This week we will apply pharmacology concepts to the gastrointestinal and hepatobiliary systems.

Symptoms of various gastrointestinal (GI) and hepatobiliary disorders often overlap, making diagnosis and treatment challenging. For example, symptoms such as nausea, vomiting, constipation, and diarrhea 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.

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 (ie diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

Learning Resources: Please plan accordingly throughout the week to review all learning resources that include but not limited to the lecturio resources and all required reading. There is much information provided but all is relevant that you will need not only for the successful completion of this course but also as you begin your practice as a Nurse Practitioner. As well, there are many required media videos for you to view this week and they are very informative.

Week 4 Assignment: Please use the following Case Studies to complete your Assignment for this week that is Due by Day 7.

To Prepare:

· Review the following case studies and answer ALL questions.

· When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.

· Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website and JNC 8 to complete assignment.

· Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.

CASE STUDY 1

Donald is a 60 year old male presenting with dyspnea (shortness of breath), chronic productive cough, wheezing, and fatigue. He smokes 1 pack of cigarettes per day for the last 40 years. Post-bronchodilator FEV1/FVC ratio < 0.70 confirms persistent airflow limitation. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?

CASE STUDY 2

Allen is a 49 year-year-old man seeking evaluation for “a burning sensation in my chest,” often after eating and worse at night. He has frequent feelings of bloating and occasional nausea. Allen consumes a diet high in fatty foods and caffeine. He drinks alcohol socially on weekends. PMH includes asthma, diabetes and hypertension. His current medications include prn albuterol, metformin 1000 mg po BID, nifedipine ER 60 mg po daily. How would you improve his drug therapy plan? What changes would you make? What is your working diagnosis and what medication would you prescribe? What information would you provide to the patient at his visit?

CASE STUDY 3

Jessica is a 37-year-old female diagnosed with mild persistent asthma. During her visit today, she reports having to use her albuterol 4 days per week over the past month. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough five nights during the last month. Her current medications include: fluticasone HFA 44 mcg, two puffs BID, albuterol MDI two puffs Q 4–6 H PRN shortness of breath, Medrol Dosepak, metformin 500 mg PO BID, Inderal LA 160 mg po daily. How would you step up therapy for this patient? What medication changes would you make? How would you monitor the effectiveness of this plan? What patient teaching would you provide?

CASE STUDY 4

June is a 71-year-old female and has Alzheimer’s Disease x 2 years. She presents with daytime dizziness, fatigue and increasing forgetfulness. Consider her labs and provide an updated drug therapy plan. Include complete medication orders. How would you monitor drug therapy? Labs: TSH 5 mU/L, vitamin D 29 ng/mL, B12 350 pg/mL, Hb 12.1 g/dL, HgA1C = 5.5% Meds: donepezil 5mg po qhs, zolpidem 10mg po qhs

Also, it will be very helpful to view the rubric for each assignment to ensure you've included all requirements before submission.

I look forward to and am excited about all that we will learn in Week 4!

Please Note: I am currently working on providing detailed feedback for your Week 2 Assignment. You will receive by end of day on Wednesday of this week.

Dr. Veleka Grady

NURS_6521_Week4_Assignment_Rubric

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