95 mg/dL, Potassium: 4.0 mEq/L, Total cholesterol: 201 mg/dL, High-density lipoprotein cholesterol: 30 mg/dL, Triglycerides: 167 mg/dL, Urinalysis: 1+ proteinuria; Electrocardiogram and chest radiograph: mild left ventricular hypertrophy; Social history: Tobacco: 35 pack years, Alcohol: pint of vodka/week, Coffee: 2 cups/day N521-Stage 1 Hypertension Discussion Essay – 65-year-old African-American man

BUY A PLAGIARISM-FREE PAPER HELP HERE

Diagnosis: Stage 1 Hypertension

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol

Discuss what you would consider to be first-line pharmacotherapy for R. S., and why.

Discuss the parameters for monitoring the success of the therapy.

Discuss health promotion recommendations you would consider for R. S.

Does the presence of Diabetes Mellitus impact your treatment selection?

N521-Stage 1 Hypertension Discussion Essay – 65-year-old African-American man

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

N512- Advanced Pathophysiology – Low-grade Cervical Dysplasia discussion 1

Discussion 1

See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal.  Her provider diagnosed her with low-grade cervical dysplasia.  What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources N512- Advanced Pathophysiology – Low-grade Cervical Dysplasia discussion 1.

ORDER A PLAGIARISM-FREE PAPER HERE

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

According to the American Cancer Society (ACS), sexually active women are encouraged to have a Papanicolaou (Pap) smear test which removes tissue from the cervix for microscopic inspection to find pre-cancerous or cancerous cells (2020.).  Cells that appear mildly abnormal is called low-grade squamous intraepithelial lesions (LSIL) (ACS, 2020).  The abnormal cell growth provides an environment for the human papillomavirus (HPV) which is responsible for causing over 90% of cervical cancer, the most common type being HPV 16 which causes 50% of all cervical cancer (Cooper & McCathran, 2020).  HPV is transmitted sexually with multiple partners increasing the risk of exposure and usually clears within eight to 24 months, but persistent infection leads to dysplasia and can subsequently start a slow progression to cervical cancer over several years (Cooper & McCathran, 2020).

35 year old See Van is Hmong-American, an Asian American community.  “The cervical cancer incidence rate among Hmong American women is three times higher than other Asian/Pacific Islanders and more than four times higher than Non-Hispanic Whites” and due to this healthcare disparity, there is an ongoing HPV vaccination initiative in this population (Beltran, et al., 2016).  Her diagnosis of low-grade cervical dysplasia would warrant an HPV test and a repeat pap smear in one year.  All sexually active women and women between the age of 21-65 should have a routine pap smear at least every three years.  In the United States of America HPV has a prevalence of 1 in 4 people within the population (Vaccines.org, 2020).  The HPV vaccine has been proven to be effective in preventing cervical cancer and other conditions associated with HPV and recommended from age 9 to 26 and even up to 45 years of age under certain circumstances (Vaccines.org, 2020) N512- Advanced Pathophysiology – Low-grade Cervical Dysplasia discussion 1.

 

References

American Cancer Society.  (2020).   
The pap (papanicolaou) test.
  Retrieved from 
https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/screening-tests/pap-test.html

Beltran, R., Simms, T., Lee H.Y., Kwon, M.  (2016).  HPV literacy and associated factors among hmong american immigrants: Implications for reducing cervical cancer disparity.  
J Community Health
. 2016;41(3):603-611. doi:10.1007/s10900-015-0135-9 Retrieved from 
https://pubmed.ncbi.nlm.nih.gov/26696118/

Cooper DB, McCathran CE. (Updated 2020 July 17). Cervical dysplasia.  
StatPearls. 
Retrieved from: 
https://www.ncbi.nlm.nih.gov/books/NBK430859/

Vaccines.org. (2020).  
(HPV) human papillomavirus
.  Retrieved from 
https://www.vaccines.gov/diseases/hpv

 

 

Dysplasia is considered abnormal cells.  N512- Advanced Pathophysiology – Low-grade Cervical Dysplasia discussion 1 With cervical dysplasia, the cervix’s abnormal cells are identified through a pap smear of women age 21 and older.
(Heinzler et al., 2018)
.  Pap smears are considered the standard of care for detecting cervical cancer, although testing remains inaccurate, allowing misdiagnosis and false negatives 
(Wasswa, Ware, Habinka-Basaza-Ejiri, & Johnes, 2019)
.

For the case study of S.V., the cellular level changes would be that the pap smear showed atypical or abnormal low-grade squamous cells or low grade squamous intraepithelial lesion (LSIL), which could lead to cervical cancer
 (Barron, Li, Austin, & Zhao, 2014)
.  These cellular changes can result from being exposed to human papillomavirus (HPV)
 (Barron et al., 2014)
. The concern for this patient would be that education regarding the test results, future and further testing, and safe sex practices.

Providing education regarding continued to follow up for cervical cancer with pap smear following the guidelines which would be every three to five years depending on HPV.  Possible colposcopy with future testing.  Review with this patient if she has or has not had the HPV vaccine. Suppose they did not to consider it.  Consider safe sex practices using condoms to help avoid sexually transmitted diseases such as HPV.

References

Barron, S., Li, Z., Austin, R., & Zhao, C. (2014). Low-grade squamous intraepithelial lesion/can not exclude high-grade squamous intraepithelial lesion (LSIL-H) is a unique category of cytologic abnormality associated with distinctive HPV and histopathological CIN2+ detection rates. 
American Journal of Clincial Pathology
, 
141
(2), 239-46.

Heinzler, J., Brucker, J., Bruckner, T., Dinkic, C., Hoffmann, J., Dornhofer, N., … Schott, S. (2018, August 3, 1018). Impact of cervical dysplasia and its treatment on quality of life and sexual function. 
General Gynecology
, 
298
, 737-45.

Wasswa, W., Ware, A., Habinka-Basaza-Ejiri, A., & Johnes, O. (2019). A pap smear analysis tool (PAT) for detection of cervical cancer from pap smear images. 
Biomedical Engineering Online
, 
18
. N512- Advanced Pathophysiology – Low-grade Cervical Dysplasia discussion 1

Module 4 Overview

Introduction

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

Learning Objectives

After completing this module, you will be able to:

Utilize advanced nursing and pharmacological interventions in treatment of respiratory and cardiovascular disorders to resolve complex and biological, psychological, physiological and pathophysiologic conditions.

Discuss evidence-based informatics resources for the prescriber

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

Reading & Resources

Read Chapters 19-23 & 25-26 in Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins

Online, open access readings

Hypertension guideline retrieved from 
http://www.nmhs.net/documents/27JNC8HTNGuidelinesBookBooklet.pdf

PulmCCM (2018). New 2017 guidelines for COPD released.  Retrieved from 
https://pulmccm.org/copd-review/new-2017-gold-guidelines-copd-released/

Qaseem, A., Wilt, T. J., Rich, R., Humphrey, L. L., Frost, J., & Forciea, M. A. (2017). Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. 
Annals of Internal Medicine, 166
(6), 430. doi:10.7326/m16-1785

White, J., Paton, J. Y., Niven, R., & Pinnock, H. (2018). Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE. 
Thorax, 73
(3), 293–297. doi:10.1136/thoraxjnl-2017-211189

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., … Westlake, C. (2017). 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. 
Journal of Cardiac Failure, 23
(8), 628–651. doi:10.1016/j.cardfail.2017.04.014

Learning Activities

Discussion
: Participate in Discussion 4.

Assignment
: Complete & Submit Assignment 2. Click on the Assignment 2 link for more details.

Discussion 4

R. S., a 65-year-old African-American man, was referred to the CNP in the hypertension clinic for evaluation of high BP noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year. Past medical history: Appendectomy 30 years ago, Peptic ulcer disease 10 years ago, Type 2 diabetes mellitus for 10 years; Family history: Father had hypertension; died of myocardial infarction at age 55, Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60; Physical examination: Height 69 in, weight 108 kg; BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm); Pulse: 84 beats/min, regular; Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages; Laboratory findings: Blood urea nitrogen: 24 mg/dL, Serum creatinine: 1.5 mg/dL, Glucose: 95 mg/dL, Potassium: 4.0 mEq/L, Total cholesterol: 201 mg/dL, High-density lipoprotein cholesterol: 30 mg/dL, Triglycerides: 167 mg/dL, Urinalysis: 1+ proteinuria; Electrocardiogram and chest radiograph: mild left ventricular hypertrophy; Social history: Tobacco: 35 pack years, Alcohol: pint of vodka/week, Coffee: 2 cups/day

Diagnosis: Stage 1 Hypertension

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol

Discuss what you would consider to be first-line pharmacotherapy for R. S., and why.

Discuss the parameters for monitoring the success of the therapy.

Discuss health promotion recommendations you would consider for R. S.

Does the presence of Diabetes Mellitus impact your treatment selection?

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

N512- Low-grade Cervical Dysplasia Discussion

A Pap smear removes cervical cells to assess for pre-cancerous and cancerous cells. The pap test results will be classified as low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), or atypical glandular or squamous cells. The squamous cells of the cervix are found on the lining of the outer portion of the cervix N512- Low-grade Cervical Dysplasia Discussion. The inner portion of the cervix are where columnar cells are found. Both sites are considered the outer surface lining of the cervix.

Tissue cells in LSIL mean there are changes in the appearance of normal cells. Although the cells still appear somewhat normal, there may be some with odd shapes, some cells that are larger and more frequent in number across the surface lining of the cervix N512- Low-grade Cervical Dysplasia Discussion. These cells are involved in the lower one-third of the squamous epithelium.

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In HSIL, the abnormal cells are well observed in abnormal size and shape and are increased in number from the normal cells. These cells also only involve the surface of the outer lining of the cervix. N512- Low-grade Cervical Dysplasia Discussion HSIL can be moderate involving the lower two-thirds of the squamous epithelium, and the severe dysplasia involves the entire layer of the squamous epithelium (American Academay of Family Physicians, 2018; Rogel Center Center Michigan Medicine, n.d.; The John Hopkins University, n.d.; Zheng & Pruett, 2020).

Research has found that cervical dysplasia is commonly caused by a viral infection, specifically, the human papillovirus (HPV), which is also the most common cause of cervical cancer around the world. HPV is a DNA virus with many genotypes that cause skin infections and introduce infection into mucosal cells which help to explain the cell changes seen (World Health Organization, 2020). HPV is also associated with oropharynx, vaginal, and anus cancers. The oncogenic HPV type is not genetically inherited. The viral gene causes genes in the host cells to change (mutate) from the way they normally function by causing abnormal cell protein instructions to take over the way the normal healthy cells generate and grow giving rise to abnormal tissue growth (dysplasia) that can progress to tumors and cancer N512- Low-grade Cervical Dysplasia Discussion. In particular, the oncogenes of HPV will encode certain normal proteins in the host changing them to oncoproteins. Because these oncoproteins have been isolated, antibodies have been found to target these oncoproteins in which vaccines have been developed to help prevent HPV infection. For example, two HPV oncoproteins (E6 and E7) are found to disrupt normal cell function. E6 will adhere to and deactivate the p53 tumor suppressor gene, and the E7 will adhere to and deactivate the Rb tumor suppressor gene in the human body. These two genes are significant because out of the many strains of HPV, the HPV strain variations with E6 and E7 oncoproteins variations are related to a low risk or a high risk of developing cancer. The low risk types are associated with benign neoplastic growths whereas the high-risk types cause pre-cancerous changes in mucosal tissues. (Abcore, Inc., 2020; Hammer & McPhee, 2019)
N512- Low-grade Cervical Dysplasia Discussion
.

Ms. Van’s prognosis at this time is good since most mild cases of cervical dysplasia resolve on their own. Given Ms. Van’s age and knowing that HPV is a common cause of cervical dysplasia, it would be important to obtain a biopsy to assess for depth of the involvement and whether there is HPV influence. Even though an HPV related dysplasia progression to cervical cancer usually takes many years, knowing the type of HPV would provide a more definitive diagnosis, treatment plan, and prognosis for her. At this point, her prognosis is good. Due to her age, she may or may not clear the HPV on her own which can take up to two years in younger adults. If she were positive for HPV, close continued surveillance would be important. The American College of Obstetricians and Gynecologist (ACOG) recommend to repeat the Pap test in one year for LSIL (American College of Obstetricians and Gynecologist, 2020) N512- Low-grade Cervical Dysplasia Discussion.

 

References:

 

Abcore, Inc. (2020). 
Oncoproteins
. Retrieved from https://www.abcore.com/oncoproteins

American Academay of Family Physicians. (2018, November 13). 
Cervical Dysplasia
. Retrieved from https://familydoctor.org/condition/cervical-dysplasia/

American College of Obstetricians and Gynecologist. (2020). 
Abnormal Cervical Cancer Screening Test Results
. Retrieved from https://www.acog.org/patient-resources/faqs/gynecologic-problems/abnormal-cervical-cancer-screening-test-results

Hammer, G. D., & McPhee, S. (2019). 
Pathophysiology of Disease: An Introduction to Clinical Medicine
 (8 ed.). New Youk: McGraw-Hill Education Medical.

Rogel Center Center Michigan Medicine. (n.d.). 
Squamous Intraepithelial Lesion (SIL)
. Retrieved from https://www.rogelcancercenter.org/gynecologic-cancers/prevention/pre-cancerous-conditions/squamous-intraepithelial-lesion

The John Hopkins University. (n.d.). 
Cervical Dysplasia
. Retrieved from https://www.hopkinsmedicine.org/kimmel_cancer_center/cancers_we_treat/cervical_dysplasia/diagnosis_and_treatment/abnormal_pap_test.html

World Health Organization . (2020). 
Biologicals 
. Retrieved from https://www.who.int/biologicals/areas/human_papillomavirus/en/#:~:text=Human%20papillomavirus%20(HPV)%20is%20a,approximately%208%2Dkb%20in%20length N512- Low-grade Cervical Dysplasia Discussion.

Zheng, A. K., & Pruett, D. (2020). 
Abnormal Pap and Cervical Dysplasia
. Retrieved from https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116920/all/Abnormal_Pap_and_Cervical_Dysplasia

Discussion 1

See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal.  Her provider diagnosed her with low-grade cervical dysplasia.  What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis N512- Low-grade Cervical Dysplasia Discussion. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Low Grade Cervical Dysplasia

            Pap smear is a test that is usually recommended during health exams for females especially when they become sexually active. If the result shows an abnormal growth on the surface lining of the cervix, implies you have cervical dysplasia. This disease ranges from mild to severe. To prevent the disease from progressing to a more severe form like invasive cervical carcinoma, early detection and treatment after proper screening is necessary (Hammer, G.D., & McPhee, S.J., 2019. P.57).

See Van in our case study was diagnosed with low-grade cervical dysplasia which is the mild form of the disease. This means that the abnormal cells are found on the surface of the cervix (epithelium). 
Human papillomavirus (HPV) infection is generally the cause for
 
Cervical dysplasia
(Stoppler, 2016). Cervical dysplasia is generally cause by HPV. Therefore, it is important to take the necessary precautions to prevent the infection from the virus. HPV vaccine is usually given between the ages of 9 to 26 and according to the Center of disease prevention and control recommendation it should be given between the ages of 11 and 12 (Blackburn, K.B., 2018) N512- Low-grade Cervical Dysplasia Discussion.

Low-grade cervical dysplasia usually goes away by itself and it does not mean you have cancer, or you’ll get cancer in the future (Nathan-Garner, L., 2017). The fact that See Van’s was diagnosed early and with the right treatments, she has very low chances for the disease to progress and develop into cancer. See Van is 35 years old and if she was not vaccinated, she should discuss about the benefit of the HPV vaccine with her Certified Midwife’s practice. This will prevent her from having the disease again after treatment.

Five years ago, my cousin when for her yearly physical and her pap smear came back abnormal. Her doctor referred her to a gynecologist who did a biopsy of her cervices. She was diagnosed with moderate grade cervical dysplasia. The doctor discussed different treatment options with her. She was so scared that the disease may affect her chances of having a baby because she just got married and they had plans of having their own baby. The doctor told her to try to conceive as soon as possible and will be closely monitored. She got pregnant two months later and she had frequent pap smears. She carried her pregnancy to term without issues and immediately after birth, she had a partial hysterectomy. Her gynecologist still scheduled her for a pap smear after a year and the result was normal.

Having an abnormal result after a regular yearly test can be very scary. Early detection of cervical dysplasia is important because the damage is still on the epithelia cell of the cervix. At this stage the disease has a very good prognosis. It is necessary to get HPV vaccine when recommended by your doctor because HPV infection is the main cause of the disease N512- Low-grade Cervical Dysplasia Discussion.

 

References:

Hammer, G.D. & McPhee, S.J., (2019). Pathophysiology of disease: An introduction to

clinical medicine (8
th
 ed.). New York, NY: McGraw-Hill Education/Medical.

Blackburn, K.B., (2018). 
HPV vaccine: What age is too late? 
MD Anderson Center.

The University of Texas. Retrieved from 
https://www.mdanderson.org/publication/focus-on-
health/focus-on-health-june-2018/hpv-vaccine-when-is-it-too-late.htm.

Nathan-Garner, L., (2017). 
Abnormal Pap test? What to know about cervical dysplasia? MD

Anderson Center. The University of Texas. Retrieved from https://www.mdanderson.org/cancerwise/abnormal-pap-test–what-to-know-about-cervical-dysplasia.html

Stoppler, M.C., (2016). 
Cervical Cancer Symptoms, Stages, and Treatment. Retrieved from

https://medicinenet.com/cervical_dysplasia/article.htm. N512- Low-grade Cervical Dysplasia Discussion

Module 3 Overview

Introduction

This week we will explore pharmacotherapy for special populations such as pediatrics, geriatrics, the pregnant patient and nursing mothers, as well as examining the interactions of over-the-counter medications to prescribed therapies.  The advanced practice nurse must be familiar with pathophysiologic changes related to age and disease.  Considerations for prescriptive therapy must be based upon the uniqueness of each diverse patient.

Learning Objectives

After completing this module, you will be able to:

Utilize advanced nursing and pharmacological interventions in select case studies to resolve complex and biological, psychological, physiological and pathophysiologic conditions.

Synthesize pathophysiologic changes related to the lifespan and recommend approiate evidence-based prescribing behaviors

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

Reading & Resources

Read Chapters 4, 5, 6, 7 & 14 In Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

Learning Activities

Discussion
: Participate in Discussion 3.

Test
: Complete Progress Test 2. Click on the Progress Test 2 link for more details.

Discussion 3

M. L. is a 15-year-old Hispanic female who plays soccer for her school team. She has noticed that when running, she sometimes has trouble catching her breath. She also reports an increased runny nose and itchy eyes. She has a frequent dry cough and is awakened with coughing spells at least four times a week. Her mother and father have seasonal allergies and her mother has asthma. This morning she woke up and heard “funny sounds” when she took a breath. Her coughing increased when she took a deep breath. In her nose, the mucosa is pale and swollen bilaterally. Her lungs have bilateral expiratory wheezing; respirations are 22 and PEF is 400. Her heart shows a normal sinus rhythm, with no murmurs or gallops; pulse is 72; and there is no cyanosis.

Diagnosis: Mild Persistent Asthma

In this discussion forum:

Discuss specific goals of pharmacotherapy for treating M. L.’s mild persistent asthma.

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

Discuss the parameters for monitoring the success of the therapy.

Discuss age appropriate health promotion recommendations you would consider for M. L.

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