Sentinel N521 Advanced Pharmacology Assignment 2
Sentinel N521 Advanced Pharmacology Assignment 2
Assignment 2
R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to his CNP in his family practice clinic. He presents with progressive difficulty getting his breath while doing simple tasks. He is having difficulty doing any manual work, but he has no symptoms when working behind his desk.
He also reports a cough, fatigue, and weight loss. He has been treated for three respiratory infections a year for the past 3 years and feels like another one is developing now. On physical examination, you notice clubbing of his fingers, use of accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs. Pulmonary function studies show an FEV1 of 58%.
In a paper not to exceed six pages, excluding title and reference pages, please answer the following:
- What is R. W.’s likely diagnosis?
- What stage of disease does RW have?
- List specific pharmacotherapeutic treatment goals for R. W.
- What drug therapy would the CNP likely prescribe? Why?
- What are the parameters for monitoring the success of the therapy?
- Describe specific patient education based on the prescribed therapy.
- List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.
- What would be the choice for second-line therapy?
- What health promotion activities should be recommended for this patient?
- If RW was currently taking metoprolol for “headaches” would a change be recommended?
Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work.
|
Competency |
40 |
36 |
33 |
0 |
Points Earned |
| Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales | Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources. | Accurate discussion of nine case study questions presented with use of current evidence-based resources. | Accurate discussion of 8 questions using current evidence-based resources |
Missing response to questions or inappropriate answers to questions. No use of evidence-based resources. |
/40
|
|
40 |
36 |
33 |
0 |
|
|
Evidence of
|
Well-defined evidence of
|
Evidence of critical thinking in prescriptive therapy, monitoring and adverse events. May have lacked a teaching plan or pathophysiologic discussion. | Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology. |
Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking. |
/40
|
|
|
10 |
9 |
8 |
0 |
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 (1-3 errors) | There are major errors in grammar, spelling, and punctuation .(4-5 errors) |
No content or more than 5 errors |
/10
|
|
10 |
9 |
8 |
0 |
|
|
| APA Compliance | The paper meets APA formatting guidelines | There are a few minor errors (1-3 errors) | There are significant errors in the format of the paper (4-5 errors) |
No content or more than 5 errors |
/10 |
| Total Points |
|
|
|
|
/100 |
- Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales
- Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources.
- Accurate discussion of nine case study questions presented with use of current evidence-based resources.
- Accurate discussion of 8 questions using current evidence-based resources
- Missing response to questions or inappropriate answers to questions. No use of evidence-based resources.
Evidence of critical thinking therapeutic decision-making in drug selection and evaluation of patient care pathophysiology and current pharmacological research assessment of the effectiveness of drug therapy formulation of clinical care and teaching plans for persons from diverse populations
Well-defined evidence of critical thinking therapeutic decision-making in drug selection and evaluation of patient care pathophysiology and current pharmacological research assessment of the effectiveness of drug therapy formulation of clinical care and teaching plans for persons from diverse populations
Evidence of critical thinking in prescriptive therapy, monitoring and adverse events. May have lacked a teaching plan or pathophysiologic discussion.
Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology.
Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking.
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 (1-3 errors)
- There are major errors in grammar, spelling, and punctuation .(4-5 errors)
- No content or more than 5 errors
APA Compliance
- The paper meets APA formatting guidelines
- There are a few minor errors (1-3 errors)
- There are significant errors in the format of the paper (4-5 errors)
- No content or more than 5 errors
Total Points /100
Sentinel N521 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.
Sentinel N521 Example Discussion 4 Approach
Specific therapy goals on the patient, in this case, R.S, include decreased blood pressure, decreased cholesterol, and lower cardiovascular disease risk (Arcangelo & Peterson, 2017). First-line therapy is influenced by age, ethnicity/race, and other medical conditions (Arcangelo & Peterson, 2017). To treat the diagnosed hypertension, R.S should be prescribed a diuretic, specifically a thiazide diuretic.
Being that R.S is of African American descent, he should be more responsive to monotherapy with the diuretic (Arcangelo & Peterson, 2017). The hypertension treatment needs to be considered in the presence of kidney issues. Arcangelo & Peterson (2017) state that the first line of treatment for dyslipidemia includes HMG-CoA reductase inhibitors or statins.
Monitoring a patient’s fasting lip levels for one to three months after therapy initiation is vital. If the LDL levels decrease, this is considered a success. A reduction of fifty percent is what is expected in a high-dose statin. A reduction of thirty percent should be seen with a moderate dose statin treatment Arcangelo & Peterson.
This patient has a diagnosis of diabetes. The goal in treating a patient in the presence of this condition and hypertension includes a blood pressure reading of less than 140/90 (Arcangelo & Peterson, 2017). Blood pressure needs to be measured at every visit. How a patient has been modifying their lifestyle should be readdressed. If a patient is not responding, a hypertension specialist’s referral may be needed (Arcangelo & Peterson 2017).
According to Arcangelo & Peterson (2017), African Americans are more prone to hypertension. R.S has a genetic predisposition to hypertension, diabetes, and hyperlipidemia. The patient should be educated at each visit on healthy lifestyle choices. R.S needs to change his diet and eating habits, maintain average body weight through exercise of at least one hundred and fifty minutes a week R.S should be educated on smoking and alcohol cessation, and a low sodium diet with a therapeutic plan should always be encouraged.
Arcangelo, V. P., Peterson, A. M., Wilbur, V. F., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: a practical approach. Wolters Kluwer.
N521 Discussion 6
To do: Make forum posts: 3
Discussion 6
- Students with last names ending in A-H: Answer questions 1-4.
- Students with last names ending in I-Q: Answer questions 5-8.
- Students with last names ending in R-Z: Answer questions 9-12.
1. Discuss the pathophysiology of tension headache, goals for medication therapy, and first, second, & third line medication therapy choice. Differentiate treatment & prophylaxis & medication choices.
2. Discuss the pathophysiology of migraine headache, diagnostic criteria, goals for medication therapy, and three medication therapy choices including the classification, route of administration, onset & duration of action, & contraindications.
3. Choose one first line & one second line medication for generalized tonic-clonic seizures. Describe the mechanism of action, dosage considerations, contraindications, and interactions.
4. Choose one first line & one second line medication for partial seizures (focal onset seizures). Describe the mechanism of action, dosage considerations, contraindications, and interactions.
5. Evaluate the decision-making process in determination of medication choice for Alzheimer’s Disease. Include discussion of one medication therapy for cognitive symptoms.
6. You are caring for a patient with Parkinson’s disease who indicates the dominant symptom is tremor. Evaluate the process of determining medication choice from the algorithm provided in Figure 38.2 in the textbook. Choose first, second, & third line medication treatments and support your choices with the literature.
7. Find a current clinical practice guideline for treatment of bipolar disorder. Describe the first line treatment recommendations. What would be the indications for a change in the treatment plan & what would those changes be (second line treatment)?
8. Many patients are interested in using complementary and alternative medications and treatments. St. John’s Wort has been used as an herbal antidepressant. Discuss any patient teaching you would provide if your patient was using St. John’s Wort.
9. Selective Serotonin Reuptake Inhibitors (SSRIs) are considered to be the first line treatment option for anxiety. Analyze the medication options in this class—side effects, adverse events, therapeutic effects, and method of action.
10. Discuss the nonstimulant medication options for Attention Deficit Hyperactivity Disorder. What are the medications, when are they appropriate to prescribe, what are the contraindications, and how long can the patient expect to wait for a medication response after beginning the medication?
11. The first step in planning treatment for a patient suspected of a substance use disorder is screening for the disorder. Discuss the screening tools available & how they can be used.
12. Discuss the use of buprenorphine as a first-line treatment for opioid use disorder. What are the requirements to prescribe, the route of administration, adverse effects, contraindications, and special considerations? What are the options if the patient cannot access buprenorphine?
Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.
N521 Module Seven: Pharmacotherapy for Special Populations—Pediatrics & Geriatrics
Module 7 Overview
This week we will explore pharmacotherapy for the special populations of pediatrics and geriatrics 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 appropriate evidence-based prescribing behaviors
- Teach patients, family members, and others from diverse populations regarding safe and effective use of medications and natural products.
Reading & Resources
- Read &/or review chapters 4, 5, 7, 9-11, 15, 24,32, & 46 In Arcangelo et al. (2022). Pharmacotherapeutics for advanced practice: A practical approach (5th ed.). Wolters Kluwer.
Learning Activities
- Discussion: Participate in Discussion 7. Students with last names that end in A- H need to answer questions 1- 4. Students with last names that end in I- Q need to answer questions 5-8. Students with last names that end in R-Z need to answer questions 9-12.
- Assignment: Submit Final Project.
Discussion 7
To do: Make forum posts: 3
Discussion 7
- Students with last names ending in A-H: Answer questions 1-4.
- Students with last names ending in I-Q: Answer questions 5-8.
- Students with last names ending in R-Z: Answer questions 9-12.
1. Discuss the indications of prescribing the anti-infective Ciprofloxacin to elderly patients with decreased renal clearance.
2. Describe the pharmacologic education required for parents when an infant is started on Prevacid for reflux. Discuss how the medication works and the pertinent side effects to look out for.
3. For an elderly patient with a urinary tract infection (UTI), which anti-infective is the first-line treatment and discuss why?
4. Elaborate on the drug class of Albuterol, what are the indications for its use in children? Discuss the safety profile and the most common side effects.
5. What is the first-line treatment of an elderly patient with atrial fibrillation and why? Discuss why this is the preferred pharmacological therapy.
6. Upon the patients’ one year checkup you have diagnosed them with anemia and have started an oral iron supplement. Discuss the formulation of the medication that is best for this age group and monitoring parameters regarding future labs. Give adequate patient education regarding starting this new medication including tips on medication adherence.
7. Discuss why H-2 Blockers should be avoided in elderly patients with delirium.
8. The advanced practice nurse is discussing treatment options with a parent regarding a UTI in a 16 year old patient. This patient is allergic to penicillin and sulfa medications. What is an appropriate course of action for this patient? What other information needs to be gathered and what treatment plan would you send them home with?
9. G.O is an 85-year-old Hispanic male who presents to your primary care office, along with his daughter for a check-up.
Past Medical History
- Type 2 Diabetes Mellitus, Chronic Kidney Disease Stage II, Hypertension, Hyperlipidemia, Atrial Fibrillation, Anxiety, History of Chronic UTI’s, Alzheimer’s Disease.
Allergies
- Amoxicillin (Hives)
Current Medications
- Amiodarone 200mg PO BID
- Nortriptyline 25mg PO QD
- ASA 81mg PO QD
- Lorazepam 1mg PO BID
- Metoprolol 50mg PO QD
- Simvastatin 10mg PO QD
- Nitrofurantoin 100mg PO QD
- Haldol 0.5mg PO BID
Provide medication reconciliation using the BEERS criteria as a guide, a discuss which medications should be avoided and why.
10. Q.R. is a 2 year old male who is in your primary care office with a 102 F fever and cold symptoms for the last 7 days. On exam you diagnosis a bilateral otitis media. The mother is hesitant to give antibiotics as he has had diarrhea from them in the past. Describe what first line treatment you would recommend and how would you counsel the mother on the indication of the antibiotics and provide her with proper education on the situation?
11. T.M. is a 70-year-old Caucasian female arrives to your primary care office, along with her son because she has had 3 falls in the past month.
Past Medical History
- Hypertension, Hyperlipidemia, Type 2 Diabetes Mellitus, Osteoarthritis
Vital Signs
- BP 110/60, Pulse 80, RR 19, BG 184mg/dl
Allergies
- NKDA
Current Medications
- ASA 81mg PO QD
- Lisinopril/HCTZ 10-25mg PO DQ
- Glimepiride 2mg PO BID
- Rosuvastatin 10mg PO QD
- Novolog 3 units TID before meals
- Oxycodone 2mg PO Q4H for pain
- Naproxen 200mg PO Q6H for pain
Provide medication reconciliation using the BEERS criteria as a guide, and discuss which medications should be avoided and why.
12. Discuss special considerations when prescribing medications for pediatric patients. This may include but is not limited to: how to dose, when to switch to adult dosing parameters, medication adherence and how to deal with medication non-compliance in the pediatric population.
Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.
