Kathy is a 12-year-old female patient who presents to your clinic with a new diagnosis of iron deficiency anemia.
Kathy is a 12-year-old female patient who presents to your clinic with a new diagnosis of iron deficiency anemia. What education regarding diet and supplements should you provide the patient and her parents? What other anticipatory guidance information is necessary for this patient? Discuss your plan for treatment and the clinical guidelines you would use for reference.
John is a 72-year-old male with long-standing hypertension, angina, and heart failure. He is aware that his obesity and lack of exercise contribute to his diagnoses. He takes aspirin daily but is starting to have gastric irritation. He asks if there are alternatives. He proudly reports that his cardiologist tells him he has “Class I angina risk.” Explain the rationale for using ASA in this patient. What are the alternatives, if any, to ASA therapy? Help clarify the use of enumerated scales for CV diseases such as angina. Does Class I angina equate to low risk?
Anne is a 68-year-old female with chronic obstructive pulmonary disease (COPD). She was recently babysitting her grandkids and reports a 1-week history of worsening productive cough (green sputum) and increased shortness of breath. Current medications are Symbicort (budesonide/formoterol) and lisinopril. Vital signs in office today are 98.7 °F oral, RR 18, HR, 104, BP 135/70 mm Hg, and SaO2 93%. Lung auscultation reveals decreased breath sounds, diffuse inspiratory and expiratory wheezes, and no crackles. What additional medications should be considered for Anne’s COPD exacerbation and why? What can she do to protect herself in the future? Why is it important for Anne to know her vaccination status?
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. In your peer replies, please reply to at least one peer who chose a different topic.
NURS676B Advanced Pharmacology
Week 2 Discussion
Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #3 Anne COPD.
Melissa is a 31-year-old, recently married female who presents to your office for an annual visit. She has three children ages 2, 5, and 8. Her new husband wants to wait at least a year before they try to have a child of their own. She has used combined oral contraceptives (COCs) for more than 10 years. Since the birth of her last child, she has been using COCs intermittently. She finds it too difficult to remember to take the pills regularly and wants an easier method. Menses are regular, although her periods seem heavier than usual, and she gets more irritable when she is not taking the COCs. She rarely exercises and admits to smoking and drinking occasionally. She is overweight. She has no medical history. What additional information do you need to obtain? Discuss her options and provide evidence for your rationale. Include patient education in your discussion.
Emily is a 44-year-old African American woman who presents with a 6-week history of initial insomnia and a 10-pound weight loss. She admits to feeling sad almost every day since she lost her job 6 weeks ago. She has no interest in engaging in previously enjoyable activities. She denies suicidality (ideation or plan). She has never been treated for depression. Her physical examination is negative, vital signs and blood work including a thyroid profile is all within normal limits, and her body mass index is 22. Her mother has a history of depression and she was treated successfully with Sertraline. What medication should be considered for Emily and why? Does her age and childbearing potential influence your treatment decision? Is medication therapy enough? Please include medication education in your discussion.
Lilly is a 6-year-old girl who presents with a 2-week history of worsening redness, dryness, and rash to the volar aspects of the wrists and dorsum of the hands. The area is moderately pruritic. She has a history of stable asthma. On assessment, you note her rash is consistent with mild eczema. You would like to prescribe a topical corticosteroid. What potency should be considered for this patient? Include the frequency of application and length of recommended treatment. What can be done about her pruritus? Are there any OTC ointments that should be considered for this patient? Include medication and general patient education in your discussion.
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
In your peer replies, please reply to at least one peer who chose a different topic.
NURS676B Advanced Pharmacology
Week 3 Discussion
Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #3 Anne COPD.
Marty is a 66-year-old male chef who has been experiencing severe reflux symptoms for the past several weeks that seem to be worsening at night. He had similar symptoms two to three years ago that went away when he stopped drinking alcohol. He claims to remain abstinent, but his symptoms have returned. What additional information should you obtain? What medications should you consider for his symptoms? Discuss your assessment and plan of care including clinical guidelines that support your decision.
Kathy is a 32-year old Caucasian female with a history of migraine headaches since age 16. She has no other health issues. She is married with 4 children under age 10. She admits to life stressors. She drinks 3 cups of coffee a day. She has been well managed on Imitrex 50 mg and occasional OTC Excedrin until the past two months. She is now using her Imitrex more than 4 times a month and is not having resolution with two doses. Her exam and recent blood work are normal. What is your initial management plan for this patient? Is she a candidate for an alternative medication regimen? Would a headache diary be helpful with this patient? Use evidence-based guidelines to support your treatment plan.
James is a 19- year old African American male who was diagnosed with HIV one-month prior at his college health clinic. He was referred to a specialized HIV clinic for management. He was seen at the clinic, and he was advised to start antiretroviral treatment (ART) based on lab results. He never followed up. He admits that he is very scared and confused about ART. What education can you provide this patient about ART? What are the benefits and risks of ART? What patient education can you offer James about self-care in HIV disease?
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
In your peer replies, please reply to at least one peer who chose a different topic.
NURS676B Advanced Pharmacology
Week 4 Discussion
Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #3 Anne COPD.
James is a 51-year-old male Hispanic truck driver with a long history of diabetes and hypertension. His current medication regimen is Lisinopril 20mg QD, metformin 1000mg QD, Lipitor 40mg QHS, and ASA 81mg QD. His A1C is 7, BP is 144/80, total cholesterol is 266, HDL 44, LDL 177, and Trig 199. What other information should you know about this patient to feel confident that his care is fairly well optimized? What parameters would you like to see improved? What clinical guidelines should you adhere to when managing this patient? Are there any changes to treatment you should consider? Support your decisions with evidence.
Sally is a 60-year-old female who weighs 300 pounds. Her last menstrual cycle occurred at age 47. She has been told that she could not get osteoporosis because of her size; however, she recently read an article that made her anxious that this may not be true. She has never been active in sports and is lactose intolerant. What is the evidence about chronic obesity and bone health during menopause? Would she be a candidate for HRT as osteoporosis prevention/treatment? Because she is lactose intolerant, what are some calcium alternatives to dairy? Use evidence-based research to support your patient recommendations.
Nancy is 26-year-old chronic hypertensive patient who has been seen at your clinic for 5 years. She happily reports to you today that she is two months pregnant with her first pregnancy and needs a referral for prenatal care. Her HTN has been well managed on a calcium channel blocker and diuretic. She is normotensive today. Is she currently on any medications that must be stopped today before she sees an obstetrician/gynecologist? Review how prescribers can find information on pregnancy categories. What are the categories of hypertension (HTN) medications that are typically given to women with preexisting HTN who become pregnant?
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
In your peer replies, please reply to at least one peer who chose a different topic.
NURS676B Advanced Pharmacology
Week 5 Discussion
Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #3 Anne COPD.
Melina is a 36-year-old female with complaints of excessive fatigue, muscle aches, difficulty sleeping, weight gain, and hair loss in the past six months. She recently lost her job as a clerk and is under a lot of stress. She denies taking any medication and denies any medical history. She is crying at the clinic today and tells you that she does not feel right. Her labs demonstrate that her TSH is significantly elevated at 8. How will you approach and manage her complaints? What discussion will you have with the patient regarding her therapy going forward?
George is a 48-year-old man who presents to the clinic with a 2-day history of fever and a productive cough. History includes mild hypertension and a half-pack per day smoking habit. He is currently not taking medication for his high blood pressure because he did not like the adverse reactions. Vital signs today are 100.9°F oral, BP 135/82 mm Hg, and SaO2 96%. He has decreased breath sounds in the left lower lobe and CXR shows a left lower lobe consolidation. You suspect he has bacterial pneumonia. What is your medication management plan for this patient? Include patient education on medication administration, adherence, and side effects. Should you address his current smoking status, and if so, why?
Jackson is a 37-year-old male with a 10-year 1-PPD smoking history. He has no other health history and his last physical exam 6 months ago was normal. He is motived to quit and has been unsuccessful with OTC smoking cessation products. In the past 3 months, he has intermittently tried nicotine gum and lozenges. He is requesting a prescriptive option. What is your treatment recommendation for this patient? What important medication information regarding adherence, side effects, and follow-up should be included? What nonpharmacologic treatment education should Jackson receive?
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
In your peer replies, please reply to at least one peer who chose a different topic.
NURS676B Advanced Pharmacology
Week 6 Discussion
Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #3 Anne COPD.
Nancy is a 24-year-old female who is sexually active with multiple partners who presents to the clinic with painful blister-like sores on the vagina, pain when having sex, and a foul-smelling vaginal discharge for the past two weeks. She is diagnosed with genital herpes and chlamydial infection. Describe your treatment plan for Nancy and for her multiple sexual partners. How should you assist Nancy in getting her sexual partners to come for treatment? What are your obligations to report sexually transmitted diseases?
Nolan is a 55-year-old male with a 5-day history of nasal congestion, rhinorrhea, malaise, and irritated sore throat. His nasal discharge has gone from clear to yellow in color. He took OTC acetaminophen at onset of symptoms with minimal relief. He has no health history and his examination in your office today is unremarkable. He has already missed 2 days of work and insists he needs an antibiotic. He adds that he “always gets an antibiotic” when he sees the other clinician in your clinic. When looking at his chart, you confirm this to be true. You have diagnosed Nolan with a viral URI. What medication treatment plan do you recommend, if any? Discuss your patient education and outcome evaluation for this patient. What does the literature say about the over prescribing of antibiotics?
Maria is a 19-year-old exchange student from Brazil. She was started on daily isoniazid (INH) 4 months ago for latent tuberculosis (TB). She would like to be seen at your clinic now because it is closer to school. She has not taken her medication for 4 weeks and cannot recall when her labs were drawn last. She has no other health history and does not take any other medications. According to the national guidelines, how long would Maria likely need to take INH? Can she restart her medication even though she has been off for 1 month? How often should she be seen for follow-up? What are the black box warnings of INH?
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
In your peer replies, please reply to at least one peer who chose a different topic.
NURS676B Advanced Pharmacology
Week 7 Discussion
Reply to both prompts.
In the subject line of your posts, please identify which prompt you are responding to, for example, prompt #1.
Discussion Prompt 1 (Complete the Pathways to Safer Opioid Use interactive in week 7 first.)
Reflect on your experience with the Pathways to Safer Opioid Use interactive exercise. How did this exercise affect your attitude toward prescribing pain medications? What has been your experience with pain management in the past? What is your philosophy toward pain management as a prescriber? Explain.
Additionally, choose two of the following to address:
What are some of the challenges Dr. Martin faces daily in his practice? How do those challenges affect the care he provides his patient? What could Dr, Martin do differently to address these challenges and provide a different standard of care to his patients?
What are some common situations that arise with acute and chronic pain management? What can you do to reduce or eliminate potentially dangerous situations?
What decisions did you make that you felt were good, practical decisions, but were not considered the best decisions?
What decision did you make when you met with your patient Janet Martinez who complained of knee pain interfering with her ability to do her job? Do yon feel you made the right decision? If you did not provide the opioids, did you educate Janice on the dangers of opioid addiction? Why or why not? How common do you think this scenario plays out in actual clinical practice? Explain.
Tom, the NP, raised an interesting question about bias. Did bias factor into your decision making?
What can you do to protect your patients and yourself against opioid misuse? Use examples from the interactive to support your answer.
What steps can you take to monitor a patient’s prescription drug use? Use examples from the interactive to support your answer.
What impact can health literacy have on pain management? Use examples from the interactive to support your answer.
Discussion Prompt 2
Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, prompt 2, #1 Shar ankle sprain.
Shar is a 28-year-old female active golfer who fell down the stairs last week and presented to the office three days ago with a high-grade sprain of the right ankle diagnosed by the orthopedist. Today, she reports to you that her ankle is painful, tender, and swollen. She had difficulty ambulating after playing a round of golf with her friends yesterday. What is your treatment plan for Shar, and why? What clinical guidelines support your decision? What patient education should you give to Shar?
Hazel is a 32-year-old who thinks she may have a bladder infection. She reports treatment for similar symptoms 3 months prior. She is afebrile, has no back pain or costovertebral angle (CVA) tenderness, and denies vaginal discharge. Her in-office urine dip is positive for nitrites, WBCs greater than 20/hpf, and RBCs less than 5/hpf. Her only medication is Loestrin for birth control. She wants medication for the dysuria. She is a nonsmoker and allergic to sulfa drugs. What is your treatment plan for this patient? Is there any history missing from this patient that would have been helpful in deciding on a treatment plan? What education does she need? Include medication administration, adherence, side effects, and outcome evaluation in your discussion.
Jane is a 25-year-old who returns to the office with additional questions after being seen yesterday. She is breastfeeding 4-week-old Harrison and she was diagnosed with mastitis. She is nervous about taking the amoxicillin/clavulanate (Augmentin) she was prescribed. She wants to know if it is safe for Harrison who is fully breastfed. Harrison is nursing every 2 to 3 hours and gaining weight well. What reassurance can you offer Jane? Where can you find evidence-based information regarding the safety of medications for breastfeeding mothers? What education can you offer Jane about the potential side effects of Augmentin to Harrison? Explain the importance of the “Pregnancy and Lactation Labeling Rule” that is found on all prescription drugs.
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
In your peer replies, please reply to at least one peer who chose a different topic.
NURS676B Advanced Pharmacology
Week 8 Discussion
Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #3 Anne COPD.
Diana is a 52-year-old female retired nurse who has been on methadone maintenance for 5 years for prior heroin addiction. Her confirmed dose is methadone 80mg po daily. She has herniated discs at L4–L5 and L5–S1. She has failed conservative treatment with physical therapy, chiropractic spinal manipulations, epidural steroid injects, and long-term NSAID use. She presents to the clinic for spinal fusion consultation. However, she is worried about having too much pain and having to take too many pain medications after surgery. What is your plan of care for Diana? Discuss different pain management options, including ways to reduce the risks associated with long-term opioid therapy and opioid use disorder and overdose.
Bridget is 16-year-old female who comes to the clinic for a sports physical with her mom. When her mom leaves the room during the examination, Bridget asks for a prescription for birth control. She requests that you do not tell her mother. Bridget is healthy with no allergies. She is at the 50th percentile for body mass index (BMI). Her blood pressure is 112/68 mm Hg and her examination is normal except for mild acne on her face and upper chest. What is Bridget’s initial treatment plan? What is the legal age in your state when adolescents can self-consent for contraception? What education does she need?
Samuel is an 82-year-old male brought in by his daughter for complaints of low blood sugar. Samuel has a history of type II diabetes well-controlled with glyburide and diet. He was treated last week at an urgent care for a suspected staph infection to his arm with sulfamethoxazole and trimethoprim. He also takes lisinopril, Lipitor, Flomax, Paxil, Coenzyme Q10, and a multivitamin. His daughter also found old prescriptions for alprazolam, atenolol, and terazosin in his medicine cabinet. With what you know about drug-drug interaction in older adults, what could be the cause of his hypoglycemia? What questions do you need to ask the patient and his daughter about safe medication management? What education should be offered to this patient and his family?
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.
In your peer replies, please reply to at least one peer who chose a different topic.
NURS676B Advanced Pharmacology
Week 2 Diabetes Mellitus Paper
Diabetes is an endocrine system disorder that affects millions of children and adults (ADA, 2015). 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 affect treatment recommendations. In this assignment, you will compare the different types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.
To prepare:
Review the chapters that discuss diabetes in Woo and Robinson (2015).
Reflect on the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
Select one type of diabetes.
Consider one type of drug used to treat the type of diabetes you selected, including the proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
Think about the short- and long-term effects on patients including the effects of drug treatments for the type of diabetes you selected.
To complete:
Write a minimum 4–page paper (excluding cover page and references) that addresses the following:
Explain 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 the proper preparation and administration of this drug.
Analyze and discuss the dietary considerations related to treatment.
Explain the short- and long-term effects of this type of diabetes on patients including the effects of drug treatments.
Include four or more appropriate scholarly sources from the last five years throughout the paper.
NURS676B Advanced Pharmacology
Week 6 Sexually Transmitted Diseases Paper
Although adolescents age 15–24 account for nearly half of the 20 million new cases of sexually transmitted diseases each year (Centers for Disease Control and Prevention, 2014), a diagnosis of an STD is a common presentation with patients of all ages in the primary care setting. For many patients, a diagnosis of this disease can lead to embarrassment, denial, and confusion. Today, there are several treatment options; however, resistance to treatment is emerging, which was not an issue in the past. In this assignment, you will consider the appropriate diagnosis and treatment of the disease, follow-up, and education of the patient.
To prepare:
Review the chapter that discusses sexually transmitted diseases and vaginitis in Woo and Robinson (2015).
Consider the therapeutic options available for the patient.
Choose at least two sexually transmitted diseases that you may encounter and treat as a primary care provider.
To complete:
Write a minimum 4-page paper (excluding cover page and references) that addresses the following:
Describe the method of diagnosing the two sexually transmitted diseases you selected.
Discuss how prevalent your chosen disease are and why you think it is a public health concern.
Discuss the treatment choice(s) and failure rate of your chosen therapeutic, if any.
Discuss your education plan and follow-up for your patient regarding diagnoses.
Include four or more appropriate scholarly sources from the last five years throughout the paper.
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