NURS 6521 Foundational Concepts

NURS 6521 Foundational Concepts

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A solid foundation in the concepts and principles of drug therapy across the lifespan is essential to the work of advanced practice nurses. Students in this course apply the advanced principles of pharmacology, including pharmacogenomics, pharmacokinetics and pharmacodynamics, by analysis of common drug classes prescribed by advanced practice nurses across the lifespan. Factors influencing successful therapy such as effectiveness, safety, acceptability, cost, genetic/environmental influences, complementary regimens, and patient behaviors are considered. Through this course, students prepare to examine complex decisions in the management and treatment of selected acute and chronic diseases across the lifespan through pharmacologic and nonpharmacologic agents. Advanced practice nursing students will have a more in-depth understanding of drug legislation and regulation for prescribing drugs.

What’s Happening In This Module?

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

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

What do I have to do?     When do I have to do it?    
Review your Learning Resources Days 1-7 Week 1
Discussion: Pharmacokinetics and Pharmacodynamics Post by Day 3 of Week 1, and respond to your colleagues by Day 6 of Week 1.
Assignment: Ethical and Legal Implications of Prescribing Drugs Submit your Assignment by Day 7 of Week 1.

Go to the Week’s Content

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

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

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

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

Learning Resources

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

  • Chapter 1, “Prescriptive Authority” (pp. 1–3)
  • Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
  • Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
  • Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
  • Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
  • Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)

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, 67(4), 674–694. doi:10.1111/jgs.15767

American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

This website details key aspects of drug registration.

Fowler, M. D. M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application (2nd ed.). Silver Spring, Maryland: American Nurses Association.

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

Ladd,E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

This article provides NPs with information regarding state-based laws for NP prescribing.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association of NursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

Required Media (click to expand/reduce)

Introduction to Advanced Pharmacology

Meet Dr. Terry Buttaro, associate professor of practice at Simmons College of Nursing and Health Sciences as she discusses the importance of pharmacology for the advanced practice nurse. (8m)

Discussion: Pharmacokinetics and Pharmacodynamics

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

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

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

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

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.

By Day 6 of Week 1

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

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



Sample Paper Week 1-Walden NURS 6521 Pharmacokinetics and Pharmacodynamics

Advanced Pharmacology

Student’s Name:

Institutional Affiliation:

Case

Recently, there has been a growing interest in personalized medicine due to the genetic, age and other factors differences among patients. There is a need to consider some risk factors that can worsen the condition of a patient especially during the intervention phase (Weerink et al. 2017). Mr. L, a 75-year-old African American man was admitted to the hospital after he complained of numbness in the limbs and face especially one side, problems in vision, severe headaches, lack of coordination, and difficulty in communication. Additionally, the patient expressed some behaviors such as being startled easily and avoiding eye contact. Besides, he had increased heart rate, shaking and sweating, numbness and cold flushes. He was diagnosed with stroke and depression

Pharmacokinetics

The patient was subjected to selective serotonin reuptake inhibitors (SSRIs) which seemed to be weakening the bones of the patient.  After some time he was subjected to ensam antidepressant drugs that were administered through transdermal routes. The absorption of these drugs was affected because of the reduced tissue blood perfusion. This is common among the elderly (Shimizu et al. 2016). Drug distribution was not profoundly affected since the drugs administered were not hydrophilic. The liver is responsible for drug metabolism, and since aging is related to low liver mass, the response to the medicine was not highly positive as compared to when younger people are administered the drug. Elimination and drug interaction was not affected by age.

Pharmacodynamics

Pharmacodynamics depends on the drug concentration at the receptor, the receptor response, post-receptor events within the cells as well as the homeostatic mechanisms (Hochhaus et al. 2016). Aging affected all these pharmacodynamics. Plasma concentration in the body of this man led to a high risk of adverse effects such as headaches, insomnia, and rash.

A Personalized Plan of Care

In treating depression and anxiety, I would use selective serotonin reuptake inhibitors (SSRIs). These drugs work by escalating brain chemicals that fight depression. To avoid thinning of bones which might cause fractures among the elderly, I would start the medication at low doses and increase them slowly for the elderly. I would also consider injection rather than transdermal routes.

References

Hochhaus, G., Khan, P., Mobley, C., & Issar, M. (2016). Pharmacokinetics and pharmacodynamics of drugs delivered to the lungs. In Pharmaceutical Inhalation Aerosol Technology, Second Edition (pp. 222-257). CRC Press.

Shimizu, R., Hotta, K., Yamamoto, S., Matsumoto, T., Kamiya, K., Kato, M., … & Tanaka, S. (2016). Low-intensity resistance training with blood flow restriction improves vascular endothelial function and peripheral blood circulation in healthy older adults. European journal of applied physiology116(4), 749-757.

Weerink, M. A., Struys, M. M., Hannivoort, L. N., Barends, C. R., Absalom, A. R., & Colin, P. (2017). Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clinical pharmacokinetics56(8), 893-913.



Assignment: Ethical and Legal Implications of Prescribing Drugs

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

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

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

To Prepare

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

  • Review the scenario assigned by your Instructor for this Assignment.
  • Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
  • Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
  • 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 (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Submission and Grading Information

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

  • Please save your Assignment using the naming convention “WK1Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 1 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 1 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK1Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submitbutton to complete your submission.

Submit Your Assignment by Day 7 of Week 1



Sample Paper Week 2-Walden NURS 6521 Ethical and Legal Implications of Prescribing Drugs

Advanced Pharmacology

Student’s Name:

Institutional Affiliation:

Advanced Pharmacology

Ethical Considerations

Several Ethical issues may arise from medicine prescription error. The nursing ethical principle of autonomy and right to self-determination accords the patients a right to make their own treatment choices according to their views, beliefs and perceived benefits (Niemann et al. 2015). Therefore, the nurse is obligated to keep patients updated on the medical progress of the treatment process which includes involves errors. They also have to help patients, make informed decisions in deciding on mitigation measures.

Additionally, the principle of beneficence and no maleficence imposes to the nurses the duty to do what is best for patients and avoid causing harm to the patient respectively. Although prescription error can be harmful to the patient in terms of loss of life and quality of life primarily due to associated long-term disabilities, the prescribing nurses should minimize damage by informing patients and management of the error so that they can decide on the most appropriate remedy earliest possible.

Prescription errors are a reflection of problematic and unethical organizational culture as well as negligent nursing which violates the QSEN ethical nursing competences of such as safety driven culture. Consequently, Nurses and organizations can be sued for medical negligence which often leads to cancelation of practice license. The lawsuits have negative impacts on organizations as well in terms of heavy financial fines, lousy reputation, and revocation of practice license. Moreover, Nurses and healthcare organizations have an ethical obligation to admit mistakes. They are required to maintain honesty and truth-telling in communication with patients and their families to establish trust. The negative impacts of non-disclosure to patients can negatively impact on the family in terms of financial burden and emotional as well as erosion of trust. Patients family entrust nurses with the health; thus when an error occurs, they expect a disclosure and a promise of measures to prevent future recurrence of the failure.

Strategies to Guide Decision Making

When a medication error occurs, the nurses reporting approach should be based on the depth of information provided by the approach about the mistake, and the ability of the method to providing information that informs a sophisticated investigation of the specific errors to understand the nature and magnitude of the problem.  As an advanced practice nurse, I would verbally report to the collaborating physician as it saves time thus enabling the application of countermeasures as early as possible. It also portrays my willingness as a nurse to communicate and recognize errors, which is a crucial aspect of nursing. Secondly, I would also consider a written report and attaching it to the patient’s story as it provides detailed information to facilitate an investigation that would help prevent future recurrence. It also enables other subsequent shift nurses to know about the medical history of the specific patient.

References

Niemann, D., Bertsche, A., Meyrath, D., Koepf, E. D., Traiser, C., Seebald, K., … & Bertsche, T.

(2015). A prospective three‐step intervention study to prevent medication errors in drug handling in paediatric care. Journal of clinical nursing, 24(1-2), 101-114.



What’s Coming Up in Module 2?

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

Looking Ahead: Week 2 Assignment

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

Module 2: 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.

What do I have to do?     When do I have to do it?    
Review your Learning Resources Days 1-7, Weeks 2 and 3
Assignment 1: Pharmacotherapy for Cardiovascular Disorders Submit your Assignment by Day 7 of Week 2.
Assignment 2: Asthma and Stepwise Management Submit your Assignment by Day 7 of Week 3.

Go to the Week’s Content

Week 2: Cardiovascular System

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

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

Learning Objectives

Students will:

Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes

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

Evaluate drug therapy plans for cardiovascular disorders

Learning Resources

Required Readings (click to expand/reduce)

  • Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd) St. Louis, MO: Elsevier.
  • Chapter 33, “Review of Hemodynamics” (pp. 285–289)
  • Chapter 37, “Diuretics” (pp. 290–296)
  • Chapter 38, “Drugs Acting on the Renin-Angiotensin-Aldosterone System” (pp. 297–307)
  • Chapter 39, “Calcium Channel Blockers” (pp. 308–312)
  • Chapter 40, “Vasodilators” (pp. 313–317)
  • Chapter 41, “Drugs for Hypertension” (pp. 316–324)
  • Chapter 42, “Drugs for Heart Failure” (pp. 325–336)
  • Chapter 43, “Antidysrhythmic Drugs” (pp. 337–348)
  • Chapter 44, “Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels” (pp. 349–363)
  • Chapter 45, “Drugs for Angina Pectoris” (pp. 364–371)
  • Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)

Required Media (click to expand/reduce)

Cardiovascular Disorders

Meet Dr. Norbert Myslinski as he discusses ACE inhibitors, angiotensin inhibitors, beta-blockers, calcium channel blockers, and diuretics as different categories of hypertension drugs. What potential drugs might be best recommended for patients suffering from hypertension? (8m)

Assignment: Pharmacotherapy for Cardiovascular Disorders

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

—Murphy et al., 2018

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

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

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

To Prepare

  • Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
  • Review the case study assigned by your Instructor for this Assignment.
  • Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
  • Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
  • Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
  • Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

By Day 7 of Week 2

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

  • Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
  • Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
  • Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Reminder: The 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 (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.

Submission and Grading Information

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

  • Please save your Assignment using the naming convention “WK2Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 2 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 2 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK2Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submitbutton to complete your submission.

Submit Your Assignment by Day 7 of Week 2



Sample Paper Week 3-Walden NURS 6521 Pharmacotherapy for Cardiovascular Disorders

Pharmacotherapy for Cardiovascular Disorders

Student’s Name:

Institutional Affiliation:

Explain How the Factor You Selected Might Influence the Pharmacokinetic and Pharmacodynamic Processes

The patient factor I selected is age. It is assumed that the patient is aged because he presents with old age-associated comorbidities like obesity, overweight, hypertension, and hyperlipidemia. The patient is also on five prescription drugs. Research shows that most Americans aged individuals take at least three prescription drugs daily due to multiple age-related comorbidities .the state has significant implications in patient’s pharmacokinetic and pharmacodynamic processes in regards to drug interaction and adverse drug reactions (Van den Anker, Reed, Allegaert & Kearns, 2018).

Aging is accompanied by progressive random changes in the body that influence the pharmacokinetics and pharmacodynamics process. Cardiovascular conditions in elderly individuals cause decreased renal functioning, reduced hepatic blood flow, increased body fat, and reduced muscle mass and total body water, thus affecting distribution, metabolism, and elimination of cardiovascular drugs (Cossart, Cottrell, Campbell, Isbel & Staatz, 2019).

These changes in the elderly include reduced elasticity and a reduction in the intrinsic heart rate, and renal impairment that impairs effective blood flow, thus hindering drug distribution in the body to the target tissues. The gastrointestinal system also changes with age.  Absorption of several substances decreases with age. Decreased organ functionality impairs the secretion of digestive enzymes that facilitate the absorption of drugs in the small intestine. Impaired muscle movement and renal impairment also cause uncontrolled fast movement of food along the duodenum, thus impairing maximum drug absorption.

Advancing age is associated with a progressive reduction in liver volume and liver blood flow. It is also associated with decreased organ functioning like liver and kidney functioning thus impairing drug clearance and facilitating high drug concentration and toxicity.

Describe How Changes in the Processes Might Impact the Patient’s Recommended Drug Therapy

The patient’s current prescription drugs are daily doses of Atenolol, Doxazosin, Hydralazine, Sertraline, and Simvastatin. The patient’s age is a factor in the absorption, distribution, metabolism, and excretion of these drugs.  The patient is on atenolol, a beta-blocker prescribed for r hypertension. The sensitivity to beta-blockers is higher increases with age, leading to increased risk of drug side effects. Therefore, a much lower dose should be used for older adults. The increased sensitivity results in increased absorption, thus increased plasma concentration and leading to increased risk of stroke and heart failure, the significant side effects. The high concentration results in increased kidney functioning to excrete the drug through urine, thus resulting in frequent urination and thirst. The drug, therefore, covers up diabetic symptoms in elderly individuals, which may lead to a late diabetes diagnosis. For this reason, the drug is discouraged in older adults (Wang, Xiang, Chen & Ji, 2019).

The second drug is doxazosin, an alpha-blocker prescribed for hypertension. Older adults are more sensitive to alpha-blockers, leading to increased absorption and high plasma concentration, therefore consequent severe side effects. The concentration is increased by impaired kidney functioning due to old age, which results in decreased drug excretion. The side effects include fainting, dizziness, and kidney failure (Abdi & Campbell, 2018). Co-administration of beta-blockers and alpha-blockers leads to extremely low blood pressure, which caused malfunctioning of blood vessels, due to muscle weakness associated with old age. It consequently impairs drug distribution via blood circulation. This is because they both act as muscle relaxers.

The third prescription is sertraline, prescribed for hyperlipidemia.it side effects include gastrointestinal complications like diarrhea, stomach upset, and intestinal bleeding. Due to the decrease in mucous lining along the digestive system associated with old age, these symptoms are severe in older adults. This consequently results in fast movement of food and impaired absorption of drugs, thus decreasing plasma concentration and drug effectiveness. Co-administration with beta and alpha-blockers increases the bleeding due to consequent muscle relaxation. This hinders transportation of drug to target tissues for metabolism (Chen et al., 2016).

The other prescription is simvastatin, a statin prescribed for high cholesterol levels. It impairs the processing of cholesterol by the liver, thus reducing general liver functioning. Old age is associated with muscle wear out hence consequent organ failure. Therefore, the drug causes faster liver failure in older individuals, leading to the permanent synthesis of body cholesterol. One of its side effects among the elderly is muscle problems. Therefore, if administered with beta and alpha-blockers, it alters the action of muscle relaxation, thus hindering drug distribution through blood circulation (Rosenthal & Burchum, 2018).

Explain How You Might Improve the Patient’s Drug Therapy Plan

First, since co-administration of beta-blockers and alpha-blockers causes’ excessive low blood pressure, and the two types of drugs lead to risk of cardiovascular complications like stroke, the AHA, only recommends prescription of Thiazide Diuretics as a first-line therapy in the treatment of hypertension in the elderly population. This is   because they have been established prevent other cardiovascular conditions like stroke, coronary artery disease and chronic heart failure. I would, therefore, discontinue Atenolol and Doxazosin, and prescribe Thiazide Diuretics; a dose of 12.5 mg of hydrochlorothiazide instead. The low dose helps prevent toxicity caused by high plasma concentration due to old age associated renal function impairment. It is supplemented by non-pharmacological approaches. Hydralazine should also be terminated as well since it should ideally be given with a beta-blocker. Simvastatin dose should be continued as it is the AHA prescribed the first-line drug for hyperlipidemia. However, the dose should be lowered to 40 g to decrease the risk of diabetes, which is one of the side effects of the drug. The reason is that although the patient does not have diabetes, his age puts him at risk of diabetes. Bariatric surgery such as gastric bypass and laparoscopic adjustable gastric banding will be prescribed for treatment, rather than obesity drugs, to prevent drug interaction.

I will also recommend Non- pharmacologic Treatment. AHA recommends that hypertension treatment in the elderly should entail both pharmacological and non-pharmacological approaches to avoid drug interaction, associated with the use of multiple drugs. It involves Lifestyle modification like exercise, Weight control, and Dietary Approaches like consumption of low sodium, sugar, and fat diet.

References

Abdi, E., & Campbell, A. (2018). Urological symptoms and side effects of treatment. In The MASCC Textbook of Cancer Supportive Care and Survivorship (pp. 469-503). Springer, Cham.

Chen, S. T., Narvaez, T. A., Harwood, D. G., Leskin, L. P., Brommelhoff, J. A., Bussel, N., & Sultzer, D. L. (2016). Sertraline for the treatment of depression in vascular cognitive impairment. The American Journal of Geriatric Psychiatry, 24(3), S171-S172.

Cossart, A. R., Cottrell, W. N., Campbell, S. B., Isbel, N. M., & Staatz, C. E. (2019). Characterizing the pharmacokinetics and pharmacodynamics of immunosuppressant medicines and patient outcomes in elderly renal transplant patients. Translational andrology and urology, 8(Suppl 2), S198.

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

Van den Anker, J., Reed, M. D., Allegaert, K., & Kearns, G. L. (2018). Developmental changes in pharmacokinetics and pharmacodynamics. The Journal of Clinical Pharmacology, 58, S10-S25.

Wang, Q., Xiang, B., Chen, S., &Ji, Y. (2019). Efficacy and safety of oral atenolol for the treatment of infantile haemangioma: A systematic review. Australasian Journal of Dermatology, 60(3), 181-185.



What’s Coming Up in Week 3?

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

Week 3: Respiratory System

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

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

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

Learning Objectives

Students will:

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

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Chapter 62, “Drugs for Asthma and Chronic Obstructive Pulmonary Disease” (pp. 557–579)

Chapter 63, “Drugs for Allergic Rhinitis, Cough, and Colds” (pp. 580–588)

Document: APA Presentation Template

Optional Resources (click to expand/reduce)

National Heart Lung and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines for the diagnosis and management of asthma. Retrieved from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

This web resource presents guidelines for diagnosing and managing asthma and outlines treatment recommendations for specific age groups.

Assignment: Asthma and Stepwise Management

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

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

To Prepare

  • Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
  • Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
  • Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

By Day 7 of Week 3

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

  • Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
  • Explain the stepwise approach to asthma treatment and management for your patient.
  • Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

Submission and Grading Information

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

  • Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 3 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 3 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK3Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submitbutton to complete your submission.
  • NOTE: SafeAssign does not accept files over 10MB in size. Please attempt to keep your files under 10MB.

Submit Your Assignment by Day 7 of Week 3

What’s Coming Up in Module 3?

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

Next Week

To go to the next week:

Module 3

Module 3: Gastrointestinal and Hepatobiliary Systems

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

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

What’s Happening This Module?

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

What do I have to do?     When do I have to do it?    
Review your Learning Resources Days 1-7, Week 4
Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Submit your Assignment by Day 7 of Week 4.

Week 4: Gastrointestinal and Hepatobiliary Disorders

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

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

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

Learning Objectives

Students will:

Evaluate diagnoses for patients with gastrointestinal and hepatobiliary disorders

Justify drug therapy plans based on patient history and diagnosis

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

  • Chapter 64, “Drugs for Peptic Ulcer Disease” (pp. 589–597)
  • Chapter 65, “Laxatives” (pp. 598–604)
  • Chapter 66, “Other Gastrointestinal Drugs” (pp. 605–616)
  • Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)

Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., . . . Sanya, A. J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1), 328–357. Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.29367

This article details the diagnosis and management of nonalcoholic fatty liver disease. Review this article to gain an understanding of the underlying pathophysiology as well as the suggested pharmacotherapeutics that might be recommended to treat this disorder.

Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

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

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

To Prepare

Review the case study assigned by your Instructor for this Assignment

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

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

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

By Day 7 of Week 4

Write a 1-page paper that addresses the following:

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

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

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

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

Submission and Grading Information

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

  • Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 4 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submitbutton to complete your submission.

Submit Your Assignment by Day 7 of Week 4



Sample Paper Week 4-Walden NURS 6521 Pharmacotherapy or Gastrointestinal and Hepatobiliary Disorders

Acute Gastroenteritis

Student’s Name:

Institutional Affiliation:

Instructor:

Course:

Date:

Acute Gastroenteritis

Health providers need to ensure that they understand the HPI of a patient to make the correct diagnosis. Asking the patient questions regarding his/her condition is also important as it can help improve the patient’s health outcome. Currently, the patient is taking Synthroid, nifedipine, and prednisone. It is vital to inquire from the client the reason for taking those medications to come up with the appropriate treatment plan that will help improve the patient’s health outcome. For example, prednisone suppresses the immune system; hence it is vital to know why the client is taking that medication. In addition to that, more tests should be carried out for more information regarding the patient’s health condition.

In this case, based on the information provided, the patient is likely suffering from acute gastroenteritis. Gastroenteritis is a condition that develops due to the inflammation of the stomach and the small intestine. A bacterial or viral infection mostly causes this condition. Acute gastroenteritis occurs when water or food that is contaminated with pathogenic microorganisms or their toxins is consumed. It is also caused by contact with someone who has the virus. Symptoms of acute gastroenteritis include vomiting, diarrhea, nausea, and abdominal pain. These symptoms are evident in the case of the patient. A patient can also experience fever, dehydration, and lack of energy.

For drug therapy, I would administer patient HL with Ondansetron 8mg. This drug helps prevent vomiting and nausea. It blocks one of the natural substances in the body that causes vomiting (Parker, Van Bennekom, Anderka, & Mitchell, 2018).  I would also advise the patient to take more fluids to prevent dehydration. Although prednisone normally suppresses the immune system, I would not discontinue it without tapering    (Batlle, Mattie, & Irwin, 2016). It would be appropriate to follow the tapering off procedure where the prednisone dose is reduced gradually over time. Tapering off prednisone dosage too quickly can worsen inflammation (“Can tapering off prednisone cause a flare?,” n.d.). In addition to that, I would encourage the patient to exercise proper hygiene (Ibrahim, Palaian, Al-Sulaiti, & El-Shami, 2016).

References

Batlle, L., Mattie, R., & Irwin, R. (2016). A medication combination for the treatment of central poststroke pain via the adjuvant use of prednisone with gabapentin: a case report. PM&R8(3), 278-281.

Can tapering off prednisone cause a flare? (n.d.). WebMD. https://www.webmd.com/drug-medication/qa/can-tapering-off-prednisone-cause-a-flare

Ibrahim, M. I., Palaian, S., Al-Sulaiti, F., & El-Shami, S. (2016). Evaluating community pharmacy practice in Qatar using simulated patient method: acute gastroenteritis management. Pharmacy Practice (Granada)14(4).

Parker, S. E., Van Bennekom, C., Anderka, M., & Mitchell, A. A. (2018). Ondansetron for treatment of nausea and vomiting of pregnancy and the risk of specific birth defects. Obstetrics & Gynecology132(2), 385-394.



What’s Coming Up in Module 4?

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

Next Week

To go to the next week:

Module 4: Endocrine System

NURS 6521 Foundational Concepts

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

What’s Happening This Module?

Module 4: Endocrine System is a 1-week module, Week 5 of the course. In this module, you examine types of drugs prescribed to patients with endocrine disorders, as well as consider the impact of patient factors on the effects of drugs. You also examine types of diabetes and the impact of diabetes drugs on patients.

What do I have to do?     When do I have to do it?    
Review your Learning Resources Days 1-7, Week 5
Discussion: Diabetes and Drug Treatments Post by Day 3 of Week 5, and respond to your colleagues by Day 6 of Week 5.

Go to the Week’s Content

Week 5: Endocrine System Disorders and the Treatment of Diabetes

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

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

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

Learning Objectives

Students will:

  • Differentiate types of diabetes
  • Evaluate the impact of diabetes drugs on patients
  • Evaluate alternative drug treatments and patient education strategies for diabetes management

Learning Resources

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

  • Chapter 48, “Drugs for Diabetes Mellitus” (pp. 397–415)
  • Chapter 49, “Drugs for Thyroid Disorders” (pp. 416–424)

American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1), S73–S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf

This article provides guidance on pharmacologic approaches to glycemic treatment as it pertains to treating patients with diabetes. Reflect on the content of this article as you continue to examine potential drug treatments for patients with diabetes.

Discussion: Diabetes and Drug Treatments

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

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

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

To Prepare

  • Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
  • Select one type of diabetes to focus on for this Discussion.
  • Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
  • Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.

By Day 3 of Week 5

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

By Day 6 of Week 5

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

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

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



Sample Paper Week 5-Walden NURS 6521 Diabetes and Drug Treatments

Diabetes

Student’s Name:

Institutional Affiliation:

Diabetes

Diabetes is a chronic condition that is usually associated with blood sugar levels that are abnormally high. There are different types of diabetes. Type 1 diabetes is caused by the inability of the pancreas to produce enough insulin or failure to produce the insulin.  In most cases, it develops during adolescence or childhood, but it can also develop in adults. Type 2 diabetes is a condition that affects how glucose in the body is metabolized. For this type of diabetes, the body tends to resist the insulin effects or fail to produce enough insulin to maintain normal glucose levels. Type 2 diabetes has no cure but various diabetes medications or insulin therapy, as well as the change of lifestyle, can help manage the symptoms of the condition (Chatterjee, Khunti, & Davies, 2017).  Gestational diabetes develops when blood sugar levels become high during pregnancy. It happens in the second half of pregnancy.  This type of diabetes usually goes away after a person gives birth. Gestational diabetes increases the risk of a person getting type 2 diabetes later in life and can also affect the baby’s health (McIntyre et al., 2019). Juvenile diabetes affects mostly young people. This type of diabetes is considered the same as type 1 diabetes, mainly because approximately 90% of people below 25 years are affected by type 1 diabetes (Bimstein, Zangen, Abedrahim, & Katz, 2019).

Treatment for Type 2 Diabetes

The condition can be managed through medication, and lifestyle change, such as healthy eating and physical activity. One type of drug that is used to treat type 2 diabetes is metformin. This drug works by lowering the production of glucose in the liver and improving the body’s sensitivity to insulin. This helps the body to be in a better position of using insulin more effectively. FDA approved this medication in 1994 as an antidiabetic medication that should be used in the treatment of type 2 diabetes mellitus (American Diabetes Association. 2018). The medication comes as an extended-release as well as an immediate release. The medication should be administered orally from 500 to 2550 mg per day. Patients are usually advised to take the medication with a meal to help reduce GI upset. Some of the gastrointestinal effects include nausea and vomiting as well as diarrhea. In addition to that, the medication should be taken at the same time daily (Rena, Hardie, & Pearson, 2017). Some of the dietary considerations for patients who have been diagnosed with type 2 diabetes include complex carbohydrates such as whole wheat, brown rice, oatmeal, quinoa, vegetables, lentils, and beans. Examples of the foods that should be avoided include pasta, sugar, flour, white bread, and pastries (Sami, Ansari, Butt, & Ab Hamid, 2017).

Impact of Type 2 Diabetes

The short-term impact of type 2 diabetes includes hyperosmolar hyperglycemic nonketotic syndrome and hypoglycemia. The long-term impact includes diabetic neuropathy, diabetic retinopathy, kidney disease, and microvascular problems. Drugs used in treating Type 2 diabetes-like Thiazolidinedione increase an individuals’ risk of heart problems; DPP-4 inhibitors result in joint pain and ay cause pancreatic inflammation (Afanasiev et al., 2018).

In Conclusion, diabetes has several types, such as Type 1 Diabetes, juvenile diabetes, which is insulin-dependent. Gestational diabetes is usually temporary and occurs during pregnancy. All kinds of diabetes can be managed through medication, a healthy diet, and physical exercise.

References

Afanasiev, S. A., Garganeeva, A. A., Kuzheleva, E. A., Andriyanova, A. V., Kondratieva, D. S., & Popov, S. V. (2018). The impact of type 2 diabetes mellitus on long-term prognosis in patients of different ages with myocardial infarction. Journal of diabetes research2018.

American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1), S73–S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf

Bimstein, E., Zangen, D., Abedrahim, W., & Katz, J. (2019). Type 1 Diabetes Mellitus (Juvenile Diabetes)–A review for the pediatric oral health provider. Journal of Clinical Pediatric Dentistry43(6), 417-423.

Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet389(10085), 2239-2251.

McIntyre, H. D., Catalano, P., Zhang, C., Desoye, G., Mathiesen, E. R., & Damm, P. (2019). Gestational diabetes mellitus. Nature Reviews Disease Primers5(1), 1-19.

Rena, G., Hardie, D. G., & Pearson, E. R. (2017). The mechanisms of action of metformin. Diabetologia60(9), 1577-1585.

Sami, W., Ansari, T., Butt, N. S., & Ab Hamid, M. R. (2017). Effect of diet on type 2 diabetes mellitus: A review. International journal of health sciences11(2), 65.



What’s Coming Up in Module 5?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

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

Looking Ahead: Midterm Exam

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

Next Week

To go to the next week:

Module 5

Module 5: Neurologic and Musculoskeletal Systems

What’s Happening This Module?

Module 5: Neurologic and Musculoskeletal Systems is a 2-week module, Weeks 6 and 7 of the course. In this module, you will analyze drugs prescribed to treat neurological and musculoskeletal disorders and explore patient education strategies for treatment and management of these disorders. You will also evaluate the impact of patient factors on the effects of prescribed drugs and drug therapy plans for neurologic and musculoskeletal disorders. You will also complete your Midterm Exam.

What do I have to do?     When do I have to do it?    
Review your Learning Resources Days 1-7, Weeks 6 and 7
Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders You are encouraged to begin your Assignment in Week 6 and continue working on it in Week 7. However, this Assignment is not due until Day 7 of Week 8 in Module 6.
Midterm Exam Complete by Day 7 of Week 7.

Go to the Week’s Content

Week 6

Week 7

Week 6: Neurologic and Musculoskeletal Disorders

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

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

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

Learning Objectives

Students will:

Evaluate patients for treatment of neurologic and musculoskeletal disorders

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

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

Learning Resources

Required Readings

  • Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd) St. Louis, MO: Elsevier.
  • Chapter 11, “Basic Principles of Neuropharmacology” (pp. 67–71)
  • Chapter 12, “Physiology of the Peripheral Nervous System” (pp. 72–81)
  • Chapter 12, “Muscarinic Agonists and Cholinesterase Inhibitors” (pp. 82–89)
  • Chapter 14, “Muscarinic Antagonists” (pp. 90-98)
  • Chapter 15, “Adrenergic Agonists” (pp. 99–107)
  • Chapter 16, “Adrenergic Antagonists” (pp. 108–119)
  • Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)
  • Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)
  • Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)
  • Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)
  • Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)
  • Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)
  • Chapter 59, “Drug Therapy of Rheumatoid Arthritis” (pp. 513–527)
  • Chapter 60, “Drug Therapy of Gout” (pp. 528–536)
  • Chapter 61, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 537–556)

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

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

Required Media (click to expand/reduce)

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

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

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

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

Disorders of The Nervous System

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



Sample Paper Week 6-Walden NURS 6521 – Neurologic and Musculoskeletal Disorders

NURS 6521 Foundational Concepts

Multiple Sclerosis

Student’s Name:

Institutional Affiliation

Multiple Sclerosis

From the case study, Sabrina is a 26-year-old female patient who was diagnosed with multiple sclerosis. The patient booked an appointment with her physician for the management and treatment of the condition. Sabrina presents several questions concerning her diagnosis. As such, she calls the nurse helpline for her hospital network. She notes that multiple sclerosis affects her musculoskeletal and neurologic systems upon talking to the physicians. She learns that although the condition is an autoimmune disease, its symptoms and signs can affect other functions. Therefore, Sabrina should be aware of the specific drug therapy and other options of treatment that her physicians could decide to administer.

Symptoms of the Disorder

Signs of multiple sclerosis may vary from person to person. Typically, the symptoms affect movement functions. They include weakness or numbness in the limbs, which mostly touch one side of the patient’s body at a time. The numbness may affect the trunk and the legs of the patient (Claes et al., 2014). Another symptom of the disorder in the electric shock sensation which occurs when the neck makes specific movements. It happens especially when the neck bends forward. Also, patients of multiple sclerosis experience unsteady gait, lack of coordination, and tremors.

Decision Tree

Multiple sclerosis has no actual cure. As such, treatment aims at speeding up the recovery process from the attacks, management of the MS signs and symptoms, and slowing the progression of the disease (Claes et al., 2014). Some patients have very mild signs, so that no treatment is necessary.

Treatment Decision for MS Attacks

Medications knowns as corticosteroids, which include oral prednisone and IV methylprednisolone, are administered to minimize the effects of nerve inflammation. However, these drugs have side effects such as mood swings, fluid retention, and insomnia. Plasmapheresis (plasma exchange) is another option for the treatment of MS attacks (Spencer et al., 2015). The liquid part of the blood is removed and isolated from the blood cells. The blood cells should then be mixed with albumin and put back into the body. This decision is made when the symptoms are severe, and they have failed to respond to the corticosteroids.

Treatment Decision to Reduce Progression

The physician may also decide to give a prescription to modify MS progression. Disease-modifying therapy (DMT) is given the MS patients to slow down the rate of progress. Treatment choices for relapsing-remitting MS are composed of different intravenous medications (Spencer et al., 2015). Glatiramer acetate medication helps to block the patient’s immune system from attacking myelin. The drug is usually injected below the skin. Beta interferons are also commonly administered to reduce the severity and frequency of relapses.

Treatment Decision for Signs and Symptoms

Another treatment decision for the MS should aim at relieving the symptoms. Physical therapy can help the patients to relax the muscles through stretching and strengthening exercises (Stangel et al., 2015). Muscle relaxants such as tizanidine (Zanaflex) are useful in alleviating the uncontrollable muscle pain, spasms, and stiffness.

Sabrina’s Treatment Decision

For Sabrina’s case study, the treatment decision was aimed at the reduction of progression. Sabrina is a young patient who was diagnosed with early symptoms of MS. The DMT therapy would ensure that the disease progression would be slightly lower than the untreated cases. Also, the treatment option given to Sabrina ensures that the relapse rate and the formation of lesions are reduced.

Differences between Actual and Expected Results

The decision to treat MS attacks is expected to reduce the effects of nerve inflammation. However, the actual outcome may differ from the anticipated results due to the side effects of the drugs, which include flu-like symptoms. Also, the treatment option to reduce progression is expected to reduce the rates of relapse (Stangel et al., 2015). However, the actual results may vary due to side effects such as blurred vision and nausea.

References

Claes, N., Dhaeze, T., Fraussen, J., Broux, B., Van Wijmeersch, B., Stinissen, P., … & Somers, V. (2014). Compositional changes of B and T cell subtypes during fingolimod treatment in multiple sclerosis patients: a 12-month follow-up study. PLoS One, 9(10), e111115.

Spencer, C. M., Crabtree-Hartman, E. C., Lehmann-Horn, K., Cree, B. A., & Zamvil, S. S. (2015). Reduction of CD8+ T lymphocytes in multiple sclerosis patients treated with dimethyl fumarate. Neurology-Neuroimmunology Neuroinflammation, 2(3), e76.

Stangel, M., Penner, I. K., Kallmann, B. A., Lukas, C., & Kieseier, B. C. (2015). Towards the implementation of ‘no evidence of disease activity’ in multiple sclerosis treatment: the multiple sclerosis decision models. Therapeutic advances in neurological disorders, 8(1), 3-13.



Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

NURS 6521 Foundational Concepts

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

To Prepare

  • Review the interactive media piece assigned by your Instructor.
  • Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
  • Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
  • You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

By Day 7 of Week 8

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

  • Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
  • Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
  • What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
  • Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

You will submit this Assignment in Week 8.

Submission and Grading Information

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

  • Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 8 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submitbutton to complete your submission.

Submit Your Assignment by Day 7 of Week 8



Sample Paper Week 6-Walden NURS 6521 – Decision Tree for Neurological and Musculoskeletal Disorders

NURS 6521 Foundational Concepts

Student’s Name:

Institutional Affiliation:

Case Summary

A 43-year-old white male presents with a chief complaint of pain. He is assisted in his ambulation with a set of crutches. The patient presents for a psychiatric evaluation after a referral by his family doctor, who felt that the pain was imaginary. The patient reports that his physician believes he is faking the pain to get narcotics to get high. He reports that the pain began7 years ago after sustaining a fall at work, landing on his right hip. He notes that the pain has led to the loss of his job and relationship, and he occasionally goes down in the dumps when he sees how the pain has impacted his life. However, he emphatically denies depression. He reports that one of the neurologists diagnosed him with complex regional pain syndrome (CRPS).

Decision 1

Start Savella 12.5 mg orally once daily on day 1; followed by 12.5 mg BID on day 2 and 3; followed by 25 mg BID on days 4-7; followed by 50 mg BID thereafter

Reasons for Selecting this Decision

In patients with CRPS, changes in the nervous system caused by injuries or trauma cause malfunctioning of peripheral sensory neurons, responsible for transmitting pain signals from the brain and spinal cord to all other parts of the body. As a result, patients with CRPS have a low pain threshold, thus more sensitive to pain. Savella is a selective norepinephrine and serotonin reuptake inhibitor (SNRI) and an NMDA antagonist. Therefore, it inhibits the reuptake of norepinephrine and serotonin neurotransmitters, restoring brain chemical balance and allows more of these neurotransmitters to travel from neuron to neuron. This produces analgesic effects (Stanton-Hicks, 2018).

Although Amitriptyline, a tricyclic anti-depressant, has been established to be effective off-label neuropathic pain management, it could not be prescribed (Benzon, Liu & Buvanendran, 2016). Some of the drug’s significant side effects are drowsiness and dizziness that the client initially stated he didn’t like. Therefore, prescribing this medication for a start might only trigger non-compliance. It is the role of a care provider to prescribe drugs that promote compliance and have fewer side effects. Neurontin, an anticonvulsant, has also been established to be effective in nerve pain relief (Finnerup et al., 2015). However, it also has the side effects of drowsiness and drowsiness; therefore, it wasn’t a viable choice.

Expected Outcome

The expected outcomes of treatment with Savella were significant pain reduction to three on a scale 10 point pain scale, and the ability to walk without support. Additionally, it was expected the patient would resume normal work routine and perform activities of daily life with minimal support and regain a happy mood (Stanton-Hicks, 2018).

Difference between Expected Outcome and Actual Outcome

After four weeks, the patient returned to the facility looking joyous and hopeful. He reports the ability to walk without support, but minimal limping was noticeable. He noted the pain had decreased to four on a ten point pain scale, but it is worse in the morning and gets better as the day progressed. The patient reported occasional sweating, sleep disturbance, and palpations. His physical assessment indicated blood pressure of 147/92mmhg and pulse rate to be 110 beats/ min. He denied depression and suicidal thoughts.  The palpitations, sweating, sleep disturbance, and elevated BP and pulse rate are determined to be Savella side effects, which can be addressed by reducing the dosage (Finnerup, et al., 2015).

Decision 2

Reduce the Savella 50 mg oral once-daily dosage to 25 mg twice daily.

Reasons for Selecting this Decision

Although the Savella prescription yielded significant progress, the patient reported unexplained sweats, sleep disturbance, and elevated blood pressure, which were established to be Savella’s side effects. A study has demonstrated that reducing the dosage of Savella can help manage its side effects (Stanton-Hicks, 2018).

Expected Outcome

It was expected that the patient’s pain level would progressively decrease, his limping would disappear, he would increasingly perform more and more daily life activities with minimal support, and that his social, professional, and physical functioning would also improve (Benzon, Liu & Buvanendran, 2016). The Savella side effects were expected to disappear as well, and he was expected to live a near-normal life.

Difference between Expected Outcome and Actual Outcome

The patient returned after four weeks walking with crutches and looking sad and discouraged by his pain management slip. He reported an inability to walk without support and a 7 out of 10 pain level. He also reported frequently waking up at night due to pain in his right leg and foot. Savella side effects are reported to have disappeared. He denied depression and suicidal ideation. His assessment results indicate his blood pressure was 124/85, and his pulse rate was 87 beats/ min. The deterioration was attributed to the previous decision to lower the Savella dosage (Murnion, 2018).

Decision 3

Change Savella to 50 mg orally in the morning and 25 mg at bedtime.

Reasons for Selecting this Decision

A higher dose of Savella prescribed during the patient’s initial visit was effective. Besides, the patient had reported the pain worsened early morning and improved as the day progressed. Study shows that reducing the dosage during parts of the day when pain is mostly under control is a good idea that can still contribute to achieving therapeutic goals (Finnerup et al., 2015).

Expected Outcome

The pain was expected to decrease to a three on a 10 point pain scale. The patient was expected to walk without support and perform daily life activities with minimal or no support. Stanton-Hicks (2018) supported that the patient would no longer experience sleep disturbance, and his mood would gradually stabilize. It was expected the drug side effect would normalize progressively.

Difference between Expected Outcome and Actual Outcome

After four weeks, the patient returned walking without the support and reported a pain level of 4 on a10 point pain scale. He seemed joyous, hopeful, and willing to continue with the treatment to attain further pain reduction. Assessment results indicated BP to be 120/84mmhg and pulse rate to be 86 beats/min. He denied depression and suicidal ideation and was future-oriented. The patient was aware that the pain might never completely disappear with neuropathic pain syndrome but can be managed at tolerable levels (Benzon, Liu & Buvanendran, 2016). He was advised to supplement the pharmacologic therapy with exercise, physical therapy, massage, and heat therapy for better outcomes (Murnion, 2018).

References

Benzon, H. T., Liu, S. S., & Buvanendran, A. (2016). Evolving definitions and pharmacologic management of complex regional pain syndrome.

Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H., … & Kamerman, P. R. (2015). Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology14(2), 162-173.

Murnion, B. P. (2018). Neuropathic pain: current definition and review of drug treatment. Australian prescriber41(3), 60.

Stanton-Hicks, M. (2018). Complex regional pain syndrome. In Fundamentals of Pain Medicine (pp. 211-220). Springer, Cham.



What’s Coming Up in Week 7?

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

Next Week

To go to the next week:

Week 7

Week 7: Midterm Exam

NURS 6521 Foundational Concepts

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

Learning Objectives

Students will:

Identify key terms, concepts, and principles related to prescribing drugs to treat patient disorders

Midterm Exam

NURS 6521 Foundational Concepts

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

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

By Day 7 of Week 7

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

Submission and Grading Information

Complete the Exam by Day 7 of Week 7

To Complete this Exam:

Week 7 Exam

What’s Coming Up in Module 6?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

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

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

Next Week

To go to the next week:

Module 6: Psychological Disorders

NURS 6521 Foundational Concepts

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

—Centers for Disease Control and Prevention, 2018

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

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

What’s Happening This Module?

Module 6: Psychological Disorders is a 1-week module, Week 8 of the course. In this module, you will examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

What do I have to do?     When do I have to do it?    
Review your Learning Resources Days 1-7, Week 8
Discussion: Decision Making When Treating Psychological Disorders Post by Day 3 of Week 8, and respond to your colleagues by Day 6 of Week 8.
Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders Submit your Assignment by Day 7 of Week 8.

Go to the Week’s Content

Week 8: Pharmacology for Psychological Disorders

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

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

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

Learning Objectives

Students will:

  • Evaluate patients for treatment of psychological disorders
  • Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders
  • Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology
  • Evaluate patients for treatment of neurological and musculoskeletal disorders
  • Analyze decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders
  • Justify decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders

Learning Resources

Required Readings

  • Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd) St. Louis, MO: Elsevier.
  • Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
  • Chapter 27, “Antidepressants” (pp. 214–226)
  • Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
  • Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
  • Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
  • Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)

Required Media (click to expand/reduce)

Laureate Education (Producer). (2019a). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.

Laureate Education (Producer). (2019c). Attention deficit hyperactivity disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder.

Laureate Education (Producer). (2019d). Bipolar therapy [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.

Laureate Education (Producer). (2019g). Generalized anxiety disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat generalized anxiety disorder.

Discussion: Decision Making When Treating Psychological Disorders

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

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

To Prepare

  • Review this week’s interactive media pieces and select one to focus on for this Discussion.
  • Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

By Day 3 of Week 8

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

By Day 6 of Week 8

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

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



            Sample Paper Week 8-Walden NURS 6521 – Decision Making When Treating Psychological Disorders

Treating Psychological Disorders

Student’s Name:

Institutional Affiliation:

Mental health issues are serious and do have debilitating outcomes, affecting normal functioning, increasing dependency levels, and not only affects the diagnosed person but also their loved ones. Mental health illness symptoms may occur temporarily or chronic and can range from mild, moderate, and severe. The mild symptoms of mental illness can be managed through life adjustment and psychotherapy, but when they are severe, a combination with medication/ pharmacotherapy is recommended. The majority of mental health experts do agree that a combination of pharmacotherapy and psychotherapy is more effective compared to implementing the individual approaches in the treatment of severe mental health issues (Pedrelli et al., 2015). This paper aims to review a case study of a Hispanic male with a major depressive disorder to assess some of the three medications proposed: Zoloft 25 mg orally daily, Effexor XR 37.5 MG orally daily, and Phenelzine 15 mg orally TID to recommend the most appropriate.

Before recommending any medications to a patient, it is best to collect sufficient information such as the patient characteristics such as age and health condition, current medication, past medical history, psychiatric history of the family, and generally the patient’s functional status. The caregiver also has to collect the patient’s objective data. After assessing the patient’s cognitive and emotional state, as in the case study, the caregiver can plan for the prescription such as patient and support education, dosage, frequency, route, and the span based on information collected (Mayo-Wilson et al., 2014). It is also best to review the medications for effectiveness, interactions, and side effects based on the patient’s condition.

Zoloft 25 Mg Orally Daily

Zoloft is a selective serotonin reuptake inhibitor (SSRI) and works by restoring serotonin in the brain. The medication is used in treating depression, post-traumatic stress disorder, panic attacks, obsessive-compulsive disorder, and social phobia. Zoloft may mend sleep disorders, appetite, mood, energy levels, and increase interest in activities which one loves (Milgrom et al., 2015). The medication may also interfere with the urge to partake in repetitive tasks that one faces in daily living, such as counting. The appropriate dosage for persons with MDD is 50mg, with a maximum upper range of 200mg for unresponsive patients.

Effexor XR 37.5 Mg Oral Daily

Also known as Venlafaxine, Effexor XR is used as a mood and energy enhancer to rejuvenate interest (Dahale e al., 2014). The antidepressant is used to treat social anxiety disorder, depression panic attacks, and anxiety. Effexor XR is a serotonin-norepinephrine reuptake inhibitor and works by restoring and balancing norepinephrine and serotonin in the brain. The oral medication is taken once daily, either in the morning or evening, and is not to be chewed as it may increase the chances of side effects. The medication is not stopped unless the caregiver orders so, and the benefits are gradual to note and may take several weeks for positive results. The 37.5 mg dosage is best at the beginning for the patient to adjust; then, it can be raised to 75mg, which is the recommended dose.

Phenelzine 15 Mg Oral TID

Phenelzine is a usual dose for depression and mostly administered to adults. The initial dose for depression is 15mg tid but can be increased to 90 mg for patients who require high monoamine oxidase inhibition. The results of Phenelzine may be noted after at least a month at 60mg daily dosing. The 15 mg dose can only be used for maintenance purposes after benefits are attained. Phenelzine is not recommended as the initial depressant to use in patient treatment, but as the last option after other medications are unresponsive on the patient (Willaert et al., 2014).

Appropriate Choice

The three medications are antidepressants and seem to have almost similar side effects such as suicidal thoughts and behavior; hence caregivers need to balance between the clinical benefits to the patient and the risks involved (Mayo-Wilson et al., 2014). From assessing the above medication in treating MDD, the first to exclude is the Phenelzine 15 mg oral TID dosage as it should be used as an alternative treatment after all other options have failed. Zoloft 25 mg orally daily is also a better prescription, but the problem is that that dosage is way below for the 50mg appropriate for treatment of MDD; hence, it may take time to restore the patient’s wellbeing. Zoloft does also have the risk of interfering with repeated tasks; thus, the patient’s job may be at stake, which may affect the patient’s wellbeing further and worsen the situation.

The recommendable medication, in this case, is Effexor XR 37.5 mg oral daily as it begins with the lowest dosage, which can be controlled based on the patient’s response. Since the medication is taken once a day, it can be prescribed in a period where the patient is off work hence cannot interfere with their daily activities. The caregivers need to monitor the patient carefully as they use antidepressants, and so should the family of the patient keeping close contact with the prescriber in case of any negative observations.

References

Dahale, A. B., Narayanaswamy, J. C., Venkatasubramanian, G., & Bagewadi, V. I. (2014). Successful use of agomelatine and venlafaxine combination in major depression. General hospital psychiatry36(1), e3.

Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry1(5), 368-376.

Milgrom, J., Gemmill, A. W., Ericksen, J., Burrows, G., Buist, A., & Reece, J. (2015). Treatment of postnatal depression with cognitive behavioural therapy, sertraline and combination therapy: a randomised controlled trial. Australian & New Zealand Journal of Psychiatry49(3), 236-245.

Pedrelli, P., Nyer, M., Yeung, A., Zulauf, C., & Wilens, T. (2015). College students: mental health problems and treatment considerations. Academic Psychiatry39(5), 503-511.

Willaert, L., Verbeke, P., Sienaert, P., & De, J. F. (2014). Irreversible monoamine oxidase inhibitors (IMAOI) to treat depressive disorders-limited use at present in Flanders. Tijdschrift voor psychiatrie56(10), 651-659.



Assignment: Decision Tree for Neurological and Musculoskeletal

By Day 7 of Week 8

Submit your Assignment, started in Week 6.

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

Submission and Grading Information

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

  • Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
  • Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
  • Click the Week 8 Assignment  You will also be able to “View Rubric” for grading criteria from this area.
  • Next, from the Attach File area, click on the Browse My Computer Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
  • If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
  • Click on the Submitbutton to complete your submission.

What’s Coming Up in Module 7?

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

Next Week

To go to the next week:

Module 7: Women’s and Men’s Health, Infections, and Hematologic Systems

What’s Happening This Module?

Module 7: Women’s and Men’s Health, Infections, and Hematologic Systems is a 2-week module, Weeks 9 and 10 of the course. In this module, you will examine women’s and men’s health, infectious diseases, and hematologic disorders as well as the types of drugs used to treat aspects of these disorders or health systems.

What do I have to do?     When do I have to do it?    
Review your Learning Resources Days 1-7, Weeks 9 and 10
Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders Post by Day 3 of Week 9, and respond to your colleagues by Day 6 of Week 10.

Go to the Week’s Content

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

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

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

Learning Objectives

Students will:

  • Evaluate patients for treatment of complex health issues
  • Evaluate patients for treatment of infections
  • Evaluate patients for treatment of hematologic disorders
  • Analyze patient education strategies for the management and treatment of complex comorbidities

Learning Resources

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

  • Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 364–371)
  • Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396)
  • Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436)
  • Chapter 51, “Birth Control” (pp. 437–446)
  • Chapter 52, “Androgens” (pp. 447–453)
  • Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)
  • Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661)
  • Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662–668)
  • Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694)
  • Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699)
  • Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714)
  • Chapter 79, “Antifungal Agents” (pp. 715–722)
  • Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
  • Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770)

Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5–15. doi:10.3109/13685538.2015.1004049

This article presents recommendations on the diagnosis, treatment, and monitoring of hypogonadism in men. Reflect on the concepts presented and consider how this might impact your role as an advanced practice nurse in treating men’s health disorders.

Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting. PLoS ONE, 9(2), e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872

This study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality, and HIV transmission.

Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. .https://doi.org/10.1016/j.maturitas.2016.01.007

This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition.

Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html

This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, and counseling.

Required Media

Laureate Education (Producer). (2019h). Pathopharmacology: Pharmacology and immunological disorders: Improvements in medications and drug administration [Video file]. Baltimore, MD: Author.
Note:
The approximate length of this media piece is 8 minutes.
Nurse Manager, Bette Nunn discusses how technology has improved the practice of administering drugs and created new and improved drug therapies. The importance of using technology as well as a patient’s knowledge of their own drug history is also discussed.

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

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

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

To Prepare

  • Review the Resources for this module and reflect on the different health needs and body systems presented.
  • Your Instructor will assign you a complex case study to focus on for this Discussion.
  • Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

By Day 3 of Week 9

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

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

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



            Sample Paper Week 9-Walden NURS 6521: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Woman’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Student’s Name:

Institutional Affiliation:

Woman’s and Men’s Health, Infectious Disease and Hematologic Disorders

Health is important for both men and women. It is a state of comprehensive physical, social, and mental well-being and not just the absence of illness or infirmity. Men and women are different. The fundamental observation spreads to their weakness and response to diverse infectious illnesses reasons for the observation being different, counting pathogens, and exposure to the common genetic aspects that control immune responses contrary to the pathogens. Also, hormonal factors that can alter vulnerability or illness progression and reaction to treatment are included.  Men and women are prone to hematologic illnesses involving blood and include complications with the red blood cells, platelets, white blood cells, bone marrow, spleen, and lymph nodes. This paper will explore the Woman’s and Man’s health, infectious disease and hematologic disorders concerning the patient presented in the case study.

Patients health needs from a case study

The patient presents with complaints of night sweats, hot flushing, and genitourinary symptoms that require immediate attention. She is 46 years old with a history of hypertension, and upon Blood Pressure (BP) check, it is at 150/90, an elevated blood pressure. The patient’s LMP is a month back and had ASCUS in pap in the last five years, which causes no problem in the late period. It can be concluded that her present symptoms indicate that she is in the perimenopausal period. When the women’s menopausal period begins, it causes a hot flush, depression, night flush, high BP, and changes in the genitourinary (Sturdee et al. 2017). She, therefore, requires to manage her symptoms to prevent more problems.

Treatment Regimen

To treat the patient, I would recommend hormone therapy, Estrogen-progestin therapy. On its own, estrogen improves menopause symptoms but, in another context, raises the risk of uterus cancer (endometrial cancer). Adding a progestin to estrogen will lower endometrial cancer’s danger to normal (Prior et al., 2017). I would also commend vaginal estrogen to avoid genitourinary complications. Vaginal estrogen, meant to deliver estrogen right to the local tissue, remains active in minimizing genitourinary symptoms like vaginal burning and dryness, painful sexual intercourse, urinary urgency and frequency, painful urination, and recurrent UTIs. Reducing the systemic estrogen exposure, even the lowest-dose vaginal ring, successfully can minimize frequency and urinary in postmenopausal females. Besides, I would commend the patient to take a low dose of antidepressants such as SSRIs to decrease symptoms and calm the mood disorder, take gabapentin to reduce night sweats and hot flush she is experiencing, clonidine to treat high blood pressure, and calcium and vitamin D supplements to strengthen her bones (Yoon et al., 2020).

Patient Education

The patient needs to manage her health needs and to help her; I would advise increasing fluid intake. Fluid intake will help flush any irritations through the bladder and out of a individuals’ body. I would also recommend the patient enhance the aerobic activity, stretching activity, and weight-bearing since these exercises reduce the risk of many hematologic disorders. It would also be good to take calcium diets. Calcium is an important mineral for the human body. It helps maintain and form healthy bones preventing disorders such as Osteoporosis (Cano et al., 2018). The patient will be required to increase the fiber intake rate, eat five portions of food, limit salt intake, and avoid tea, alcohol, coffee, and smoking that cause hot flushes. She should also avoid saturated fats and high-calorie diets taking omega 3fatty acids for a healthy heart, and have consistent screening to prevent cervical and breast cancer.

Conclusion

Health is important for both men and women. It is a state of comprehensive physical, social, and mental well-being and not just the absence of illness or infirmity. Men and women are different, and the fundamental observation spreads to their weakness and response to diverse infectious illnesses following diverse reasons. Men and women as well are prone to hematologic illnesses. As revealed in the case study, the patient’s complaints of night sweats, hot flushing, and genitourinary symptoms indicate that she is in the perimenopausal period and requires immediate attention in terms of treatments. Some of the treatments that can be recommended following her condition include hormone therapy, Estrogen-progestin therapy, vaginal estrogen, and a low dose of antidepressants such as SSRIs to decrease symptoms and calm mood disorder. Patient education would also be important, such as fluid intake, aerobic activity, and taking calcium diets to manage her needs fully.

References

Cano, A., Chedraui, P., Goulis, D. G., Lopes, P., Mishra, G., Mueck, A., … & Tuomikoski, P. (2018). Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide. Maturitas107, 7-12.

Prior, J. C., Seifert-Klauss, V. R., Giustini, D., Adachi, J. D., Kalyan, S., & Goshtasebi, A. (2017). Estrogen-progestin therapy causes a greater increase in spinal bone mineral density than estrogen therapy-a systematic review and meta-analysis of controlled trials with direct randomization. Journal of musculoskeletal & neuronal interactions17(3), 146.

Sturdee, D. W., Hunter, M. S., Maki, P. M., Gupta, P., Sassarini, J., Stevenson, J. C., & Lumsden, M. A. (2017). The menopausal hot flush: a review. Climacteric20(4), 296-305. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/13697137.2017.1306507

Yoon, S. H., Lee, J. Y., Lee, C., Lee, H., & Kim, S. N. (2020). Gabapentin for the treatment of hot flushes in menopause: a meta-analysis. Menopause27(4), 485-493. Retrieved from https://journals.lww.com/menopausejournal/Abstract/2020/04000/Gabapentin_for_the_treatment_of_hot_flushes_in.17.aspx

What’s Coming Up in Week 10?

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

Next Week

To go to the next week:

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

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

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

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

Learning Objectives

Students will:

  • Evaluate patients for treatment of complex health issues
  • Evaluate patients for treatment of infections
  • Evaluate patients for treatment of hematologic disorders
  • Analyze patient education strategies for the management and treatment of complex comorbidities

Learning Resources

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

  • Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)
  • Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396)
  • Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436)
  • Chapter 51, “Birth Control” (pp. 437–446)
  • Chapter 52, “Androgens” (pp. 447–453)
  • Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)
  • Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661)
  • Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662–668)
  • Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694)
  • Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699)
  • Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714)
  • Chapter 79, “Antifungal Agents” (pp. 715–722)
  • Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
  • Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770)

Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5–15. doi:10.3109/13685538.2015.1004049

This article presents recommendations on the diagnosis, treatment, and monitoring of hypogonadism in men. Reflect on the concepts presented and consider how this might impact your role as an advanced practice nurse in treating men’s health disorders.

Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting. PLoS ONE, 9(2), e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872

This study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality, and HIV transmission.

Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. .https://doi.org/10.1016/j.maturitas.2016.01.007

This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition.

Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html

This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, and counseling.

Document: Final Exam Study Guide (PDF)

Required Media

Laureate Education (Producer). (2019h). Pathopharmacology: Pharmacology and immunological disorders: Improvements in medications and drug administration [Video file]. Baltimore, MD: Author.
Note:
The approximate length of this media piece is 8 minutes.
Nurse Manager, Bette Nunn discusses how technology has improved the practice of administering drugs and created new and improved drug therapies. The importance of using technology as well as a patient’s knowledge of their own drug history is also discussed.

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

To Prepare

  • Review the resources for this module and reflect on the different health needs and body systems presented.
  • Review your peers case studies from Week 9.
  • Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

By Day 6 of Week 10

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

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

What’s Coming Up in Module 8?

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

Looking Ahead: Final Exam

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

To go to the next week:

Module 8

Module 8: Pediatrics

As an advanced practice nurse, you provide patient care across all stages of the lifespan. While you may not necessarily specialize in pediatrics, you will likely come across pediatric patients and may be involved in developing, implementing, and recommending drug therapy plans for pediatric patients. Of special note, the proper dosing and administration of pharmacotherapeutics for pediatric patients ensures their continued growth, development, and promotion of positive health outcomes.

What’s Happening This Module?

Module 8: Pediatrics is a 1-week module, Week 11 of the course. In this module, you will examine the practice of prescribing off-label drugs to children and explore strategies for making off-label drug use safer for children. You also complete your Final Exam.

What do I have to do?     When do I have to do it?    
Review your Learning Resources Days 1-7, Week 11
Assignment: Off-Label Drug Use in Pediatrics Submit your Assignment by Day 5 of Week 11.
Final Exam Complete by Day 7 of Week 11.

Go to the Week’s Content

Week 11: Pediatrics

Children, like adults, deal with variety of health issues, but they also have issues that are more prevalent within their population. One issue that significantly impacts children is the prescription of drugs for off-label use. As an advanced practice nurse, how do you determine the appropriate use of off-label drugs in pediatrics? Are there certain drugs that should be avoided with pediatric patients?

This week, you examine the practice of prescribing off-label drugs to children. You also explore strategies for making off-label drug use safer for children from infancy to adolescence, as it is essential that you are prepared to make drug-related decisions for pediatric patients in clinical settings.

Learning Objectives

Students will:

  • Evaluate the practice of prescribing off-label drugs to children
  • Analyze strategies to make the off-label use of drugs safer for children
  • Identify key terms, concepts, and principles related to prescribing drugs to treat patient disorders

Learning Resources

Required Readings

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Chapter 9, “Drug Therapy in Pediatric Patients” (pp. 58—60)

Corny, J., Lebel, D., Bailey, B., & Bussieres, J. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives. The Journal of Pediatric Pharmacology and Therapeutics, 20(4), 316–328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557722/

This article highlights pediatric governmental initiatives to prevent unlicensed and off-label drug use in children. Review these initiatives and guidelines and how they might impact your practice as an advanced practice nurse.

Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423

This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing. This study also examines off-label prescribing to children with ADHD.

Document: Final Exam Study Guide (PDF)

Required Media

Laureate Education (Producer). (2019i). Therapy for pediatric clients with mood disorders [Interactive media file]. Baltimore, MD: Author.

Assignment: Off-Label Drug Use in Pediatrics

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

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

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

To Prepare

  • Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
  • Reflect on situations in which children should be prescribed drugs for off-label use.
  • Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

By Day 5 of Week 11

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

  • Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
  • Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

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

Submission and Grading Information



Sample Paper Week 11-Walden NURS 6521: Off-Label Drug Use in Pediatrics

Advanced Pharmacology

Student’s Name:

Institutional Affiliation:

Circumstances under which Children Should be Prescribed Drugs for Off-label Use

More than 50% of drugs approved by the Food and Drug Administration (FDA) do not contain labeling for children. Therefore, pediatricians have to decide the appropriate prescription based on their clinical judgment. There is however specific guidance by various pediatric associations such as the American Academy of Pediatrics (AAP) on circumstances under which physicians can use drugs off-label on children.

These circumstances include absence of safe and licensed therapeutic options for a specific disease, the failure of the existing standard therapy to achieve success in treating the condition and lack of alternative forms of therapy for children. Other circumstances include lack of clinical trials and availability of convincing evidence on their effectiveness and safety of the of label drugs in children (Panther, Knotts, Odom-Maryon, Daratha, Woo & Klein, 2017).

Strategies to Make the Off-label Use and Dosage of Drugs Safer for Children from Infancy to Adolescence

The risk of adverse drug reaction is high in off-label use compared to approved medication. The risk is even higher for outpatients compared to hospitalized patients due to limited monitoring. Off label, medication requires maximum monitoring since they have not been previously tried on children thus the pediatricians are uncertain of reactions. Safety strategies include administering of label medication to inpatients only to maximize monitoring of the adverse effect. Secondly, physicians should report adverse reactions of off label medication as required by their professional code for purposes of documentation thus reference in subsequent cases (Tanemura, Asawa, Kuroda, Sasaki, Iwane & Urushihara, 2019).

Other strategies include use of electronic health systems to improve the quality of prescribing by integrating parameters such as age, weight, body surface area and renal function status in complex dosage calculations, which is essential in off-label medication. electronic health records facilitates correct dosage  and putting of precaution on negative  drug interactions by sharing patients medical  information to all additional participants in the treatment process (Corny, Lebel, Bailey & Bussières, 2015).

Another strategy is increasing access to evidence-based information regarding off label children medication and integrating pharmacists in pediatric wards for consultation in decisions regarding pediatric prescription of off label medication.

One of the off-label drugs that require extra care and attention when used in pediatrics is Budesonide. It is an inhaled corticosteroid used for asthma treatment. The children’s inability to use inhalers poses a danger of overdose of the drug. Other asthma drugs like mometasone and ciclesonide are new in the market therefor there lacks existing evidence on the implications of their use on children. They should therefore be cautiously prescribed for pediatric use.

References

Corny, J., Lebel, D., Bailey, B., & Bussières, J. F. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives. The Journal of Pediatric Pharmacology and Therapeutics20(4), 316-328.

Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics22(6), 423-429.

Tanemura, N., Asawa, M., Kuroda, M., Sasaki, T., Iwane, Y., & Urushihara, H. (2019). Pediatric off-label use of psychotropic drugs approved for adult use in Japan in the light of approval information regarding pediatric patients in the United States: a study of a pharmacy prescription database. World Journal of Pediatrics15(1), 92-99.



Final Exam

This Exam covers the content you have explored throughout this course.

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

By Day 7 of Week 11

Complete the Final Exam.

Submission and Grading Information

Complete the Exam by Day 7 of Week 11

To Complete this Exam:

Week 11 Exam

Module in Review

In this module, you evaluated the practice and circumstances of prescribing off-label drugs to children and analyzed the strategies used to make their use and dosage safer for children. After you have completed the Discussion and the Final Exam for this week, you have finished the course. Congratulations! Please complete the Course Evaluation form and submit by Day 7.

Congratulations! After you have finished all of the assignments for this week, you have completed the course. Please submit your Course Evaluation by Day 7.

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