Tag: Clinical-Nursing

Pharmacotherapy of Mental & CNS Disorders Essay

Module 7 Overview

Introduction

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

Learning Objectives

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After completing this module, you will be able to:

Utilize advanced nursing and pharmacological interventions in mental and CNS disorders to resolve complex and biological, psychological, physiological and pathophysiologic conditions.

Teach patients, family members, and others from diverse populations regarding safe and effective use of drugs and natural products in mental and CNS disorders. Pharmacotherapy of Mental & CNS Disorders Essay

Reading & Resources

Read Chapters 38-45. 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 7.

Assignment: 
Complete & Submit Assignment 3. Click on the Assignment 3 link for more details.

Discussion 7

J. T., who is a Native American male, age 8, is always interrupting his teacher, jumping out of his seat in class, fidgeting relentlessly, and butting into other children’s games. At home, he runs around recklessly and is uncontrollable. His mother comes to the CNP in the Pediatric Clinic and wonders why he will not listen. She is concerned because his grades at school are dropping. After medical evaluation, you find nothing wrong with J. T. physically, and he is taking no other medications. Through questioning, you determine that he has trouble concentrating on his homework, often forgets he has homework, loses pieces of games frequently, and hates to sit and read. His mother is unsure of the time frame over which these behaviors developed, but she thinks it has been since her second child was born 5 years ago. Pharmacotherapy of Mental & CNS Disorders Essay While in your office, J. T. did not seem to be hyperactive or inattentive, but you notice he is easily distracted by people passing in the hallway because the door is slightly ajar.

Diagnosis: Attention-Deficit Hyperactive Disorder (ADHD)

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. T.’s ADHD.

Discuss the first-line drug therapy for J. T., and why.

Discuss monitoring parameters you would institute for J. T.’s parents and his teachers.

Discuss specific patient education you would provide to J. T.’s parents based on the prescribed therapy.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Pharmacotherapy of Mental & CNS Disorders Essay Discussion Participation Requirements and Grading Criteria.

Anti-infective Medications Essay

Module 6 Overview

Introduction

This week we will focus on the pharmacotherapeutics of anti-infective medications, including their use in commonly occurring conditions and the more commonly prescribed medications.  The presence of infection may occur in any body system and include causative agents such as bacteria, viruses, fungi, and protozoans Anti-infective Medications Essay.  The evidence-based treatment will vary with the cause and area of infection.

Learning Objectives

After completing this module, you will be able to:

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Utilize advanced nursing and pharmacological interventions in the use of anti-infective medications to resolve complex and biological, psychological, physiological and pathophysiologic conditions. Anti-infective Medications Essay.

Synthesize evidence-based clinical practice guidelines to develop pharmacotherapeutics plans for common infections such as pneumonia, otitis, urinary tract infections, sexually transmitted infections, skin infections, dental infections, gastroenteritis, and sepsis.

Teach patients, family members, and others from diverse populations regarding safe and effective use of drugs and natural products within the anti-infective medication classifications.

Reading & Resources

Read Chapters 8, 17, 18, 24, 27, 31, 32, & 35 In Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Anti-infective Medications Essay

Visit Infectious Disease Society of America (IDSA) Practice guidelines at 
https://www.idsociety.org/PracticeGuidelines/

Learning Activities

Discussion: 
Participate in Discussion 6.(Remember to use the IDSA resource)

Discussion 6

J. P. is a 36-year-old Caucasian gay male who was diagnosed with HIV infection 2 years ago. He and his male partner, T. R., were married shortly after his diagnosis. T. R. is not HIV positive. Anti-infective Medications Essay He has been feeling well for the past 2 years, and he maintains a healthy, active lifestyle by exercising three to four times a week and eating a balanced diet. His medications include a multiple vitamin and occasional omeprazole for heartburn. He has never received antiretroviral therapy. He comes to your office for a routine physical exam and blood work. The physical examination is unremarkable, and the laboratory results are as follows: Electrolytes, serum creatinine, liver function tests: within normal limits; Complete blood count with differential: within normal limits, CD4+ T-cell count: 210 cells/mm3; Viral load: 10,000 copies/mL, Genotype: No resistance mutations detected Anti-infective Medications Essay

Diagnosis: Asymptomatic HIV Infection

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. P.’s asymptomatic HIV infection.

Discuss when prophylaxis for infection is indicated ie daily bactrim Anti-infective Medications Essay

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

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for J. P.

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

Asymptomatic HIV Infection Essay Discussion 6

J. P. is a 36-year-old Caucasian gay male who was diagnosed with HIV infection 2 years ago. He and his male partner, T. R., were married shortly after his diagnosis. T. R. is not HIV positive. He has been feeling well for the past 2 years, and he maintains a healthy, active lifestyle by exercising three to four times a week and eating a balanced diet. His medications include a multiple vitamin and occasional omeprazole for heartburn. He has never received antiretroviral therapy Asymptomatic HIV Infection Essay. He comes to your office for a routine physical exam and blood work. The physical examination is unremarkable, and the laboratory results are as follows: Electrolytes, serum creatinine, liver function tests: within normal limits; Complete blood count with differential: within normal limits, CD4+ T-cell count: 210 cells/mm3; Viral load: 10,000 copies/mL, Genotype: No resistance mutations detected Asymptomatic HIV Infection Essay

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Diagnosis: Asymptomatic HIV Infection

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. P.’s asymptomatic HIV infection.

Discuss when prophylaxis for infection is indicated ie daily bactrim

Discuss the drug therapy a CNP would likely prescribe and why. Asymptomatic HIV Infection Essay

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for J. P.

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

Pharmacotherapy of Gastrointestinal and Endocrine Disorders

Module 5 Overview

Introduction

This week we will focus on the pharmacotherapeutics of gastrointestinal and endocrine disorders, including commonly occurring conditions and their commonly prescribed medications.  As you review this week’s content consider the impact of comorbid disease on each condition.  It is not unusual to encounter a patient who has underlying cardiovascular disease in the presence of diabetes.  Think about the impact of pharmacotherapeutics on all organ systems Pharmacotherapy of Gastrointestinal and Endocrine Disorders.

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Learning Objectives

After completing this module, you will be able to:

Utilize advanced nursing and pharmacological interventions in gastrointestinal, renal and endocrine disorders to resolve complex and biological, psychological, physiological and pathophysiologic conditions. Pharmacotherapy of Gastrointestinal and Endocrine Disorders

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

Reading & Resources

Read Chapters 28-31 and 46-47.  In Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

American Diabetes Association (2017). Standards of medical care in diabetes—2018 abridged for primary care providers. 
Clinical Diabetes, 36
(1), 14–37. doi:10.2337/cd17-0119. Retrieved from 
http://clinical.diabetesjournals.org/content/36/1/14

Learning Activities

Discussion: 
Participate in Discussion 5. Remember there are two cases and if your last name begins with A-L complete case 1 and reply to two peers in case 2.  If your last name begins with M-Z complete case two and reply to two peers in case 1.

Test: 
Complete Progress Test 3. Click on the Progress Test 3 link for more details. Pharmacotherapy of Gastrointestinal and Endocrine Disorders

Discussion 5

This week if your last name begins with A-L complete case 1 and reply to two peers in case 2.  If your last name begins with M-Z complete case 2 and reply to two peers in case 1.

Case 1:

C. J. is a 55-year-old Hmong postmenopausal woman presenting with Type II diabetes mellitus, hypertension and urinary incontinence. She reports that she often cannot get to the bathroom in time when she feels the urge to urinate. She also wets herself when she laughs or sneezes. She is very embarrassed about this problem and has decreased her excursions from the house because of it. She drinks six cups of coffee a day. She does not follow a special diet, She takes hydrochlorothiazide for hypertension, and metformin for DM. Today her HgbA1C is 12.  She wants treatment for her urinary complaints Pharmacotherapy of Gastrointestinal and Endocrine Disorders.

Diagnosis: Uncontrolled Type II DM, HTN, and urinary incontinence

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating C. J..

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

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for C. J.

Pharmacotherapy of Gastrointestinal and Endocrine Disorders

Case 2:

Mr. Z is a 36-year-old construction worker who presents to the nurse with fatigue and a foot ulcer. He is a smoker with type 1 diabetes for 25 years, and he take 20 units of

70/30 insulin twice a day. He lost his meter a year ago. He is very thin, although he eats constantly on the job because he is worried about hypoglycemia; he cannot remember the last time he had hypoglycemia, but it was years ago. Pharmacotherapy of Gastrointestinal and Endocrine Disorders He recently received a call from the office because his TSH level was greater than 10 and he was told he has “thyroid” problems.  He thinks this may be the cause of his fatigue.

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating Mr Z

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

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for Mr Z.

Pharmacotherapy of Gastrointestinal and Endocrine Disorders

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

Uncontrolled Type II DM, HTN, and urinary incontinence Essay – C. J. and Mr. Z

Discussion 5

This week if your last name begins with A-L complete case 1 and reply to two peers in case 2.  If your last name begins with M-Z complete case 2 and reply to two peers in case 1.

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Case 1:

C. J. is a 55-year-old Hmong postmenopausal woman presenting with Type II diabetes mellitus, hypertension and urinary incontinence. She reports that she often cannot get to the bathroom in time when she feels the urge to urinate. Uncontrolled Type II DM, HTN, and urinary incontinence Essay – C. J. and Mr. Z She also wets herself when she laughs or sneezes. She is very embarrassed about this problem and has decreased her excursions from the house because of it. She drinks six cups of coffee a day. She does not follow a special diet, She takes hydrochlorothiazide for hypertension, and metformin for DM. Today her HgbA1C is 12.  She wants treatment for her urinary complaints. Uncontrolled Type II DM, HTN, and urinary incontinence Essay – C. J. and Mr. Z

Diagnosis: Uncontrolled Type II DM, HTN, and urinary incontinence

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating C. J..

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

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for C. J.

Case 2:

Mr. Z is a 36-year-old construction worker who presents to the nurse with fatigue and a foot ulcer. He is a smoker with type 1 diabetes for 25 years, and he take 20 units of

70/30 insulin twice a day. He lost his meter a year ago. He is very thin, although he eats constantly on the job because he is worried about hypoglycemia; he cannot remember the last time he had hypoglycemia, but it was years ago.  He recently received a call from the office because his TSH level was greater than 10 and he was told he has “thyroid” problems.  He thinks this may be the cause of his fatigue.

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating Mr Z

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

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for Mr Z.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. Uncontrolled Type II DM, HTN, and urinary incontinence Essay – C. J. and Mr. Z

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

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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.

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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.