Assignment

The Client with Fibromyalgia

You are a busy family nurse practitioner working in a local family practice. The chief complaint of the first patient of the day is “fibromyalgia”. You enter the room to find a woman in her mid-40s sitting in a chair in your exam room crying. Between her tears, she states she went to see a rheumatologist and was diagnosed with fibromyalgia, but he didn’t tell her anything about the disease. She states she isn’t sure what this means and wants you to explain it to her so she can let her friends know because they all think she has a made-up illness.

List five treatment options for fibromyalgia. Is one preferred over the other?

Identify four websites you could refer her to for further information.

Important Instruction about the Assignment 

1. The paper should always have an introduction statement that explains what the paper will entails.

2. Remember to include a cover page and use the most recent update APA formatting for references.

3. For this paper, you must provide 5-7 pages well written evidence-based research paper according to the rubric guidelines, follow the APA format formatting for references and support your paper with at least 5 nursing or medical evidence-based research articles not older than 7 yrs.

4. please take time to read and review it, if the paper is not up a master’s degree level standard, I will not accept the work. I just want to be clear about that before I assigned it to anyone. This is an advanced degree work that requires a very strong writer with the background and experience in Nursing and Medical field and a very well-developed English and written expertise. 

Another reflection, everyone…this one will help you to discover (or re-discover?) your own approach to advanced inquiry…Here is your prompt:

Recall in the Module 3 section titled, Differences in Research Methodologies, I described having all 3 research methodologies in my portfolio: Quantitative, Qualitative, and Mixed Methods. While you are not researchers (yet!), and therefore you may not have consciously considered this, we all have a philosophical perspective that guides our thoughts, beliefs, and values as we walk through this life. This means that how we view ‘reality’ or the world ‘out there’ will strongly influence the methods we choose to investigate it.  

Reflecting on how you view the world will provide perspective on why you view the world as you do and yourself in it. Such introspection provides a model for social inquiry and, by extension, advanced nursing inquiry. Considering that it is not unusual for a researcher (or a non-researcher for that matter) to occupy a range of positions along the spectrum from Positivist to Pragmatist to Constructivist, where would you place yourself on that continuum? How do you know? What real-world examples lead you to this conclusion? As a result of critically reflecting on your beliefs and values, which is intended to lead us to a better understanding of self, which research methodology would you be drawn to as a nurse researcher and why? Why is this process of self-discovery an important leg of your journey of learning in this course?

As you are engaging in this process of reflection, please do not restate the questions in your response post but rather weave your answers into a scholarly narrative. Also as FYI, references are never required when you are self-reflecting… 😉 Dr. R.

Click here for a reminder about the process and importance of self-reflection…

Describe the “levels of evidence” and provide an example of the type of practice change that could result from each.

Case Study – Pakistani Woman With Delusional Thought Processes. 

You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest.  The course page suggests writing 1 page per decision – my opinion is that it will be very difficult to justify your treatment decisions and provide scientific evidence in 1 page (especially for decision #1). I do not need you to tell me about the patient or the treatment options available to you – I am very familiar with the cases.  Your introductory page should be an overview of the disease state you are treating along with a purpose statement for the assignment.  Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data).

Introduction to the case (1 page)

• Briefly explain and summarize the disease state you are treating this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

Decision #1

• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Again, provide STRONG scientific evidence.  Clinical studies or treatment guidelines are a good place to start!
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #2 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Again, provide STRONG scientific evidence.  Clinical studies or treatment guidelines are a good place to start!
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision #3 (1 page)

• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Again, provide STRONG scientific evidence.  Clinical studies or treatment guidelines are a good place to start!
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Conclusion (1 page)

• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

After writing up your rationale at each decision point, I would ask yourself the following questions:

• Have I provided clinical data from a meta-analysis, case report or clinical trial to support the drug I picked being safe, efficacious and the best choice for this patient?
• Have I provided clinical data, etc. to support a clear rationale as to why the other treatment options are NOT optimal?
• Is the focus of my discussion on mechanism of action and receptors/neurotransmitters that the drug acts on? If the answer is YES, you should consider doing additional research to address the above two questions

Also include how ethical considerations might impact your treatment plan and communication with clients.

The rubric, as I interpret it, suggests 5 references cited with every assignment for full credit on this portion (20 points).  References used for your introductory paragraph, ethical considerations or conclusion do not count towards the 5 references required.  As a general rule of thumb, I would encourage you to reference AT LEAST two sources (not including the textbook) for each decision point – this will result in 6 references total for your clinical decision making.