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As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

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

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

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 in your case study.

By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples
  Pharmacology is the study of the interactions between drugs and the body. The two broad divisions of pharmacokinetics refers to the movement of drugs through the body, whereas pharmacodynamics refers to the body’s biological response to drugs. Pharmacokinetics describes the drug’s exposure by characterizing absorption, distribution, bioavailability, metabolism, and excretion as a function of time, while pharmacodynamics describes drug response in terms of biochemical or molecular interactions (Arcangelo et al., 2017). The focus of this discussion will be in the process of warfarin in term of pharmacokinetics and pharmacodynamics of it in the body.   Ms. J.J. ‘s Health issue:   I was in charge of Ms. J. care couple years ago, a 85 year old African American women who was diagnosed with dementia cerebral infarction due to unspecified occlusion of cerebral artery, arthropathy, major depressive disorder, atrial fibrillation with a history of long-term use of anticoagulants, contracture of muscle, constipation, hypertension and GERD. She is currently on coumadin for the atrial fibrillation and the blood levels are monitoring every week in order to control the drugs therapeutic levels and avoid any adverse reactions.  Pharmacodynamics versus pharmacokinetics of this anticoagulant:  Many statistics from the stroke prevention in atrial fibrillation (SPAF) trial suggest that safety of anticoagulant in the elderly can be maximized through a careful monitoring and maintenance of the INR which is between 2 and 3. Ms. J’s therapeutic window for warfarin 2 to 3 which is the normal range for coumadin therapeutic level. Her weekly dosage is adjusted to her current blood levels. Bleeding is the most related complication of anticoagulant. Amy INR that increasing to 3.4 or 4.0 from Ms. J will result in nose bleeding, decreasing the coumadin or stop it for one or two days will be the only option (Horton & Bushwick, 1999).     Factors influencing Ms. J’s drugs therapy:   Multiple factors may affect the absorption of her medication. For example, the presence or the absence of flood in the stomach, blood flow to the area for absorption, and the dosage form of the drug. In Ms. J’s case, the most critical factor. Influencing her absorption of coumadin is gastric motility due to the history of constipation that she has, while a routine laxative dose and stools softens are administered daily for bowel movement.  Patient-centered care plan for management of constipation:   A non-pharmacologic care plan management can be introduced for the constipation in order to reduce the frequency and the quantity of laxative and stool. Softens doses that Ms. J is getting and ultimately gain a net decrease in gastrointestinal absorption of coumadin. Increasing a dietary fiber in her menu, encourage fluid and prune juice can have a significant impact on her bowel movement (Portalatin & Winstead, 2012).     Portalatin, M., Winstead, N. (2012). Medical Management of Constipation. Clinic in Colon and   Rectal Surgery. Doi: 10.1055/s-0032-1301754. Retrieved from   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348737/  Horton, J. D., Bushwick, B. M. (1999). Warfarin Therapy: Evolving Strategies in Anticoagulation American Family Physician. 59(3):635-646. Retrieved from   https://www.aafp.org/afp/1999/0201/p635.html     Arcangelo, V. P., Peterson, A. M., Wilburg, V., Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. (4th Ed.). Wolters Kluwer Lippincott Williams &
 

Healthcare Spending

Paying for health care consists of multiple approaches by insurance companies, state and federal governments, public payers, private payers, and the uninsured. Changes in payments for health care services occur as legislative changes are made, as well as changes to the Affordable Care Act (ACA).

Analyze how health care providers receive payment by health care users

Include the following aspects in the assignment:

Ø  Explore at least three types of health care providers.

Ø  What type of services does each health care provider provide (hospitals, nursing homes, home health care, MDs, APRNs).

Ø  Describe three types of healthcare users (private payers, public payers, and the uninsured).

Ø  Provide a listing of how each provider gets paid by users (insurance plans, self-pay, government agency pays).

Ø  Investigate several complicating factors in the actual financing of care of health insurances.

Ø  Complete this assignment in 1-2 pages.

 THIS IS NOTAN EASSAY IT IS AN ASSIGNMENT

Present a case study of a patient with suspected anemia. The patient may have a chief complaint of fatigue, dizziness, or failure to thrive (choose one). Include the following in the case study:

1. Identifying data
2. Chief complaint (CC)
3. History of present illness (HPI)
4. Review of systems (ROS)
5. Pertinent medications or allergies
6. Physical exam
7. Screening tools
8. Assessment, including differential diagnoses and any pitfalls of which one must be aware

 Purpose 

The process for affecting positive change to improve practice outcomes can start with either the identification of an area of interest or the identification of a potential or existing practice problem. Selecting an area of interest helps to define a direction for further inquiry. The purpose of this assessment is for students to identify and discuss an area of interest specific to advanced practice nursing. Students will identify a common practice problem related to the selected area of interest and provide a recommendation to affect positive change. Students will build on this project in later courses. 

Note: The purpose of the MSN project is to translate evidence currently found in the literature into practice within the chosen specialty track. Due to the research complexity, time involvement, and implications regarding human subjects, drug studies are not acceptable areas of interest for an MSN project. 

Requirements: 

Criteria for Content 

For this presentation, select an area of nurse practitioner (NP) practice that is of interest to you and in which you would like to see a practice change occur. Conduct a review of literature to see what is currently known about the topic and to find research support for the practice change you are recommending.  You may use a topic from the list at the link below or may investigate a topic of your choice as long as it pertains to NP practice. If you are unsure of your topic, please reach out to your instructor.  Be sure to provide speaker’s notes for all slides except the title and reference slides.  

Through this assignment, the student will demonstrate the ability to: 

1. Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care. (CO1)  
2. Analyze essential skills needed to lead within the context of complex systems. (CO3) 
3. Explore the process of scholarship engagement to improve health and healthcare outcomes in various settings. (CO4) 

List of Possible Topics 

Note: The purpose of the MSN project proposal  is to translate evidence currently found in the literature into practice within the chosen specialty track.  Due to the research complexity, time involvement, and implications regarding human subjects, drug studies are not acceptable areas of interest for a MSN project.

FNP

· Best evidence available about a topic (i.e. frequency of mammography)

· Screening recommendations (i.e. PSA for prostate cancer)

· Information about a healthcare-related phenomenon (i.e. when to talk to a person about ending treatment for a terminal illness, non-compliance of diet for individuals with congestive heart failure)

· Vaccinations for adults and/or children

· Early assessment for health-related concerns (i.e. depression in teenagers; suicide prevention for the elderly)

· Life style changes (i.e. smoking cessation, increasing activity in teenagers)

· Relationship between events or health concerns (i.e. relationship between dementia and caffeine consumption.

· Selection on an intervention (i.e. use of small group theory to lessen anxiety)

· Symptom management (i.e. pain, vomiting)

Create an 8-12 slide PowerPoint Presentation that includes the following: 

1. Introduction: slide should identify concepts to be addressed and sections of the presentation. Include speaker’s notes that explain, in more detail, what will be covered. 
2. Evidence-based projects: slide should explain the general importance of master’s-prepared nurses engaging in evidence-based projects related to nursing practice and profession. Provide speaker’s notes with additional detail and support from at least one outside scholarly source (not the textbook or course lesson). 
3. Conceptual Model: slide should provide an illustration of a conceptual model that could be used to develop an evidence-based project. Possible models include The John’s Hopkins or Advancing Research and Clinical Practice through Close Collaboration (ARCC) Models or you may select another model you find in the literature. In the speaker’s notes, explain how the model would be applied to the development of an evidence-based project. Provide support from at least one outside scholarly source (not the textbook or course lesson). 
4. Area of Interest: identify an area of interest related to NP practice in which a practice change may be needed. Slide should identify the area of interest and what is currently known on the topic. Speaker’s notes more fully explain what is currently known and should provide rationale for why the area of interest is important to NP practice. Provide support from at least one outside scholarly source (not the textbook or course lesson). 
5. Issue/concern and recommendation for change: slide should identify a specific concern related to your general area of interest and your recommendation for a practice change. Speaker’s notes should more fully explain the recommended change and rationale for the change. Recommendation should be supported by at least one outside scholarly source (not the textbook or course lesson). 
6. Factors Influencing Change: slide should identify at least 2 internal and external factors that could impact your ability to implement your recommended change. Speaker’s notes should more fully explain how the factors you’ve identified would support or impede the implementation of your recommendations. Factors may be based on personal experience or on information you found in your research. If the identified factors come from the literature, provide reference citations to support your ideas. 
7. NONPF Competencies: slide identifies at least two NONPF Competencies that are relevant to an evidence-based project related to your area of interest. Speaker’s notes should explain how the competencies relate to your area of interest. Provide support from at least one outside scholarly source (not the textbook or course lesson). 
8. Conclusion: slide provides summary points of presentation. Speaker’s notes provide final comments on the topic.  

Preparing the presentation 

Submission Requirements 

1. Application: Use Microsoft Power Point™ to create the PowerPoint presentation.  
2. Length: The PowerPoint presentation must be 8-12 total slides (excluding title and reference slides).   
3. Speaker notes are used and include in-text citations when applicable. 
4. A minimum of four (4) scholarly literature references must be used. 
5. Submission: Submit your file: Last name_First initial_Wk6Assessment_Area of Interest. 

Best Practices in Preparing the Project 

The following are best practices in preparing this project: 

1. Review directions thoroughly. 
2. Follow submission requirements. 
3. Make sure all elements on the grading rubric are included. 
4. Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing. 
5. Review the Creating a Professional Presentation located resource.  
6. Ideas and information that come from scholarly literature must be cited and referenced correctly. 
7. Abide by CCN academic integrity policy. 

 ASSIGNMENT CONTENT  

 Introduction  

 Slide should identify concepts to be addressed and sections of the presentation. Include speaker’s notes that explain, in more detail, what will be covered.  

 Evidence-based projects   

 Slide should explain the general importance of master’s-prepared nurses engaging in evidence-based projects related to nursing practice and profession. Provide speaker’s notes with additional detail and support from at least one outside scholarly source (not the textbook or course lesson).  

 Conceptual Model 

 Slide should provide an illustration of a conceptual model that could be used to develop an evidence-based project. Possible models include The John’s Hopkins or Advancing Research and Clinical Practice through Close Collaboration (ARCC) Models or you may select another model you find in the literature. In the speaker’s notes, explain how the model would be applied to the development of an evidence-based project. Provide support from at least one outside scholarly source (not the textbook or course lesson).  

 Area of Interest 

 Identify an area of interest related to NP practice in which a practice change may be needed. Slide should identify the area of interest and what is currently known on the topic. Speaker’s notes more fully explain what is currently known and should provide rationale for why the area of interest is important to NP practice. Provide support from at least one outside scholarly source (not the textbook or course lesson).  

 Issue/concern and recommendation for change 

 Slide should identify a specific concern related to your general area of interest and your recommendation for a practice change. Speaker’s notes should more fully explain the recommended change and rationale for the change. Recommendation should be supported by at least one outside scholarly source (not the textbook or course lesson).  

 Factors Influencing Change  

 Slide should identify at least 2 internal and external factors that could impact your ability to implement your recommended change. Speaker’s notes should more fully explain how the factors you’ve identified would support or impede the implementation of your recommendations. Factors may be based on personal experience or on information you found in your research. If the identified factors come from the literature, provide reference citations to support your ideas.  

 NONPF Competencies  

 Slide identifies at least two NONPF Competencies that are relevant to an evidence-based project related to your area of interest. Speaker’s notes should explain how the competencies relate to your area of interest. Provide support from at least one outside scholarly source (not the textbook or course lesson).  

 Conclusion  

 Slide provides summary points of presentation. Speaker’s notes provide final comments on the topic.   

 ASSIGNMENT FORMAT  

 APA Formatting  

1) References on reference slide must be in APA format. May use bullets instead of hanging indents.

2) In-text citations on slides and in speaker’s notes must be in APA format. 

 Writing Mechanics  

 Writing mechanics follow the rules of grammar, spelling, word usage, punctuation, and other aspects of formal written work as found in the current edition of the APA manual. Presentation length meets assignment guidelines.  

 Slide Formatting 

1) Presentation has title slide 

2) Presentation has reference slide(s)  

3) Slides are professional in appearance and tone;  

4) Slides are balanced spatially, including words and graphics.