NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing

NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing – Step-by-Step Guide

The first step before starting to write the NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing Example Solution

Ethical and Legal Implications of Prescribing Drugs

As an advanced practice nurse prescribing drugs, you are responsible for the safety of your patients each day. The prescriber is responsible for ensuring that any medical intervention they propose will align with the ethical and legal guidelines. The nurse practitioner must be knowledgeable about the most recent rules governing advanced practice nurses with the power to prescribe.

According to Rosenthal and Burchum (2021), writing prescriptions should prioritize patient safety and minimize medication errors through thorough assessment, clear documentation, electronic prescribing systems, and ongoing monitoring. The prescriber should ensure that any intervention taken has to account for the patient’s wishes and those of the family members and the primary caregivers.

Ethical and Legal Implications

1. Prescriber:

From the scenario, as an advanced nursing practitioner, prescribing medication makes the nurse face ethical and legal responsibilities. Ethically, the prescriber must prioritize AC’s best interests and respect his autonomy. The prescriber should consider the principle of beneficence by providing appropriate and necessary treatment.

They should also respect AC’s autonomy by ensuring his values and wishes are considered, even without advanced directives (Rosenthal & Burchum, 2021). Legally, the prescriber must follow applicable laws and regulations regarding informed consent, decision-making capacity, and end-of-life care.

2. Pharmacist:

The pharmacist has ethical and legal obligations as well. Ethically, the pharmacist should prioritize patient welfare and respect the autonomy of AC. They should ensure that the prescribed medications are appropriate, safe, and effective. The pharmacist may also play a role in counseling the patient’s family about the potential benefits, risks, and alternatives to treatment options. Legally, the pharmacist must adhere to laws and regulations related to medication dispensing, patient privacy, and confidentiality (Rosenthal & Burchum, 2021).

3. Patient (AC):

Although unresponsive and unable to communicate, AC has the ethical right to receive appropriate and compassionate care. The ethical principle of autonomy requires that AC’s values and wishes, as expressed by his family, be considered (American Geriatrics Society, 2019). If AC had previously expressed his wishes regarding end-of-life care, those should be respected. The healthcare team must act in his best interests if his wishes are unknown.

4. Patient’s Family (wife and daughter):

The wife and daughter have emotional and ethical involvement in AC’s care. Ethically, the wife’s belief that AC would not want to live in his current state should be respected, as it aligns with the principle of autonomy. The daughter’s belief that AC should be kept alive raises questions about the balance between hope and futility. Ethical discussions and family meetings can help address their concerns, consider AC’s values, and reach a consensus regarding his care.

Strategies to Address Disclosure and Non-disclosure

1. Open communication and shared decision-making: Engage in open dialogue with the wife, daughter, and other relevant stakeholders. Discuss the prognosis, treatment options, and potential outcomes. Please encourage them to express their concerns, values, and beliefs. By involving them in decision-making, you promote shared decision-making and respect for their autonomy (Rosenthal & Burchum, 2021).
2. Respecting patient confidentiality: Maintain patient confidentiality and privacy throughout the discussions. Ensure that sensitive information is only shared with individuals who have a legitimate need to know. Familiarize yourself with the laws specific to your state regarding patient confidentiality and privacy, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States, and adhere to them.
3. Exploring legal frameworks: Familiarize yourself with the legal framework in your state regarding disclosure and nondisclosure in healthcare. Laws may vary, but generally, healthcare professionals have a duty to disclose information to patients or their surrogates that is relevant to the patient’s condition and treatment decisions. However, laws also recognize exceptions where disclosure may not be appropriate, such as when it could cause serious harm to the patient or if the patient has explicitly requested nondisclosure (Rosenthal & Burchum, 2021).
4. Involving an ethics committee or legal counsel: In complex situations with conflicting views, involving an ethics committee or seeking legal counsel can provide guidance and ensure compliance with legal and ethical obligations. These resources can help navigate the specific laws in your state and provide recommendations on how to address disclosure and nondisclosure appropriately.

Strategies to Guide My Decision Making

1. Ethical reflection and consultation: Engaging in ethical reflection allows for a thoughtful examination of the situation, weighing the principles of autonomy, beneficence, and non-maleficence. Consulting with colleagues, an ethics committee, or a supervisor can provide different perspectives and support in decision-making. Discussing the ethical dilemma of disclosing the error with trusted individuals can help ensure a well-considered decision.
2. Adherence to professional standards and guidelines: Utilizing professional standards, such as those set forth by nursing organizations, can provide a framework for decision-making. These standards emphasize the importance of patient safety, communication, and accountability. In this scenario, disclosing the error may align with professional standards and guidelines, as it promotes transparency, fosters trust with the patient and family and allows for shared decision-making.

Whether to disclose the error should be carefully considered, considering the potential impact on the patient, their family, and the healthcare team. Justification for disclosing the error may include promoting transparency, maintaining trust, and involving the patient and family in decision-making (Rosenthal & Burchum, 2021). However, it is important to consult legal and institutional policies to ensure compliance with disclosure requirements specific to the jurisdiction.

The Process of Writing Prescriptions

1. Patient assessment and diagnosis: Conduct a thorough assessment of the patient, including their medical history, current symptoms, and any allergies or contraindications. Accurate diagnosis is crucial for prescribing the appropriate medication (Shojaei & Salari, 2020).
2. Selecting the medication: Choose the most appropriate medicine based on the patient’s diagnosis, considering efficacy, safety, dosage form, and patient-specific factors (e.g., age, comorbidities).
3. Determine dosage and frequency: Calculate the correct dosage and frequency of administration based on the patient’s age, weight, renal or hepatic function, and other relevant factors. Double-check calculations and refer to reliable references or prescribing guidelines.
4. Write clear and legible prescriptions: Use clear and concise language when writing prescriptions, including the medication name, strength, dosage form, instructions for use, and duration of treatment. Avoid abbreviations or ambiguous terminology to minimize confusion.
5. Electronic prescribing systems: Utilize electronic prescribing systems whenever possible, as they can help reduce errors by providing decision support, alerts for potential interactions or allergies, and automated dose calculations.
6. Double-check and review: Review the prescription for accuracy and completeness before transmitting or handing it to the patient. Ensure there are no potential drug-drug interactions, duplications, or contraindications (Shojaei & Salari, 2020).
7. Communication and patient education: Clearly communicate the prescription instructions to the patient or caregiver, ensuring they understand the medication regimen, potential side effects, and any necessary precautions.
8. Ongoing monitoring: Regularly assess the patient’s response to the medication, monitor for adverse effects, and adjust the prescription as needed.

Conclusion

The case scenario presented ethical and legal implications for all stakeholders involved, including the prescriber, pharmacist, patient, and patient’s family. The conflicting perspectives regarding end-of-life care highlighted the importance of open communication, shared decision-making, and respecting patient autonomy. Strategies such as ethical reflection, adherence to professional standards, and consultation with ethics committees or legal counsel can guide decision-making in complex situations.

Additionally, the process of writing prescriptions should prioritize patient safety and minimize medication errors through thorough assessment, clear documentation, electronic prescribing systems, and ongoing monitoring. By considering the ethical and legal aspects while implementing strategies to minimize errors, healthcare professionals can provide compassionate and appropriate care in challenging situations.

NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing References

American Geriatrics Society. (2019). Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society Download Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. https://evolve.elsevier.com/cs/product/9780323554954

Shojaei, A., & Salari, P. (2020). COVID-19 and off-label use of drugs: an ethical viewpoint. DARU Journal of Pharmaceutical Sciences, 28, 789-793. https://www.mdpi.com/1383694

Also read:

NURS 6521 Week 2 EmmaGarcia Pharmacotherapy For Cardiovascular Disorders

NURS 6521 Week 3 EmmaGarcia Asthma and Stepwise Management

NURS 6521 Week 4 EmmaGarcia Pharmacotherapy For Gastrointestinal And Hepatobiliary Disorders

NURS 6521 WEEK 1: AT A GLANCE BASIC PHARMACOTHERAPEUTIC CONCEPTS/ETHICAL AND LEGAL ASPECTS OF PRESCRIBING

INTRODUCTION

How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow? Have a look at NURS 6521 Week 2 Assignment: Pharmacotherapy For Cardiovascular Disorders. 

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

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

LEARNING OBJECTIVES

Students will:

• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients
• Assess patient factors and history to develop personalized plans of care
• Evaluate ethical and legal implications related to prescribing drugs
• Analyze ethical and legal practices of prescribing drugs
• Analyze strategies to address disclosure and nondisclosure
• Justify advanced practice nurse strategies to guide prescription drug decision-making
• Analyze the process of writing prescriptions to avoid medication errors

NURS 6521 Week 1 Discussion

To prepare:

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history in your case study.

BY DAY 3 OF WEEK 1

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

NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing Sample 2

While working at a medical ward in my 4th year of practice, I encountered a 72-year-old male named Mr. Smith. The patient had been in the ward for over a month and presented with hypertension and chronic kidney disease. His blood pressure was through the roof as he had a history of non-compliance with medication regimens and a significant genetic predisposition to drug metabolism variations. The patient has been on antihypertensives but has no detectable elevated blood pressure changes.

Factors That May Have Influenced Mr. Smith’s Pharmacokinetic and Pharmacodynamic Responses

1. Genetics and Pharmacogenetics: Mr. Smith may have had changed drug metabolism and clearance rates due to genetic differences in drug-metabolizing enzymes, such as cytochrome P450 enzymes. Higher medication concentrations and a higher likelihood of negative consequences may follow (Rosenthal & Burchum, 2021).
2. Age: Given Mr. Smith’s age of 65, changes in drug absorption, distribution, metabolism, and excretion due to aging may take place. For instance, decreased renal function in CKD may impact medication clearance, potentially causing drug buildup and protracted effects.
3. Pathophysiological Changes: Mr. Smith’s chronic kidney disease may have changed his pharmacokinetic characteristics, particularly for medications whose main route of elimination are the kidneys. Medication clearance may be lowered, and medication exposure may rise due to impaired renal function (American Geriatrics Society, 2019).
4. Non-Compliance: The effectiveness of Mr. Smith’s prescription antihypertensive medicine may have been harmed by his prior history of non-compliance with medication regimens. Drug levels in the body can fluctuate due to inconsistent drug use, which can lessen the intended therapeutic effects.

Individualized Plan of Care:

Mr. Smith could have the individualized plan of care listed below based on the patient’s medical history and contributing factors:

1. Pharmacogenetic testing should be carried out to find particular genetic variants that could affect medication metabolism. The likelihood of adverse drug reactions can be decreased by using this information to help with dosage modifications and medication selection.
2. Individualized Dosing: Change the antihypertensive drug dosage based on Mr. Smith’s renal function and pharmacokinetic data. Regular medication level monitoring and renal function testing are essential for appropriate dosing.
3. Patient Education and Counseling: Stress to Mr. Smith the value of drug compliance. Inform him of the dangers of disobeying instructions and the advantages of constantly following his prescribed drugs (Rosenthal & Burchum, 2021).
4. Use a multidisciplinary approach to manage Mr. Smith’s chronic kidney illness and monitor his renal function. The effectiveness of the treatment should be checked frequently, and the prescription schedule should be changed as necessary.

References

American Geriatrics Society (2019). Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society Download Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. https://evolve.elsevier.com/cs/product/9780323554954

NURS 6521 Week 1 Assignment 2 ETHICAL AND LEGAL IMPLICATIONS OF PRESCRIBING DRUGS

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

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

As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority.

Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

Please use the following scenario for this assignment:

• AC is a 72-year-old male who is admitted to your ICU after suffering a massive stroke that has left him unresponsive and unable to communicate.  He is currently on a ventilator.  His wife of 48 years is available along with their one adult daughter.  The wife informs you that they don’t have any advanced directives, but she is “pretty sure her husband would not want to live like this.”  However, their daughter is adamant her dad would want to be kept alive in case there is any chance to come out of this.

Talk to you all soon!

To Prepare:

• Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
• Review the scenario assigned by your Instructor for this Assignment.
• Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
• Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

BY DAY 7 OF WEEK 1

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

• Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
• Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
• Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
• Explain the process of writing prescriptions, including strategies to minimize medication errors.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements. All papers submitted must use this formatting.

NURS 6521 Module 2: Cardiovascular and Respiratory Systems

MODULE 2: AT A GLANCE – CARDIOVASCULAR AND RESPIRATORY SYSTEMS

WHAT’S HAPPENING THIS MODULE?

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

INTRODUCTION

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

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

LEARNING OBJECTIVES

Students will:

• Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes
• Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapies
• Evaluate drug therapy plans for cardiovascular disorders

PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

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

—Murphy et al., 2018

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

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

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

[Music] One of the missions of this course is to straddle the basic sciences and the clinical sciences. Many years ago, Sir William Osler said, “One cannot become a competent clinician “without the full knowledge of human physiology “and pathology. “Without it, one flounders along “in an aimless fashion, never able to gain “an accurate conception of disease, “practicing a sort of popgun pharmacy, “hitting now the malady and again the patient, he himself not knowing which.”

This week, Dr. Norbert Myslinski examines how categories of drugs working through different mechanisms can provide a synergistic effect creating more treatment options. So often in hospitals and the doctors’ offices and also in medical schools and nursing schools and dental schools, there is this dichotomy between the two. I mean, you first learn the basic sciences, then you forget about those and you go to the clinics, I think you learn the real stuff, but we want to do with this course is to produce a bridge between the two.

And make the understanding of the clinical portions more relevant by knowing the basic science– knowing the basic science that we have. Another way in which groups are important is synergism. In pharmacology, we have a concept where the effect of two different drugs is greater than the sum of the individual drugs and which is very important when you combine different drugs and especially when you have groups of drugs or categories that work via different mechanisms of action.

You may have a same end result of different categories of drugs, but they work via different mechanisms. And if you do that, you’re more likely to get a synergistic effect than if they all worked via the same mechanism. Some drugs work via same mechanism no matter what their effects are, okay? For instance, aspirin. Aspirin has many effects, all right? Aspirin is an analgesic that alleviates pain. Aspirin is anti-inflammatory, alleviates inflammation. Aspirin is an anticoagulant for the blood.

Aspirin also is antipyretic. It decreases body temperature, okay? But how does it do it? It has many effects. By the way, all drugs have multiple effects. No drug only has one effect. All drugs have more than one effect. But how does aspirin do all these different effects? Via the same mechanism. And that’s through the inhibition of a certain compound in the body called prostaglandins. So inhibition of the synthesis of prostaglandins produces all of them. Okay? There are many different types of prostaglandins and therefore we have different effects in there, Okay?

So if we have two different drugs, they work via the inhibition of prostaglandins. Say, aspirin and Tylenol, right? They’re not going to have a synergistic effect. They’ll have an additive effect, right? But if you have, for instance, a narcotic like morphine, okay? And then you also have Tylenol, you can have a synergistic effect with those two. Although with Tylenol and aspirin, there is a ceiling. You can take two or three tablets and that’s the maximum pain relief you’re going to get. No matter if you take five or 10 after that, you may have gastric distress, but it’s more of an effect, it’s a ceiling.

With morphine though there is no ceiling. You just keep going, going, going, you get more and more pain relief, you know, until your respiration shuts down and you die. So if we look at hypertension, that silent killer. That’s one disorder that we have a wealth of groups and categories of drugs working via many different mechanisms. So we can have a very nice synergistic effect. We can tailor-make their pharmacotherapy, you know, so they can control their blood pressure with the least amount of side effects and they can function in society.

For example, you have your ACE inhibitors, you have your angiotensin inhibitors, you have your beta-blockers, you have your calcium-channel blockers, you have your diuretics, all of them can reduce blood pressure, all of them work via different mechanisms. There are two types of blood vessels that go up, which is the carotids and the vertebrals and then they go into a little area here and distributed throughout the brain and one of the most common causes of disability that we have is stroke.

Now, stroke is when you have a deprivation of oxygen going to a part of the brain. And that’s usually due to one of three things. Either there is a buildup of a clot in that blood vessel, a primary site, so the blood stops going to that area or you have a clot that breaks off from a different part of your body, more likely from the left side of heart because you may have atherosclerosis, build up of fatty tissues and clots there and if one breaks off, it can go into your brain and to clog a blood vessel, that will be quick or you can have a weak blood vessel wall so that it blows up like a balloon, a balloon is aneurysm and eventually it bursts and when it bursts then you have a stroke in that part of the area of brain.

Now, the symptoms of a stroke on many patients that nurses treat for chronic time periods, the symptoms of a stroke can be quite varied. You know, as many functions that are functions of the brain depending upon where the stroke is, depending upon where the stroke is, okay? For instance, if it happens here at the back of the brain, you’ll have a lot of visual symptoms because this is where the brain processes visual information, occipital lobes. If you have one over here in the temporal lobes, that process is hearing, okay?

So you’d have hearing problems, okay? If you have a stroke that affects this part over here, this is somatosensory cortex, you may have a problem with the feeling, touch, and pressure in different parts of your body. Over here is the motor cortex and that has to do with movement. So you may have problems with movement of your body. Okay, so it all depends upon where that injury is and it’s very interesting because when there is a stroke, the main part dies and then the other parts around it shut down and unless treatment is given quickly and drugs can be given that can dissolve a clot real quickly, okay, the part that sort of are not dead yet, but they are affected around there if not treated quickly then that part may also die.

And so when you first have a stroke your symptoms involve not only the dead part, but also the part back here sort of shut down, all right? If you’re treated quickly, if you have the signs of a stroke you have what we call a brain attack then you get right there to the emergency center, you can dissolve the clot, and then you can have reversal of some of the symptoms. Like dysfunction of all these ones around, the dysfunctional ones can come back and we can have reversal of the symptoms, but if you don’t get the treatment, these will eventually die too and the others– those symptoms will stay around for a very long time. And so it all depends upon where the dysfunction is and that determines what kind of symptoms we have. 

NURS 6521 Week 3 Assignment Instructions – Asthma and Stepwise Management

INTRODUCTION

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

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

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

LEARNING OBJECTIVES

Students will:

• Evaluate drug therapy plans for asthma
• Assess the impact of asthma treatments on patients
• Analyze the stepwise approach to asthma treatment and management

ASTHMA AND STEPWISE MANAGEMENT

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

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