Reflect on your experience as Dr. Manning in the Do No Harm interactive exercise. How did this exercise affect your understanding of how to identify and prevent prescription medication misuse?
DQ1 Reflect on your experience as Dr. Manning in the Do No Harm interactive exercise. How did this exercise affect your understanding of how to identify and prevent prescription medication misuse? What tools and techniques did you learn? Can you see yourself realistically using any of them in your practice? Why or why not?
Additionally, choose two of the following to address:
Which patient(s) from the video do you feel you worked well with, and which patient situation could you have handled differently? Explain.
Which patient from the video was the most challenging for you to work with? Why? Do you think you would work with them in “real life” the same way that you worked with them in this simulation?
How realistic did you find the portrayal of the relationship between Dr. Manning and Dr. Edwards? In your experience, do doctors interact in this way? Why do you think their interaction was included in this scenario?
How realistic did you find the portrayal of the relationship between the nurse practitioner and the doctor? In your experience, do doctors and NPs interact in this way? Why do you think their interaction was included in this scenario?
How realistic do you think these patient situations are? In your experience, have you seen a need for increased vigilance in PMM? Explain.
How does PMM awareness and prevention support the Hippocratic Oath? Use one of the patient scenarios to support your answer.
DQ2 Do an Internet search for standardized protocols and procedures for advanced practice registered nurses in an outpatient care or ambulatory care setting. Review the standardized procedures requirements for APRN practice in your state. Answer the following questions:
How do you think these standardized protocols and procedures guide advanced nursing practice?
What are the components that each standardized procedure should include according to your state requirements?
Discuss the difference between a disease-specific standardized procedure and a process protocol.
NURS676A 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, choice #2 using Schedule II substances.
There are a variety of requirements or restrictions states may impose on advanced practice registered nurses (APRNs) who prescribe controlled substances. In your state, discuss the role of the APRN in administering and dispensing drugs under the federal drug classification and schedules. Discuss your state requirements and restrictions, and identify practice barriers to the nurse practitioner role including the administration of controlled substances.
You have determined after a thorough history and examination that your patient’s injury requires treatment using a Schedule II substance. What are the policies for writing a prescription for a Schedule II CS? Can you offer the patient refills? What is the DEA policy on post-dated prescriptions for Schedule II drugs? How can you avoid tampering with prescriptions for controlled substances? This may vary by state. Make sure to research both the federal and state requirements where you practice.
Controlled substances are categorized using a classification system. Define the five different schedules for controlled drugs, and provide examples of drugs in each schedule. Explain the reason why controlled substances need to be categorized. What are the associated controls required in your state for prescribing in each schedule?
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.
NURS676A 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, choice #2 using Schedule II substances.
Della is a 52-year-old female with no medical history who has had difficulty sleeping for the past several months and is experiencing menopausal symptoms. She refuses any type of prescription medication and states, “I don’t trust them at all.” What options should you recommend for her to help alleviate her symptoms and why?
Bridget is a 22-year-old female with a history of controlled asthma. She takes Advair daily. She comes to you for advice on taking vitamin D supplementation. She is considering a vegan diet. She wants to know how much OTC vitamin D she should take, the food sources she should consider, and if she should have a blood test to check her vitamin D levels?
Valerie is a 38-year-old female with a history of adult cystic acne. She has been taking tetracycline 500 mg BID for the past five months with no improvement in symptoms. Further assessment reveals that she has been taking her tetracycline with breakfast and dinner and has recently (three months) started taking daily OTC antacids for her heartburn. Discuss the possible reasons for the failed response of tetracycline. What changes in her medication regimen do you recommend and why?
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 case study.
NURS676A 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, choice #2 using Schedule II substances.
Mary is 52-year-old female with HTN on Lisinopril 40mg and well controlled. She comes to the office because she has had a sore throat for several days, which is found to be strep negative. She has no fever or cough. What should you recommend for her sore throat and stuffy nose and why? What precautions should you give her regarding over-the-counter medication because of her medical history and why?
Astrid is an 18-year-old Asian female. She is a college freshman and recently went to a party where she had alcohol for the first time. She describes to you “horrible” side effects of facial flushing, nasal congestion, and dizziness. She is convinced she was “drugged.” With what you know about pharmacokinetics and racial differences, how can you help her understand the reaction she had to alcohol? What important education points do you need to provide and why?
John is an 82-year-old male patient with multiple chronic health issues, including mild dementia. He is a well-established patient, but you are seeing him for the first time. He needs all his medications refilled. He cannot remember the names of his medications. The provider who saw him three months ago reconciled his medication list. Is it safe to rely on your colleague’s chart notes? What steps can you take to ensure safe medication prescribing? What are the standards of medication reconciliation by the APRN?
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 case study.
NURS676A 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, choice #2 using Schedule II substances.
Jana, a 36-year-old single mother of three children, has a 15-year history of asthma. For the past month, she has been using albuterol every day. Previously, she had been using the inhaler every 3 to 4 months. She is in the office for a refill. What further information is needed to treat this patient and why? What clinical guidelines should you refer to for her medication management and why?
Susan is a 47-year-old female patient in for a follow-up visit to monitor her treatment for type 2 diabetes. Regular insulin was added to her treatment regimen last month. She denies symptoms of hypoglycemia and her glucose levels have been between 60 and 80. She tells you that her visit to her cardiologist went well and she was prescribed a new medication, atenolol. Discuss the possible complications when patients with diabetes are treated with a beta blocker. Are certain beta blockers more likely to create problems more than others are?
Lester is a 67-year-old male who is prescribed Warfarin for his new onset atrial fibrillation. He is concerned about starting this medication and admits he is forgetful about taking meds and doesn’t understand why he has to have follow-up blood tests. Discuss the patient education you would offer about Warfarin (include side effects). How would you address his concerns and questions? How can you ensure your patient education information is accurate and up to date?
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 case study.
NURS676A 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, choice #2 using Schedule II substances.
Clara has a five-week history of epigastric pain that is worse after she eats. The pain is minimally relieved by Mylanta or burping. She has come to your office for evaluation and your initial impression is gastritis. What is your recommendation and treatment plan? What clinical guidelines support your decision and why?
April is an 18-year-old female who comes to clinic today for her sports physical and immunizations. Her immunization history notes she has had all her vaccines through age 5 and one dose of the HPV vaccine at age 11. Can she finish the HPV series or will she need to start over? Based on the pharmacotherapeutics of this vaccine, what precautions and contraindications do you need to consider? What are the adverse drug reactions? What is the VIS and why is it important?
Janice is a 64-year-old black female with a history of HTN. She currently takes Lisinopril 20mg daily and Norvasc 10mg daily. Her most recent labs show cholesterol 360, triglycerides 450, LDL 220, and HDL 60. Her CR is 1.2 and GFR is normal. Her current blood pressure is 150/90. Do you think Janice’s treatment plan is optimal? What other information would you like to obtain? Discuss how you would guide Janice’s treatment plan using evidence-based guidelines.
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 case study.
NURS676A Advanced Pharmacology
Week 7 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, choice #2 using Schedule II substances.
Janice is a 64-year-old black female with a history of diabetes and HTN, currently controlled on metformin 1000mg daily, Lisinopril 20mg daily, and Norvasc 10mg daily. Her most recent labs show cholesterol 360, triglycerides 450, LDL 220, and HDL 60. Her CR is 1.2 and GFR is normal. Her current blood pressure is 150/90. Do you think Janice’s treatment plan is optimal? What other information would you like to obtain? Discuss how will you guide Janice’s treatment plan and provide evidence for your rationale.
Darren is a 46-year-old African American male with a history of HTN and hypertriglyceridemia. Current medications include ezetimibe 10 mg daily, niacin SR 1,000 mg at bedtime and HCTZ/lisinopril 25/20 mg daily. He complains of lack of energy, core weight gain, and a decrease in erections. Labs reveal testosterone 180 ng/dL (193–836 ng/dL) with normal TSH/Thyroxine, FSH, LH, and PSA. Is this patient a candidate for testosterone therapy? Why or why not? Which, if any, of his medications are contributing to his symptoms?
Tom is 50-year-old male who presents with distal lateral subungual onychomycosis of his left great toe. He has had symptoms for four months. On exam, he also appears to have interdigital tinea pedis. Referring to clinical guidelines, what is the first-line treatment for both tinea pedis and onychomycosis in adults? What medication precautions does the patient need to be educated on? What kind of follow-up does the patient require?
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 case study.
NURS676A 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, choice #2 using Schedule II substances.
Clementine is a 48-year-old female who has had right ear pain and fullness for the past week that is worsening. She has felt hot but has not taken her temperature. In the office, her temperature is 101, and her TM is red, bulging, and painful to examination. The canal is red and stenosed. Your impression is otitis media and externa. What is your treatment plan for her and why? What patient teaching should you provide? Why did you choose this teaching?
Matt is a 15-year-old male who presents with complaints of ankle pain x 4 hours after “twisting” his foot while playing soccer. His x-ray is negative and examination is consistent with a moderate ankle sprain. He rates his pain 8/10 (1-10 pain scale). What pain medication options can you offer Matt? What side effects of your prescribed regimen does he need to be educated on? Should his parents be involved in your discussion?
Maria is a 26-year-old female with a 2-week history of cough and congestion, which started out as a “normal cold” and now “feels worse.” She took 3 days of antibiotics her mother gave her from Mexico (name unknown). No change in symptoms. NKDA. Notes green mucous and nasal discharge. Positive exam findings include temperature of 100.0°F, greenish postnasal drainage, swollen turbinates, and frontal sinuses tenderness. What is your recommendation for treatment and why? When should the patient expect to feel better? Are there any OTC remedies to consider?
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 case study.
NURS676A Advanced Pharmacology
Week 2 Assignment
Legal Profession Paper
You are working as an advanced practice nurse at a community health clinic. You unintentionally make an error when prescribing a drug to a patient. You do not think the patient knows that you made the error.
To prepare:
Consider the ethical implications of disclosure and nondisclosure.
Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic.
Consider what you would do as the advanced practice nurse in this scenario including whether you would disclose your error.
Review the Institute for Safe Medication Practices website. Consider the process of writing prescriptions, and think about strategies to avoid medication errors.
To complete:
Write a minimum 4-page paper in APA format (excluding cover page and references) that addresses the following:
Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state.
Describe what you would do as the advanced practice nurse in this scenario including whether you would disclose your error. Provide evidence for your rationale.
Explain the process of writing prescriptions and include strategies to minimize medication errors.
Include four or more appropriate scholarly sources from the last five years throughout the paper.
NURS676A Advanced Pharmacology
Week 6 Assignment
Cardiovascular Paper
According to the CDC, 32.5% of people in the United States have hypertension, and 3.7 million patients have a diagnosis of essential hypertension (CDC/National Center for Health Statistics: http://www.cdc.gov/nchs/fastats/hypertension.htm [accessed March 26, 2016]). Hypertension is frequently managed in primary care, and its sequelae can be life altering for patients. Patients with hypertension may have other comorbid conditions, including diabetes, hyperlipidemia, and obesity.
For this assignment, you must choose from one of the following patients and develop a treatment plan that addresses your chosen individual’s issue in total, which will help to optimize her or his health.
Case #1: A 46-year-old African American female with long-standing blood pressure of 180/110, treated intermittently because of insurance issues. The patient also has type 2 diabetes and a BMI of 27. She currently is employed and has a PPO. Her last blood pressure medication was HCTZ and she tolerated it well, but her blood pressure has never been lower than 170/80.
Case #2: A 69-year-old Caucasian female with history of MI 20 years ago, currently on metoprolol and Norvasc. Her blood pressure readings on her last several visits have been 155–170/70–90 with a heart rate of 70–90. She has no chest pain. Her other medications are ASA 325mg, Prilosec 20mg, Lipitor 20mg, and Tylenol prn. She has a history of high cholesterol, and her lipid profile has been normal for the past 2 years.
Case #3: A 59-year-old Hispanic male with type 2 diabetes on metformin 1000mg, Amaryl 4mg, Lipitor 40mg, lisinopril/Hctz 40/25, and Tricor. His last A1C was 12, and his current blood pressure is 170/88. Office urine microalbumin 100ug/mg.
Case #4: A 39-year-old Hispanic female with headaches for the past two weeks. She is new to you, but she has been to the office 3 times in the past 4 weeks. Your partner put her on HCTZ for a blood pressure of 188/90. Today, her blood pressure is 180/74, and her heart rate is 90. She continues to have headaches. Her lab work had the following abnormalities: Her lipid profile shows total cholesterol of 325, HDL of 30, LDL of 78, and triglycerides 322, A1C 8, and BMI of 33.
To prepare:
Review the chapter that discusses rational drug selection, diabetes mellitus, hyperlipidemia, and hypertension in the text (Woo & Robinson).
Consider the medications that are used for patients with diseases outlined in the patient problems listed above, taking into consideration age, gender, and culture.
Think about the pathophysiology of comorbid diseases.
To complete:
Write a minimum 4-page paper in APA format (excluding cover page and references) that addresses the following:
Briefly describe the disease processes of your chosen patient.
Describe the approach to the pharmacological treatment plan for the patient that should optimize this patient’s health.
Describe your optimal goal for your chosen patient and discuss the national guidelines that support your goals.
Describe the potential pharmacological interactions of your chosen plan and the education necessary for the patient in regards to these potential interactions.
Describe the interdisciplinary team that might be involved in the care of the patient and how working collaboratively as a team affects patient outcomes.
Discuss the nonpharmacological educational needs for this patient.
Discuss the health maintenance needs for this patient to maintain optimized health.
Include four or more appropriate scholarly sources from the last five years throughout the paper.
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