Week 10 Discussion pharm

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Howard is a 24 year-old male who presents to the clinic with his wife for what he states is severe lower back pain. He states the pain is so bad that he rates it as a “50 out of 10.” He also tells you that due to a past medical history of an ulcer, he cannot take any medications “like Motrin.” He states that the pain is from a car accident in 2012, and that it flairs up and he needs pain medications. He also tells you that he has a high pain tolerance, and that when he gets pain meds he requires the higher doses.

Discussion 1

  1. What would you do first prior to prescribing any medication?
  2. What are the various schedules of medications for controlled substances?
  3. Would you prescribe a long or short acting narcotic? Why or why not?

Discussion 2

  1. What other non narcotic medication options can you offer to this patient?
  2. What patient education is needed with them?
  3. What would you do if the patient and his wife tell you that none of them work for him?

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Discussion

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Case Study: A 16-year-old arrived at a local family planning clinic with pregnancy concerns due to unprotected intercourse. This encounter occurred two nights prior, and she believes she may be fertile but wants information regarding the “morning-after pill”.

  • What additional information should the nurse obtain during the assessment?
  • What educational information should the nurse provide to the patient regarding emergency contraception treatment and the side effects?

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Discussion 2 Patho

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  1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
  2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
  3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
  4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
    In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
  5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
  6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

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The DNP Project: PICOT Question, Purpose and Evidence-Based Intervention

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Practice Question

The following practice question will serve as the basis for the proposed DNP project  “For caregivers of children, on an acute pediatric medical-surgical unit at a tertiary Children’s Hospital, does the implementation of  ‘Commit to Sit’ integrative nurse rounding, compared with current practice, improve caregiver satisfaction, over 8-10 weeks?”

Purpose

The purpose of the proposed DNP project is to improve the caregiver satisfaction scores in an acute pediatric medical-surgical unit at a tertiary Children’s Hospital by implementing ‘Commit to Sit’ integrative nurse rounding which supports patient and family engagement by sitting during the interaction, at eye level, and maintaining eye contact.  Nurses will be empowered and supported to include the ‘Commit to Sit’ integrative nurse rounding intervention to daily rounds to improve satisfaction.  The project’s primary aim is to answer the PICOT question about whether the inclusion of ‘Commit to Sit’ integrative nurse rounding can impact patient satisfaction on an acute medical-surgical unit in 8-10 weeks.

The primary aim will be supported by the following objectives: (a) educate the acute medical-surgical unit nursing staff at a tertiary Children’s Hospital about ‘Commit to Sit’ integrative nurse rounding through a PowerPoint presentation to reinforce and support the outcomes of the project, (b) measure the compliance of the nurses’ incorporation of commit to sit integrative nurse rounding as it was intended which will be verified by the DNP student’s audit and observation, (c) assess the nurses’ adherence to the commit to sit nurse rounding which will be recorded by the DNP student through observation spot checks, rounding, and chart audits, (d) identify barriers and comfort level of nurses in using commit to sit nurse rounding, which will be queried and recorded by the student during scheduled daily huddles, staff meetings, and 1:1 interviews.

Evidence-Based Intervention

In the early 2000’s the Centers for Medicare and Medicaid Services (CMS) Value-Based Purchasing Program established by the Affordable Care Act, shifted compensation from volume of services to the overall quality of care provided (Centers for Medicare, and Medicaid Services [CMS], 2018; Mazurenko et al., 2017). As part of this change, person and community engagement or consumer satisfaction constituents a large component for reimbursement, and innovative strategies were developed to improve satisfaction.

The intervention to improve patient satisfaction of the hospitalized patient is the daily inclusion of ‘Commit to Sit’ to daily nurse rounding (CTS-R) (Pattison et al., 2017). This evidence-based intervention consists of the nurse performing daily rounds in a sitting position, using eye contact at an appropriate eye level during each interaction (Pattison et al., 2017). The intervention focuses on therapeutic communication, enhancing attentiveness, and improved perceptions of care without increasing the actual time spent at the bedside (Merel et al., 2016; Orloski et al., 2019; Pattison et al., 2017). This intervention has been supported and associated with The Beryl Institute Experience Framework as it aligns with the person-centeredness theme for patient experience (Silvera et al., 2017). The ‘Commit to Sit’ integrative rounding has been nationally recognized as a best practice that focuses on delivering patient and caregiver-centric communication to improve satisfaction (Merel et al., 2016; Orloski et al., 2019; Pattison et al., 2017).

As a best practice recognized by The Beryl Institute, CTS-R fosters a harmonious dialogue between the nurse, patient, and caregiver that supports a trusting, safe, and caring environment (Lidgett, 2016; Silvera et al., 2017). Placing control in the patient and caregiver’s hands, the nurse prompts the CTS-R with the question, “Do you mind if I sit and talk with you?” (Lidgett, 2016). Having the nurse in a sitting position at eye level, maintaining eye contact, evokes mutual interest and builds a rapport that has been seen to improve the experience and overall satisfaction of both the caregiver and patient without increasing time spent at the bedside and no additional costs (Lidgett, 2016; Merel et al., 2016; Orloski et al., 2019; Pattison et al., 2017).

The DNP student as a project manager has identified a Project Team of CTS-R champions who have agreed to assist in the implementation of this change project. The CTS-R Project Team consists of medical-surgical registered nurses from both day and night shifts.

References

Centers for Medicare & Medicaid Services. (2018). Hospital consumer assessment of healthcare providers and systems (HCAHPS) Survey. Retrieved November 4, 2021, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS (Links to an external site.)

Lidgett, C. D. (2016). Improving the patient experience through a commit to sit service excellence initiative. Patient Experience Journal, 3(2), 67-72. https://doi.org/10.35680/2372-0247.1148 (Links to an external site.)

Mazurenko, O., Collum, T., Ferdinand, A., & Menachemi, N. (2017). Predictors of hospital patient satisfaction as measured by HCAHPS: A systematic review. Journal of Healthcare Management, 62(4), 272-283. https://doi.org/10.1097/JHM-D-15-00050 (Links to an external site.)

Merel, S. E., McKinney, C. M., Ufkes, P., Kwan, A. C., & White, A. A. (2016). Sitting at patients’ bedsides may improve patients’ perceptions of physician communication skills. Journal of Hospital Medicine, 11(12), 865-868. https://doi.org/10.1002/jhm.2634 (Links to an external site.)

 (Links to an external site.)Orloski, C. J., Tabakin, E. R., Shofer, F. S., Myers, J. S., & Mills, A. M. (2019). Grab a seat! Nudging providers to sit improves the patient experience in the emergency department. Journal of Patient Experience, 6(2), 110-116. https://doi.org/10.1177/2374373518778862 (Links to an external site.)

Pattison, K. H., Heyman, A., Barlow, J., & Barrow, K. (2017). Patient perceptions of sitting versus standing for nurse leader rounding. Journal of Nursing Care Quality, 32(1), 1-5. https://doi.org/10.1097/NCQ.0000000000000214 (Links to an external site.)

Silvera, G. A., Haun MPH, C. N., & Wolf PhD, J. A. (2017). Patient experience: The field and future. Patient Experience Journal, 4(1), 7-22. https://pxjournal.org/journal/vol4/iss1/3

I NEED A COMMENT FOR THIS DISCUSSION BOARD WITH 2 PARAGRAPHS AND USE AT LEAST 3 SOURCES NO LATER THAN 5 YEARS.

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

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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 week, 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.

 

Case Study 1

 

HH is a 68 year-old M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.

Ht: 5’8” Wt: 89 kg

Allergies: Penicillin (rash)

 

Instructions:

 

1. Post a brief description of your patient’s health needs from the patient case study (see above). Be specific.

 

2. 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.

 

3. 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.

 

4. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

 

5. APA 7

 

6. At least 5 references

 

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 pat

ient’s health needs?

What education strategies might you recommend for ensuring positive patient health outcomes?

 

 

For this

week

, 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.

 

 

Case

 

Study

 

1

 

 

HH is a 68 y

ear

–

o

ld

 

M who has been admitted to the medical ward with community

–

acquired

 

pneumonia for the past 3 days. His PMH is significant for COPD, HTN,

 

hyperlipidemia,

 

and

diabetes. He remains on empiric antibiotics, which include

 

ceftriaxone

 

1 g IV

 

qday

 

(d

ay 3)

and

 

azithromycin

 

500 mg IV

 

qday

 

(day 3). Since admission, his clinical status

 

has improved, with

decreased oxygen requirements. He is not tolerating a diet at this

 

time with complaints of nausea and

vomiting.

 

Ht: 5’8” Wt: 89 kg

 

Allergies: Penicillin

(rash)

 

 

In

structions:

 

 

1.

 

Post

 

a brief description of your patient’s health

 

needs from the patient case study

(see above)

. Be

specific.

 

 

2.

 

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

.

 

 

 

3.

 

E

xplain 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

yo

ur response.

 

 

 

4.

 

Explain a patient education strategy you might recommend for assisting your patient with the

management of their health needs. Be specific and provide examples.

 

 

5.

 

APA 7

 

 

6.

 

At least 5 references

 

 

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 week, 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.

 

Case Study 1

 

HH is a 68 year-old M who has been admitted to the medical ward with community-

acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and

diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3)

and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with

decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and

vomiting.

Ht: 5’8” Wt: 89 kg

Allergies: Penicillin (rash)

 

Instructions:

 

1. Post a brief description of your patient’s health needs from the patient case study (see above). Be

specific.

 

2. 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.

 

3. 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.

 

4. Explain a patient education strategy you might recommend for assisting your patient with the

management of their health needs. Be specific and provide examples.

 

5. APA 7

 

6. At least 5 references

 

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unit 9 assignment

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For this assignment, you will be developing and presenting an Educational, Narrative PowerPoint. In the presentation of your chosen topic, be sure to examine the pathophysiological factors that influence the incidence and manifestations of acute, episodic, and chronic diseases in populations across the lifespan (MN551-3).

Narrative, PowerPoint Assignment Requirements

· Make sure all of the content topics of the assignment have been addressed.

· Cite at least three references in your PowerPoint; this may include peer-reviewed journal articles, textbooks, or evidence-based practice websites to support the content.

· All reference sources must be within 5 years.

· Do not use sources such as Wikipedia or UpToDate as a reference.

Design and develop a 8- to 12-slide PowerPoint presentation using voice/narrative feature on each slide (the title and reference slides do not count in the slide count, but must be included in the assignment), that will be used to educate the community about one of the following topics:

· Type II Diabetes

· Atherosclerosis

· Hypertension

· Depression

· Urinary Tract Infection

Narrative, PowerPoint Contents to include, but not be limited to:

· Risk factors and causes

· Possible consequences

· Prevention Strategies

· Treatment Modalities

PowerPoint Format:

· Follow APA 7th edition format for PowerPoint presentations.

· Use the slide notes section in the presentation to include information that follows your narration, being sure to follow the conventions of Standard English.

· Slide content should include brief points that identify the areas that will be addressed in the narration.

· In-text citations should be included with any brief points that were researched from outside sources, and the narration should fully explain the points.

· Reference all sources on a separate reference slide at the end of the presentation and cite each source in the body of the presentation using 7th edition APA format.

· Identify the sources of any pictures you use, being sure to cite them correctly in 7th edition APA style, using in-text citations.

Narration Guidelines:

· Maintain a professional tone by summarizing observations and evaluations for each slide.

· Ensure that your presentation is highly ordered, logical, and unified.

· Words should be clearly enunciated and professional tone should be sustained throughout the presentation narration.

· Audio recording should be free of background noise and interruptions.

Before finalizing your work, it is important to:

· Review Narrative PowerPoint Assignment Requirements (described above) and the Narrative PowerPoint Grading Rubric (under the Course Resources), to ensure you have completed all required elements of the assignment.

· Make sure to review your chosen topic carefully to make sure you have answered all content effectively.

· Utilize spelling and grammar checks to minimize errors.

· Follow the conventions of Standard English (correct grammar, punctuation, etc.).

· Make sure your presentation is original, insightful, and utilizes your logic and critical thinking skills; that your presentation is well-organized, with superior content, style, and mechanics.

· Utilize APA 7th edition format.

· Be diligent about APA formatting including paraphrasing and direct quotations, utilizing appropriate in-text citations, and referencing your sources.

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Discussion: Expert Testimony, Causality, and Argument from AnalogY

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Step 1 Consider the scenario.

For two weeks, Jeff and Dana have gone back and forth over what movie to see Friday after work. Jeff wants to go see a foreign picture, claiming it will broaden both of their cultural horizons. “I was a film major,” he says, “what more authority do you need?” Of course, Dana can’t argue with the fact that Jeff excelled in his film courses, “but that hardly makes you an expert. In fact, you’re so stubborn it feels like I’m talking to a wall. I want to see something romantic, something to remind you of how I should be treated once in a while!” Dana’s suggestion falls on deaf ears. “I swear, when it comes to romance movies, if you see one you’ve seen them all,” Jeff says. “It’s like running circles around the same old track. I could write the script for you and save us each the 10 dollars.”

Step 2 In your original post, evaluate arguments and post responses to the following.

  • Why does each kind of argument create an inferential claim? For example, why would Jeff’s expert testimony weigh more heavily than Dana’s when it comes to film choices?
  • Are we ever 100% certain about causal inferences?
  • Why do analogies work in some arguments but not in others?
  • Of the separate analogies presented in the scenario, which do you believe was the most successful? Why?
  • Present an example of a commonly used argument form.

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Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

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Generalized Anxiety Disorder is a psychological condition that affects 6.1 million Americans, or 3.1% of the US Population. Despite several treatment options, only 43.2% of those suffering from GAD receive treatment. This week you will review several different classes of medication used in the treatment of Generalized Anxiety Disorder. You will examine the potential impacts of pharmacotherapeutics used in the treatment of GAD. Please focus your assignment on FDA approved indications when referring to different medication classes used in the treatment of GAD.

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 with GAD.

The QUESTION

1.   Discuss the pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD.

2.   Compare and contrast different treatment options that can be used.

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Title : Chronic obstructive pulmonary disease

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Power point presentation Students are expected to expand their use of resources for evidence-based practice beyond the required text and explore nursing and related literature to improve their understanding and application of advanced interventions.

Each student will present a clinical case study and will be able to interpret health assessment findings and to evaluate clinical data and therapeutic options to differentiate between problem situations requiring nurse practitioner management, collaborative management, or referral to other providers. Refer to the PowerPoint presentation rubric

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Discussion 4

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my role is Functional Medicine Nurse Practitioner

Considering your role specialization (nurse educator, nurse informatics, nurse administrator, and family or adult-gerontology NP), reflect on the top three current trends or issues that you believe to be most important with regard to your chosen role and the impact the role has on patient outcomes. Synthesize knowledge from values theory, ethics, and legal regulatory statute.

Please note:

  • This is a reflection and therefore no references are needed nor expected.
  • There is only one (1) post for this discussion board.
  • There is no requirement to respond to any of your peers.
  • Your response should be 200-250 words in length.

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