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Interview Transcript Assignment: Advocating for the Nursing Role in Program Design and Implementation

Assignment: Advocating for the Nursing Role in Program Design and Implementation

As their names imply, the honeyguide bird and the honey badger both share an affinity for honey. Honeyguide birds specialize in finding beehives but struggle to access the honey within. Honey badgers are well-equipped to raid beehives but cannot always find them. However, these two honey-loving species have learned to collaborate on an effective means to meet their objectives. The honeyguide bird guides honey badgers to newly discovered hives. Once the honey badger has ransacked the hive, the honey guide bird safely enters to enjoy the leftover honey.

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Much like honeyguide birds and honey badgers, nurses and health professionals from other specialty areas can—and should—collaborate to design effective programs. Nurses bring specialties to the table that make them natural partners to professionals with different specialties. When nurses take the requisite leadership in becoming involved throughout the healthcare system, these partnerships can better design and deliver highly effective programs that meet objectives.

In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.

To Prepare:

Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.

Select a healthcare program within your practice and consider the design and implementation of this program.

Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation. Interview Transcript Assignment: Advocating for the Nursing Role in Program Design and Implementation

The Assignment: (2–3 pages)

In a 2- to 3-page paper, create an interview transcript of your responses to the following interview questions:

Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?

Who is your target population?

What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?

What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?

What is the role of the nurse in healthcare program implementation? How does this role vary between the design and implementation of healthcare programs? Can you provide examples?

Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

 

1

Interview: Implementing a New Program (please annotate your title here)

First Name Last Name

Walden University

Policy and Advocacy for Improving Population Health

NURS 6050

Date

2

Interview: Implementing a New Program (please state your title here)

The introduction provides context to your readers to prepare them for your paper’s

argument or purpose. An introduction should begin with discussion of your specific topic (not

a broad background overview) and provide just enough context (definitions of key terms, for

example) to prepare your readers for your purpose statement. A purpose statement should come

at the end of your introduction and state clearly and concisely what the purpose or central

argument of your paper is. The introduction prepares your reader for the purpose statement, and

the rest of the paper follows in support of it. The introduction and purpose statement should be

at least 6-8 clear and detailed sentences with credible sources to support the writing.

Interview Questions with Responses

Interviewer: Tell us about the healthcare program, within your practice. What are the costs

and projected outcomes of this program?

Dr. Denise: Answer using at least 6-8 complete and detailed sentences

Interviewer: Who is your target population? (Be specific using at least 6-8 complete and

detailed sentences)

Dr. Denise: The target population consist of 300 men and women who… (6-8 complete and

detailed sentences)

Interviewer: What is the role of the nurse in providing input for the design of this healthcare

program? Can you provide examples?

Dr. Denise: Answer using at least 6-8 complete and detailed sentences.

Interviewer: · What is your role as an advocate for your target population for this healthcare

program? Do you have input into design decisions? How else do you impact design?

3

Dr. Denise: Answer using at least 6-8 complete and detailed sentences with information from

the stated credible sources to support the writing.

Interviewer: What is the role of the nurse in healthcare program implementation? How does

this role vary between design and implementation of healthcare programs? Can you provide

examples?

Dr. Denise: 6-8 complete and detailed sentences

Interviewer: Who are the members of a healthcare team that you believe are most needed to

implement a program? Can you explain why? Interview Transcript Assignment: Advocating for the Nursing Role in Program Design and Implementation

Dr. Denise: 6-8 complete and detailed sentences

Conclusion

The conclusion both restates your paper’s major claim and ties that claim into a larger

discussion. Rather than simply reiterating each major and minor point, quickly revisit your

purpose statement or thesis and focus on ending the paper by summarizing the main points of

the writing. Use at least 5-6 sentences to summarize the paper.

The writing should be in APA format. Review the Rubric to ensure all criteria is addressed.

·

·

4

References

(Provide at least 3 references for the assignment. Credible sources

provide support for the writing).

APA interview format does not require a reference to the interview in your reference list since it is not a

source that can be found by another person.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).

Burlington, MA: Jones & Bartlett Learning. Interview Transcript Assignment: Advocating for the Nursing Role in Program Design and Implementation

 

NURS__Week_8_Assgn_interview_Example_Paper

NURS 6521: Advanced Pharmacology final exam

Question 1

A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session?

Targeted therapies achieve the therapeutic benefits of traditional chemotherapy with no risk of adverse effects.

Targeted therapies have the potential to provide prophylactic protection against neoplasia in high-risk individuals.

Targeted therapies are significantly more cost-effective than traditional chemotherapeutic drugs.

Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected.

 

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Question 2

Alprostadil (Caverject), a drug used to treat erectile dysfunction, has been prescribed to a 42-year-old patient. When providing education to the patient and his wife, the nurse should inform the wife about which of the following adverse effects?

Low blood pressure

Vaginal burning

Increased heart rate

Reduced desire for sexual activity

 

 

Question 3

A 12-year-old boy is being discharged from the hospital after … The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to

the mother regarding why the boy needs to take the medications.

both the boy and his mother regarding all medication issued. NURS 6521: Advanced Pharmacology final exam

the boy by telling him not to worry about the medications and to take them as directed.

the mother and be sure to reinforce the need to force the medications, if her son does not want to take them.

 

 

Question 4

A 30-year-old African-American woman tested positive for …and is prescribed … The nurse will plan the patient’s care to include close monitoring of the drug therapy because

the process of drug

the therapeutic .

the patient is at greater risk for high serum levels of the drug.

the process of

 

 

Question 6

A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient?

Take

Avoid

Take the

.

 

 

Question 7

Laboratory testing has confirmed that a patient has chloroquine-resistant malaria and the patient’s physician has prescribed quinine along with an adjunctive drug. The nurse should question the physician’s order if the patient has a history of

osteoporosis or

chronic .

 

 

 

 

Question 8

A nurse is explaining to a pregnant 21-year-old college student why she cannot continue to take ibuprofen (Advil) for her headaches. The nurse draws a picture depicting drug molecules crossing the placental membrane and entering into the fetal circulation. The nurse tells the patient that the main reason this happens is because

there is a 40% increase in blood volume during pregnancy.

the mother’s heart rate is 10 to 15 beats per minute faster during pregnancy.

drugs compete with the hormones of pregnancy for albumin-binding sites.

hemodilution of plasma albumin occurs.

 

 

66-year-old man has made an appointment with his primary care provider to discuss his recent …and has requested a prescription for …based on television commercials he has seen. What characteristic of this patient would most likely contraindicate the use of

The patient takes allopurinol for the treatment of gout

The patient has a family history of osteoporosis and has undergone bone density testing

The patient has unstable angina and uses a nitroglycerin patch

The patient often takes ginseng when he gets a common cold

 

 

 

Question 10

A man has a demonstrated history of androgen deficiency and the consequences of this health problem include an inability to maintain an erection. Which of the following medications would best address this patient’s erectile dysfunction (ED)?

Exogenous testosterone

 

 

Question 11

A 39-year-old woman is receiving doxorubicin for the treatment of cancer. After each treatment, the patient has acute nausea and vomiting accompanied by a slightly increased heart rate. The nurse will advise her to

perform relaxation techniques after the treatments.

make an appointment for cardiac function tests.

take the drug only at bedtime.

perform light exercise after administration of the drug.

 

 

 

Question 12

A nurse has administered filgrastim to a diverse group of patients in recent months. Which of the following patients should the nurse observe for extremely elevated white blood cell counts following administration of the drug?

A 19-year-old

A 25-year-old female with

A 39-year-old female with

A 47-year-old male with a=

 

 

 

Question 13

A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following?

Dental hygiene practices

Headaches

 

 

Question 17

A female patient is taking filgrastim (Neupogen) to decrease the incidence of infection. The nurse notices a small increase in the neutrophil count 2 days after starting therapy. The nurse’s evaluation of the increase is that

the therapeutic effect of the drug is slow, and it is likely to cause adverse effects.

the drug

the therapeutic effect of the drug is fully evident.

the increase in the

 

 

 

Question 18

A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment?

The mother and grandmother’s understanding about the drugs

How clean the house is

The health status of

Where the

 

 

Question 19

A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to

the inability of infants and children and describe symptoms of adverse drug reactions.

increased body surface area relative to body volume in infants and children.

increased heart rate and subsequently rapid drug distribution among infants and children.

immature liver and kidney function in infants and children.

 

 

 

Question 19

A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to

the inability of infants and children and describe symptoms of adverse drug reactions.

increased body surface area relative to body volume in infants and children.

increased heart rate and subsequently rapid drug distribution among infants and children.

immature liver and kidney function in infants and children.

 

 

 

Question 20

A nurse is caring for a 46-year-old female patient who is taking paclitaxel for ovarian cancer. Two or three days after the infusion of the drug, the nurse must closely monitor for which of the following?

Neurotoxicity

 

 

 

Question 21

A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?

Nephrotoxicity

 

 

 

Question 22

A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause

orange-tinged urine.

staining of permanent teeth.

sleep deprivation.

deep muscle pain.

 

 

Question 23

Mr. Laird is a 49-year-old electrician who experienced severe burns on his trunk, arms, and hands in a workplace accident 2 weeks ago. Part of his ..

Apply a layer of silver sulfadiazine that is sufficiently thick to make the wound bed invisible.

Cleanse the wound of

Apply a thin layer of the drug to

Perform thorough

 

 

Question 24

A patient has been prescribed daptomycin for a complicated skin infection. Which of the following will the nurse advise the patient to report immediately?

Nausea and

Muscle pain or tingling

 

 

Question 25

An immunocompromised 7-year-old child was recently discharged home with a … for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, …

Caregiver

Ineffective Family Therapeutic Regimen Management

Delayed

Knowledge

 

Question 26

A patient’s current course of cancer treatment involves the administration of a conjugated monoclonal antibody. What characteristic of the ?

The drug is derived from .

The targeted therapy is combined with .

The targeted therapy is combination of a monoclonal antibody, a kinase inhibitor, and an inorganic cytotoxin.

The drug is able to adapt its pharmacokinetics to the etiology of the patient’s cancer.

 

 

 

Question 27

 

A female patient has been prescribed estrogen therapy. Which of the following will the nurse advise the patient is a common ?

 

Migraine headaches

 

Breakthrough bleeding

 

Dizziness

 

Changes in libido

 

 

Question 28

A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine?

A 38-year-old Caucasian woman with

A 60-year-old African-American man who

A 48-year-old Caucasian man who has

A 28-year-old African-American woman with

 

 

Question 29

A patient with a diagnosis of chronic myeloid leukemia has met with her oncologist, who has recommended treatment with the kinase inhibitor imatinib. What route of administration should the nurse explain to the patient?

Daily intramuscular injections throughout the

Peripheral IV administration three times a day

Weekly IV infusions over 6 to 8 hours through a

Oral administration of imatinib in a

 

Question 37

A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A …will be to

take an antiemetic or antidiarrheal for adverse .

use an alternative form of birth control, if taking an oral contraceptive.

use an aspirin for relief of.

take the drug with . NURS 6521: Advanced Pharmacology final exam

 

 

Question 38

A nurse is assigned to a patient who is at 32 weeks’ gestation and is receiving …for 24 hours to control preterm labor. Which of the following nursing actions will the nurse take to decrease the risk of hypotension and promote circulation to the fetus?

Instruct the patient to lie on her back during the infusion.

Instruct the patient to notify the nurse if she experiences palpitations.

Instruct the patient to limit the amount of her fluid intake during the therapy.

Instruct the patient to lie on her left side during the infusion.

 

 

Question 39

A nurse is caring for a patient with cancer who has been prescribed dronabinol (Marinol) to help reduce nausea and vomiting from chemotherapy. The nurse will inform the patient that h…NURS 6521: Advanced Pharmacology final exam

methamphetamine.

 

 

Question 40

A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the intramuscular route. The nurse participating in the

Incontinence, Functional, related to neurosensory and musculoskeletal changes

Confusion, Chronic, related to CNS changes resulting from adverse drug effects

 

 

 

Question 41

A 9-year-old boy was bought to his primary care provider by his mother with signs and symptoms of hookworm infection and will be sent home with a prescription for … When provided patient and family education, the nurse should teach the mother with which of the following measures to avoid reinfection following treatment?

The importance of vigilant hygiene for the boy and the other members of the family

The need for the boy to provide serial stool samples for 6 months following treatment

The need to supplement the anthelminthic

The need to use prescription skin cleansers during

 

 

 

Question 42

A patient has been admitted to the critical care unit of the hospital with bacterial septicemia that has failed to respond to initial antibiotic treatment. The patient’s most recent blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA) in the patient’s blood. The nurse

Doripenem (Doribax)

 

NURS 6521: Advanced Pharmacology final exam Question 43

A nurse is working in a women’s hospital where she is caring for a new mother who is experiencing postpartum urinary retention. Bethanechol (Urecholine) has been ordered. The nurse will observe for which of the following?

Hypertension

Decreased salivation

 

 

 

Question 44

A patient is pregnant and is at 7 weeks’ gestation. She has type 1 diabetes and has been taking insulin since she was 13 years old. She asks the nurse if the insulin will be harmful to her baby. The best response to the patient by the nurse would be

“I will tell your physician that you are concerned about taking insulin during your pregnancy.”

“You will have to discontinue the insulin therapy during your pregnancy, but you will

“You will need to continue taking your insulin because

“Insulin is usually the drug of choice for controlling blood glucose levels during pregnancy because it does not cross into the placenta.”

 

 

 

NURS 6521: Advanced Pharmacology final exam Question 58

A female patient is prescribed oprelvekin therapy to treat thrombocytopenia. Which of the following should the nurse continuously monitor to determine the efficacy and duration of the ?

Red and white blood cell count

Cardiac arrhythmias

 

 

 

Question 59

Which of the following is critical to helping prevent development of resistant strains of ?

Limit the exposure of

Keep the

Maintain the optimum duration of the antimicrobial agent

Maintain the maximum safe frequency of antimicrobial drug ingestion

 

 

 

uestion 60

A 30-year-old woman who is in the first trimester of pregnancy has presented to her primary care provider with a 4-day history of a reddened, itchy left eye that is … The clinician suspects a bacterial, rather than viral, etiology. How will the patient’s pregnancy affect the potential use …?

Ciprofloxacin is safe to use in pregnancy and the patient may use to same dose and route as a nonpregnant patient.

The use of c.

It is safe for the patient to use topical ciprofloxacin but the oral route is potential teratogenic.

The patient will require a lower dose and longer course of .

 

 

Question 68

A 56-year-old woman will soon begin treatment of her …. What patient teaching should the nurse provide to this woman?

“It’s good to measure your heart rate before you take your Detrol each day, and withhold it if your heart rate is below 60 beats/minute.”

“You’ll probably need to stop taking your “

“You’ll likely find that you have scant amounts of blood in your urine for the first few days, but this is not unusual or problematic.”

“You might find that you get a dry mouth or a headache from this drug, but this does not mean

 

 

Question 69

A nurse is instructing a colleague on how …effect. Which of the following should be included in the nurse’s teaching?

The first drugs used to treat infections date back to the 17th century.

…with the growth and development of the bacteria cell wall.

Selective toxicity determines the appropriate drug dosage needed.

…interferes with synthesis of the bacteria cell wall.

 

 

 

NURS 6521: Advanced Pharmacology final exam Question 70

A nurse is explaining to the parents of a 6-year-old child suffering from …for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?

A child has an …, which increases drug absorption, causing an increase in adverse effects.

A child’s …decreased, causing less of the drug to be absorbed from the subcutaneous skin, therefore producing more adverse effects.

A child has a greater body surface area, creating greater permeability resulting in an increase in absorption of topical agents, which may result in more adverse effects.

A child has a smaller body surface area, resulting in an increase in topical absorption, which can cause more adverse effects.

 

 

 

Question 71

A patient is being discharged from the hospital and will be taking ….. The nurse will instruct the patient that she will be taking a medication

that will be provided in pill form and which may cause lightheadedness.

that will be administered as a weekly IM injection in an outpatient setting.

that may be prescribed as a patch and which may cause dry mouth.

that can be inhaled and that may cause occasional heart palpitations.

 

 

Question 72

A nurse is aware that the concept of …is foundational to … Which of the following statements most accurately describes ….?

A drug harms microbes without harming human cells.

A drug’s effect on microorganisms is proportionate to dose. NURS 6521: Advanced Pharmacology final exam

Most microbes may be collected from a host and cultured on an alternative medium.

A drug can be isolated and produced in a controlled manner in a laboratory setting.

 

 

Question 98

A nurse is caring for a patient who is at 28 weeks’ gestation and is receiving …to control … Which of the following assessment parameters should the nurse prioritize?

Maternal body temperature

Fetal heart rate (FHR)

Correct fetal position

Fetal blood pressure

 

 

NURS 6521: Advanced Pharmacology final exam Question 99

 

An oncology nurse is aware of the risks for injury that exist around the preparation, transportation, and administration of chemotherapeutic agents. In order to reduce these risks of injury, the nurse should take which of the following actions?

 

Dispose of intravenous lines used for chemotherapy administration in a covered trash can in the patient’s room.

 

Use an IV system for administration that includes needles to reduce the risk of accidental spills.

 

Prime the IV tubing with an approved IV solution rather than with the drug itself.

 

Encourage patients who have been receiving chemotherapy to use a bedside commode rather than a toilet.

 

Question 100

A nurse is discussing with a 58-year-old male patient the causes of erectile dysfunction in men over 50 years of age. Which of the following will the nurse inform the patient is the primary physical cause of erectile dysfunction of men in this age group?
NURS 6521: Advanced Pharmacology
final exam

Emotional stress

Atherosclerosis of the penile artery

Diabetes mellitus

Decrease in testosterone levels

Pharmacology Exam Question 1

1 out of 1 points

The nurse’s assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this?

 

Response Feedback:

True allergic reactions include formation of rash or hives, itching, redness, swelling, difficulty breathing, and anaphylactic shock. Nausea and vomiting, however, are adverse effects of drug therapy. Similarly, an unsafe drop in blood pressure and gastric bleeding from aspirin use are adverse drug effects, not allergic reactions.

Question 2

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1 out of 1 points

A patient has been prescribed several drugs and fluids to be given intravenously. Before the nurse starts the intravenous administration, a priority assessment of the patient will be to note the

 

Response Feedback:

Baseline body weight and height, heart rate, and blood pressure are all important considerations during the assessment of a patient. However, if a patient has to be given drugs intravenously, it is important to inspect the skin for rashes, moles, or sores, so those areas can be avoided as an insertion or injection site.

Question 3

1 out of 1 points

A nurse has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to

 

Response Feedback:

The first-pass effect involves drugs that are given PO and absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. Once in the liver, enzymes break the drug into metabolites; they may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for this phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.

Question 4

1 out of 1 points

A patient has been receiving regular doses of an agonist for 2 weeks. Which of the following should the nurse anticipate? Pharmacology Exam

 

Response Feedback:

Receptors are not static; they can change or modify their response to a stimulus. Such change occurs when a receptor is continuously stimulated to act or continually inhibited from action. Continual stimulation from an agonist usually makes the receptor desensitized to the drug and thus less active. Therefore, the nurse should anticipate a decrease in effectiveness of the drug.

Question 5

1 out of 1 points

An unconscious patient has been brought to the hospital, and the physician has prescribed a life-saving drug to be administered parenterally. Which of the following methods would be the most appropriate for the nurse to use when administering the medication?

 

Response Feedback:

Intravenous infusion is the preferred method for use in emergency situations when rapid drug effects are desired. Absorption is considered to be instantaneous, as the drug is placed directly into the bloodstream. The subcutaneous and intramuscular routes could be used but would not ensure rapid drug effects. Intrathecal administration is usually done by a physician or a specially trained health care provider.

Question 6

1 out of 1 points

In order to promote therapeutic drug effects, the nurse should always encourage patients to

 

Response Feedback:

Taking a drug at the appropriate time will help the patient maintain therapeutic drug levels. Not all medications should be taken with food, which can alter the absorption of some drugs. A patient should never increase or decrease a medication dosage without checking with the prescriber. Alternative therapy should only be used if the patient has discussed the therapy with the prescriber and they are in agreement.

Question 7

1 out of 1 points

A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction?

 

Response Feedback:

The nurse should post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient’s record; this will allow continuous access of the dietary staff and the other members of the health care team to the information and serve to limit errors. The prescriber would always ask the patient about her allergies before prescribing a new medication. The patient is not having an allergic reaction, so treating her for an allergic reaction is unnecessary. If the allergies are documented in the appropriate area of the patient’s record, the dietary staff will be aware that the patient should not be served eggs.

Question 8

1 out of 1 points

A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient’s medication regimen. Which of the patient’s medications should prompt the nurse to teach her to avoid drinking grapefruit juice?

 

Response Feedback:

Metabolism of many varied drugs such as calcium channel blockers (used to treat hypertension), statins (used to lower blood lipid levels), and antihistamines (used to prevent allergic reactions) is affected by grapefruit juice.

Question 9

1 out of 1 points

Which of the following affects drug distribution throughout the body?

 

Response Feedback:

Both protein binding and altered pH of extracellular fluids affect drug distribution. The presence of food in the gastrointestinal tract affects drug absorption, whereas an increase in hepatic enzymes affects drug metabolism. High blood levels are not known to affect drug pharmacokinetics.

Question 10

1 out of 1 points

A patient is treated with an antibiotic for an infection in his leg. After 2 days of taking the antibiotic, the patient calls the clinic and reports that he has a rash all over his body. The nurse is aware that a rash can be an adverse effect of an antibiotic and can be either a biologic, chemical, or physiologic action of the drug, which is an example of

 

Response Feedback:

Pharmacodynamics is the biologic, chemical, and physiologic actions of a particular drug within the body and the study of how those actions occur, including adverse effects. It is how the drug affects the body. The pharmacodynamics of a drug is responsible for its therapeutic effects and sometimes its adverse effects. Pharmacotherapeutics refers to the desired, therapeutic effect of the drug. Pharmacokinetics is the changes that occur to the drug while it is inside the body. Pharmacogenetics is the study of how genetic variables affect the pharmacodynamics of a drug in a specific patient. Pharmacology Exam

Pharmacology Exam Question 11

1 out of 1 points

A 60-year-old African-American man lives with a number of chronic health problems. Genetic factors are likely to influence his etiology and/or treatment of

 

Response Feedback:

The incidence of hypertension is significantly higher among African-Americans than other ethnic groups. As well, African Americans respond to some antihypertensive drugs differently than whites.

Question 12

1 out of 1 points

A patient has been prescribed 1 mg lorazepam (Ativan) sublingual prior to the scheduled insertion of a peripherally inserted central (PIC) line. How should the nurse direct the patient when administering this medication?

 

Response Feedback:

Sublingual tablets are placed under the tongue where they dissolve and are absorbed into the bloodstream. Swallowing the pill may render it less effective, but is not unsafe. It is not recommended to chew and hold sublingual medications nor to hold them in the mouth for length of time.

Question 13

1 out of 1 points

Tylenol 325 mg/tablet, patient needs 650 mg; how many tables should patient take?

Question 14

1 out of 1 points

In which of the following patients would a nurse expect to experience alterations in drug metabolism?

 

Response Feedback:

The liver is the most important site for drug metabolism. If the liver is not functioning effectively, as with cirrhosis, drugs will not be metabolized normally and toxic levels could develop. Drug dosage will have to be altered to ensure normal levels in the body. The patient with kidney stones and the patient in acute renal failure would most likely have alterations in drug excretion. If there are no complications with the cervical cancer patient, there should be no alterations in drug therapy Pharmacology Exam.

Question 15

1 out of 1 points

For which of the following patients would a nasogastric tube most likely be considered to aid in the administration of medications?

 

Response Feedback:

The use of an NG tube for medication administration requires a functioning GI tract. An NG tube would not be used if a patient is vomiting frequently or has had recent bowel surgery. Similarly, an NG tube would not be used in the case of a competent adult who wishes to discontinue his or her medications.

Question 16

1 out of 1 points

A home health nurse notes that there have been changes to a patient’s oral drug regimen. The nurse will closely monitor the new drug regimen to

 

Response Feedback:

Changes in the drug regimen may cause changes in drug absorption and thereby decrease the anticipated drug effect. This decrease is due to the prevention of binding and loss of absorption and overall drug effectiveness. A change in the drug regimen would not help a nurse to track the route of metabolism or determine the speed of chelation. If any adverse effect were to occur as a result of a drug regimen change, it would not necessarily be immunotoxicity; it could also be nephrotoxicity, ototoxicity, or cardiotoxicity.

Pharmacology Exam Question 17

1 out of 1 points

A nurse is instructing a patient concerning a newly prescribed drug. Which of the following should be included to help improve patient compliance and safety?

 

Response Feedback:

If patients are aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication and providing for safe administration. A list of pharmacies can be useful information, but will not improve safety or compliance. Knowing the cost of the brand versus the generic could also be helpful to the patient. However, a substitution may not be allowed, and the cost of a drug does not improve patient safety. Most patients are not concerned with statistics regarding drug testing, and the testing is usually not discussed with patients.

Question 18

1 out of 1 points

5 ml = _______________tsp

Question 19

1 out of 1 points

An older adult patient with a history of Alzheimer’s disease and numerous chronic health problems has been prescribed several medications during his current admission to hospital and recent declines in the patient’s cognition have impaired his ability to swallow pills. Which of the following medications may the nurse crush before administering them to this patient?

 

Response Feedback:

A tablet that is designed for immediate release into the gastric environment is normally safe to crush and administer to the patient. Enteric coated and sustained release tablets may not be crushed because doing so compromising the delayed release into the GI tract that is intended with these medications. Sublingual medications should be placed under the tongue to dissolve rather than swallowed.

Question 20

1 out of 1 points

A patient who has been admitted to the hospital for a mastectomy has stated that she has experienced adverse drug effects at various times during her life. Which of the following strategies should the nurse prioritize in order to minimize the potential of adverse drug effects during the patient’s stay in the hospital?

 

Response Feedback:

In an effort to minimize the potential of adverse drug effects, it is necessary to closely monitor the patient. It would be inappropriate for the nurse to alter the route or frequency of administration or to encourage herbal remedies that also carry the potential for adverse effects. Pharmacology Exam

Hypertension or COPD Medication Essay Assignment

Assignment: Hypertension or COPD Medication

Choose either hypertension or COPD. Discuss at least three symptoms caused by physiologic changes and consequences of the disease and how pharmaceutical treatments are designed to alleviate those symptoms. What are the risks and benefits of these treatments? What patient education is needed? Locate at least one scholarly website or video that discusses a hypertension or COPD medication.

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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages Hypertension or COPD Medication Essay Assignment.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

• The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

 

Hypertension Management

CASE SUMMARY:
Mr. James Franks is a 64-year-old African-American male. Presents today with complaints of occasional headache. Mr. Franks has a 14-year history of hypertension with co-morbid diagnoses of diabetes mellitus type 2 for 16 years, COPD GOLD 3/group c, Benign Prostatic Hypertrophy (BPH), Chronic Kidney Disease (CKD), and Gout. He has been taking Naproxen Sodium to relieve gout pain. Plan of care today will focus on Mr. Franks hypertension, with reeducation to lower salt intake, education to not consume alcohol with current medications, weigh daily while on diuretic and report losses and gains of three pounds daily and five pounds in one week, and refer to home health for nurse to educate patient on medications and manage medications administration times, monitor vital signs, monitor for adverse side effects, and educate on disease process.

5334 CASE SUMMARY TABLE 

1.
      Symptoms: 
List two pertinent signs and symptoms

Headache

Dizziness

14-year history of hypertension with current blood pressure readings in office 162/90 sitting and 164/92 standing

2.
       Recommended Drugs:     
**Drug of choice – list at least 3 recommended drugs

List recommended drugs as indicated for this diagnosis

·         Demadex (Torsemide) 2.5–5 mg once daily, may increase to 10 mg once daily after 4–6 wk (Vallerand, Deglin, & Sanoski, 2017).

·         Prinivil, Zestril (Lisinopril) 10mg daily with Creatinine Clearance (CCr) of >60mL/minute, 5mg daily CCr of 30 – 60mL/minute, 2.5mg daily CCr of 10 – 30mL/minute (Vallerand, Deglin, & Sanoski, 2017).

·         Norvasc (Amlodipine) 5 – 10mg daily (Vallerand, Deglin, & Sanoski, 2017).

·         Tylenol (Acetaminophen) 500mg one to two tabs every six hours as needed for pain (Vallerand, Deglin, & Sanoski, 2017).

3.
      Drug Categories and Subcategories: 
Identify the category of each recommended drug.

·         Demadex (Torsemide) is therapeutically an antihypertensive, pharmacologically a loop-diuretic, and a pregnancy B category medication (Vallerand, Deglin, & Sanoski, 2017).

·         Prinivil, Zestril (Lisinopril) is therapeutically an antihypertensive and pharmacologically classified as an angiotensin-converting enzyme and a pregnancy category D medication (Vallerand, Deglin, & Sanoski, 2017).

·         Norvasc (Amlodipine) is therapeutically an antihypertensive and pharmacologically a Calcium Channel Blocker and is a pregnancy category C medication (Vallerand, Deglin, & Sanoski, 2017).

·         Tylenol (Acetaminophen) therapeutically a non-opioid pain reliever and an antipyretic and a pregnancy B category medication (Vallerand, Deglin, & Sanoski, 2017).

4.
      Drug(s) of Choice: FOR THE MAIN DIAGNOSIS ONLY, provide the chosen drug(s) of choice for treatment.

5.
      Rationale: 
Provide rationale, clinical guidelines, or evidence for the selected drug of choice

·         Demadex (Torsemide) blocks the active reabsorption of sodium and does not have a profound effect on the glomerular filtration rate (Vadivelan, 2013).

·         Prinivil, Zestril (Lisinopril) Angiotensin-Converting Enzymes are recommended in those hypertensive individuals with concomitant diagnoses of DM and CKD (NKF, n.d.).

·         Tylenol (Acetaminophen) Non-Steroid Anti-Inflammatory Drugs carry a greater risk to increase blood pressure at levels for pain relief (NSAIDs, n.d.).

6.
     
Contraindications and or Risks, as appropriate: 
Identify contraindications and risks as appropriate

·         Demadex (Torsemide) hypersensitivity; cross-sensitivity may occur with thiazides and sulfonamides; use with caution in sever liver disease as a potassium sparing diuretic may be needed in conjunction, decreased electrolytes, diabetes, increased azotemia, the elderly as they may have an increased risk of side effects like hypotension and electrolyte imbalances, pregnancy, lactation, and pediatric populations (Vallerand, Deglin, & Sanoski, 2017).

·         Prinivil, Zestril (Lisinopril) hypersensitivity, a history of angioedema previously, concurrent use of aliskiren in individuals with diabetes or CKD with CCr less than 60mL/minute, do not use in pregnancy as fetal death can occur, do not breastfeed; use cautiously in renal impairment, hepatic impairment, concurrent diuretic therapy, as a monotherapy in African American patients, hyponatremia, hypovolemia, women of childbearing age, surgery, anesthesia, excessive hypotension may occur when used with other antihypertensive medications or diuretics (Vallerand, Deglin, & Sanoski, 2017).

·         Tylenol (Acetaminophen) previous hypersensitivity; consumption of alcohol, aspartame, saccharine, yellow dye number five, sugar, tartrazine, active liver disease, hepatic impairment (Vallerand, Deglin, & Sanoski, 2017).

7.
     
What Patients Must Understand:  Identify at least 3 appropriate teaching points for the patient and/or family (HINT: 3 teaching points is rarely adequate for good patient care)

Demadex (Torsemide)

·         Side effects/Adverse reactions include:

Dermadex (Torsemide) headache, dizziness, hypotension, nervousness, ringing of the ears, hearing loss, constipation, diarrhea, dry mouth, vomiting, indigestion, increased blood urea nitrogen, increased urination, hyperglycemia, rash, Steven’s Johnson Disease, light sensitivity, hyperuricemia, hypocalcemia, hyponatremia, metabolic acidosis, dehydration, hypovolemia, Toxic Epidermal Necrolysis, hypokalemia, hypomagnesemia, arthralgia, hypochloremia, myalgia, and muscle cramps (Vallerand, Deglin, & Sanoski, 2017).

Prinivil, Zestril (Lisinopril) dizziness, headache, fatigue, drowsiness, vertigo, weakness, cough, dyspnea, vomiting, anorexia, tachycardia, chest pain, edema, abdominal pain, taste disturbances, problems getting, or maintaining erections, constipation, diarrhea, hyperuricemia, renal dysfunction, renal failure, rashes, proteinuria, flushing, pruritis, hyperkalemia, angioedema, agranulocytosis, muscle pain, back pain, myalgia (Vallerand, Deglin, Sanoski, 2017).

Demadex (Toresemide) increases low blood pressure when used with other blood pressure medications, nitrates or consumption of alcohol take blood pressure prior to taking and avoid drinking alcohol; use of NSAIDs such as aspirin, naproxen sodium, and ibuprofen may decrease the effects of this medication and increase your risk of salicylate poisoning (Vallerand, Deglin, & Sanoski, 2017).

Tylenol (Acetaminophen) agitation, headache, anxiety, fatigue, atelectasis, insomnia, difficulty breathing, hepatoxicity, hypotension, hypertension, constipation, nausea, increased liver enzymes, vomiting, hypokalemia, renal failure in chronic use of high doses, neutropenia, pancytopenia, trismus, Steven’s Johnson’s Disease, muscle spasms, rash, Acute Generalized Exthematous Pustulosis, Toxic Epidermal Necrolysis, urticaria (Vallerand, Deglin, & Sanoski, 2017).

·         Avoid using salt substitutes and foods with high potassium unless directed by your primary care provider (Vallerand, Deglin, Sanoski, 2017).

·         Take Demadex (Torsemide) as directed, take missed doses as soon as you have missed them unless it is close to the next dose, do not double doses (Vallerand, Deglin, & Sanoski, 2017).

·         Take Lisinopril as directed at the same time every day even if you are feeling well, take any missed doses as soon as you notice unless it is time for your next dose, do not double up on dose, and do not stop taking unless directed to do so (Vallerand, Deglin, & Sanoski, 2017).

·         Avoid driving and other activities that require you to be mentally alert until you know how you react on Lisinopril (Vallerand, Deglin, & Sanoski, 2017).

·         Change positions slowly and allow yourself time to get acclimated to the new position prior to walking to decrease your chances of sudden low blood pressure (Vallerand, Deglin, & Sanoski, 2017).

·         Avoid drinking alcohol, exercising in hot weather, or standing for long periods of time as this will increase your chance of low blood pressure (Vallerand, Deglin, & Sanoski, 2017).

·         When you first start taking Lisinopril you may notice a change in how things taste, this usually subsides after eight to 12 weeks with continued therapy (Vallerand, Deglin, & Sanoski, 2017).

·         If you are scheduled for surgery it is important for you to advise the surgeon of use of Lisinopril (Vallerand, Deglin, & Sanoski, 2017).

·         Weigh daily and contact the office if you gain two to three pounds in one day (Vallerand, Deglin, & Sanoski, 2017).

·         Do not take any over-the-counter medications, including herbal and vitamin supplements without consulting primary care provider first (Vallerand, Deglin, & Sanoski, 2017).

·         Contact office if you notice a rash, muscle cramps, weakness, nausea, numbness, dizziness, tingling of extremities (Vallerand, Deglin, & Sanoski, 2017).

·         Monitor your blood sugar closely as this medication may increase your blood sugar (Vallerand, Deglin, & Sanoski, 2017).

·         Take Demadex (Torsemide) even if you start feeling better, it is not a cure for your hypertension (Vallerand, Deglin, Sanoski, 2017).

·         It is important that you keep a close watch on your salt intake and decrease this intake, exercise by walking daily, reduce your stress, and avoid drinking alcohol to assist in decreasing your blood pressure (Vallerand, Deglin, & Sanoski, 2017).

·         Do not take naproxen sodium for your gout pain, take acetaminophen as they can increase your blood pressure (NSAIDs, n.d.).

·         Do not drink alcohol while taking, or limit your alcohol consumption to less than three glasses if taking one or two doses of Tylenol (Acetaminophen) as this increases hepatoxic effects (Vallerand, Deglin, & Sanoski, 2017).

·         Do not take Tylenol (Acetaminophen) NSAIDs with this medication as this may further damage your renal system (Vallerand, Deglin, & Sanoski, 2017).

·         Do not exceed 2grams of Tylenol (Acetaminophen) daily to limit your chances of hepatoxicity (Vallerand, Deglin, & Sanoski, 2017).

·         Do not take Tylenol (Acetaminophen) longer than 10 days unless directed to do so by your primary care provider (Vallerand, Deglin, & Sanoski, 2017).

·         Stop taking Tylenol (Acetaminophen) if you develop a rash and call the office (Vallerand, Deglin, & Sanoskin, 2017).

·         Read all over-the-counter medication labels to determine if they contain acetaminophen to avoid taking more than your recommended daily amount (Vallernad, Deglin, & Sanoski, 207).

The Prescription(s)

 

 

 

Shannon Delite Leake, RN, Student FNP

727 I Live Here Lane

Mt. Pleasant, TX 75455

Cell #: (903) 867-5301

Fax #:  (903) 867-5302

DEA # DL55599999

NPI # 012345678

License # 99991006

 

Name:
 
xxxx
             DOB:­­­­­­­­­­­­­­
08/17/19xx    

Address: 
  123 Pharmacology Drive, Mt. Pleasant, TX 75455  
  Date:
October 26, 2017

Male / F
: Circle one

Allergies
:
No known drug allergies       .
      Weight:
 95 killograms 209 pounds)

Pt Phone
:
903-903-9033

Rx

Drug: Demadex (Torsemide)

Sig: 5
mg daily for 4 weeks

Dispense: #28
(Twenty-eight)

Refills
:
  No Refills
.

Void after
:
   
October 26, 2018
.

Substitution Permitted
:

yes

Dispense as written
:

no

Signature:

Shannon Delite Leake

Shannon Delite Leake, RN, Student FNP

727 I Live Here Lane Hypertension or COPD Medication Essay Assignment

Mt. Pleasant, TX 75455

Cell #: (903) 867-xxxx

Fax #:  (903) 867-xxxx

DEA # DL5559

NPI # 012345

License # 99991

 

Name:
 
xx
             DOB:­­­­­­­­­­­­­­
08/17/19xx    

Address: 
  123 Pharmacology Drive, xx 
  Date:
October 26, 20xx

Male / F
: Circle one

Allergies
:
No known drug allergies       .
      Weight:
 95 killograms 209 pounds)

Pt Phone
:
903-903-xxxx

Rx

Drug: Zesril (Lisinopril)

Sig: 5
mg daily for 4 weeks

Dispense: #28
(Twenty-eight)

Refills
:
  No Refills
.

Void after
:
   
October 26, 2018
.

Substitution Permitted
:

yes

Dispense as written
:

no

Signature:

Shannon Delite Leake

9.
    
Supplementary Documentation:

 

Hypertension

*Population: Known as the “Silent Killer”, hypertension is the most diagnosed condition in the United States, affecting roughly one in three adults over 29-years-old and increased to nearly two-thirds of the population who are over 60, affects men and women equally, with African Americans ranking with higher rates of high blood pressure (McNance, et al, 2014).

*Pathophysiology: Increased cardiac output, total peripheral resistance, or both cause hypertension. Cardiac output is increased by any condition that increases either blood viscosity or vasoconstriction (McNance, et al, 2014).

*Symptoms: In the early stages the only symptom is increased blood pressure, which leads to its alias of the “Silent Killer” (McNance, et al, 2014).

*Goals of Treatment: Slow progression of disease process by controlling high blood pressure at or below specified range for age of individual and co-morbid diagnoses Traynor, 2014). Hypertension or COPD Medication Essay Assignment

Demadex (Lisinopril)

*Class:  Antihypertensive, Loop-Diuretic (Vallerand, Deglin, & Sanoski, 2017).

*Indications: Edema due to heart failure, renal disease, hepatic disease, or hypertension (Vallerand, Deglin, & Sanoski, 2017).

*Mechanism of Action: Inhibits the reabsorption of chloride and sodium in the Loop of Henle and the distal renal tubule; increases excretion of water, sodium, chloride, hydrogen, magnesium, and calcium with its effect persisting in the presence of renal function impairment; decreased blood pressure (Vallerand, Deglin, & Sanoski, 2017).

*Pharmacodynamics: 80% absorbed orally, widely distributed, with around 99% protein binding (Vallerand, Deglin, & Sanoski, 2017).

*Pharmacokinetics: 20% excreted in urine and 80% metabolized in the liver (Vallerand, Deglin, & Sanoski, 2017).

Generic Name: Demadex (Vallerand, Deglin, & Sanoski, 2017). Hypertension or COPD Medication Essay Assignment

Brand Name: Torsemide (Vallerand, Deglin, & Sanoski, 2017).

*Indications: Edema due to heart failure, renal disease, hepatic disease, or hypertension (Vallerand, Deglin, & Sanoski, 2017).

Outcomes: Slow progression of disease process by controlling high blood pressure at or below specified range for age of individual and co-morbid diagnoses Traynor, 2014).

Instructions: Take 5mg by mouth daily for four weeks and return to office.

Zestril (Lisinopril)

Class: Antihypertensive, Angiotensin-Converting Enzyme (ACEi) inhibitor (Vallerand, Deglin, Sanoski, 2017).

Indications: Monotherapy, or polytherapy to manage hypertension, manage heart failure, reduce risk of death following myocardial infarction, reduce risk of heart failure following myocardial infarction (Vallerand, Deglin, & Sanoski, 2017)

Mechanism of Action: ACEi’s block conversion of angiotensin I to angiotensin II (a vasoconstrictor), prevent the degradation of bradykinin and other vasodialatory prostaglandins (Vallerand, Deglin, & Sanoski, 2017).

Pharmacodynamics: 25% is absorbed in oral administration, cross the placenta, minimal penetration of Central Nervous System (CNS), enters breast milk (Vallerand, Deglin, &B Sanoski, 2017).

Pharmacokinetics: 100% excreted via the kidney (Vallerand, Deglin, & Sanoski, 2017) Hypertension or COPD Medication Essay Assignment.

Generic Name: Lisinopril

Brand Name: Zestril, Prinivil

Dose: 5mg daily by mouth

Indications: Monotherapy, or polytherapy to manage hypertension, manage heart failure, reduce risk of death following myocardial infarction, reduce risk of heart failure following myocardial infarction (Vallerand, Deglin, & Sanoski, 2017)

Instructions: Take 5mg by mouth daily for four weeks then return to office.

Side/Adverse Effects: dizziness, headache, fatigue, drowsiness, vertigo, weakness, cough, dyspnea, vomiting, anorexia, tachycardia, chest pain, edema, abdominal pain, taste disturbances, problems getting, or maintaining erections, constipation, diarrhea, hyperuricemia, renal dysfunction, renal failure, rashes, proteinuria, flushing, pruritis, hyperkalemia, angioedema, agranulocytosis, muscle pain, back pain, myalgia (Vallerand, Deglin, Sanoski, 2017).

Demadex (Toresemide) increases low blood pressure when used with other blood pressure medications, nitrates or consumption of alcohol take blood pressure prior to taking and avoid drinking alcohol; use of NSAIDs such as aspirin, naproxen sodium, and ibuprofen may decrease the effects of this medication and increase your risk of salicylate poisoning (Vallerand, Deglin, & Sanoski, 2017) Hypertension or COPD Medication Essay Assignment.

Outcomes: Reduction of blood pressure

Tylenol (Acetaminophen)

Class: Non-Opioid pain reliever, antipyretic  (Vallerand, Deglin, & Sanoski, 2017).

Indications:

Mechanism of Action:

Pharmacodynamics:

Pharmacokinetics:

 

GENERIC NAME

Generic Name:  Acetaminophen (Vallerand, Deglin, & Sanoski, 2017).

Brand Name: Tylenol (Vallerand, Deglin, & Sanoski, 2017).

Dose: 500mg

Indications: Relief of mild to moderate pain (Vallerand, Deglin, & Sanoski, 2017).

Instructions:  Take one tablet for mild pain by mouth every six hours as needed for pain and take two tablets every six hours for moderate pain (Vallerand, Deglin, & Sanoski, 2017) Hypertension or COPD Medication Essay Assignment.

Side/Adverse Effects: Tylenol (Acetaminophen) agitation, headache, anxiety, fatigue, atelectasis, insomnia, difficulty breathing, hepatoxicity, hypotension, hypertension, constipation, nausea, increased liver enzymes, vomiting, hypokalemia, renal failure in chronic use of high doses, neutropenia, pancytopenia, trismus, Steven’s Johnson’s Disease, muscle spasms, rash, Acute Generalized Exthematous Pustulosis, Toxic Epidermal Necrolysis, urticaria (Vallerand, Deglin, & Sanoski, 2017).

Outcomes: Relief of mild to moderate pain (Vallerand, Deglin, & Sanoski, 2017).

Side/Adverse Effects include: headache, dizziness, hypotension, nervousness, ringing of the ears, hearing loss, constipation, diarrhea, dry mouth, vomiting, indigestion, increased blood urea nitrogen, increased urination, hyperglycemia, rash, Steven’s Johnson Disease, light sensitivity, hyperuricemia, hypocalcemia, hyponatremia, metabolic acidosis, dehydration, hypovolemia, Toxic Epidermal Necrolysis, hypokalemia, hypomagnesemia, arthralgia, hypochloremia, myalgia, and muscle cramps (Vallerand, Deglin, & Sanoski, 2017).*Outcomes: Increased ability to tolerate physical activity and walk further due to reduction of IC  (Vallerand, Deglin, & Sanoski, 2017) Hypertension or COPD Medication Essay Assignment.

Counseling: Side effects/Adverse reactions include:

Dermadex (Torsemide) headache, dizziness, hypotension, nervousness, ringing of the ears, hearing loss, constipation, diarrhea, dry mouth, vomiting, indigestion, increased blood urea nitrogen, increased urination, hyperglycemia, rash, Steven’s Johnson Disease, light sensitivity, hyperuricemia, hypocalcemia, hyponatremia, metabolic acidosis, dehydration, hypovolemia, Toxic Epidermal Necrolysis, hypokalemia, hypomagnesemia, arthralgia, hypochloremia, myalgia, and muscle cramps (Vallerand, Deglin, & Sanoski, 2017).

Prinivil, Zestril (Lisinopril) dizziness, headache, fatigue, drowsiness, vertigo, weakness, cough, dyspnea, vomiting, anorexia, tachycardia, chest pain, edema, abdominal pain, taste disturbances, problems getting, or maintaining erections, constipation, diarrhea, hyperuricemia, renal dysfunction, renal failure, rashes, proteinuria, flushing, pruritis, hyperkalemia, angioedema, agranulocytosis, muscle pain, back pain, myalgia (Vallerand, Deglin, Sanoski, 2017).

Tylenol (Acetaminophen) agitation, headache, anxiety, fatigue, atelectasis, insomnia, difficulty breathing, hepatoxicity, hypotension, hypertension, constipation, nausea, increased liver enzymes, vomiting, hypokalemia, renal failure in chronic use of high doses, neutropenia, pancytopenia, trismus, Steven’s Johnson’s Disease, muscle spasms, rash, Acute Generalized Exthematous Pustulosis, Toxic Epidermal Necrolysis, urticaria (Vallerand, Deglin, & Sanoski, 2017) Hypertension or COPD Medication Essay Assignment.

Demadex (Toresemide) increases low blood pressure when used with other blood pressure medications, nitrates or consumption of alcohol take blood pressure prior to taking and avoid drinking alcohol; use of NSAIDs such as aspirin, naproxen sodium, and ibuprofen may decrease the effects of this medication and increase your risk of salicylate poisoning (Vallerand, Deglin, & Sanoski, 2017).

Avoid using salt substitutes and foods with high potassium unless directed by your primary care provider (Vallerand, Deglin, Sanoski, 2017) Hypertension or COPD Medication Essay Assignment.

Take Demadex (Torsemide) as directed, take missed doses as soon as you have missed them unless it is close to the next dose, do not double doses (Vallerand, Deglin, & Sanoski, 2017).

Take Lisinopril as directed at the same time every day even if you are feeling well, take any missed doses as soon as you notice unless it is time for your next dose, do not double up on dose, and do not stop taking unless directed to do so (Vallerand, Deglin, & Sanoski, 2017).

Avoid driving and other activities that require you to be mentally alert until you know how you react on Lisinopril (Vallerand, Deglin, & Sanoski, 2017).

Change positions slowly and allow yourself time to get acclimated to the new position prior to walking to decrease your chances of sudden low blood pressure (Vallerand, Deglin, & Sanoski, 2017).

Avoid drinking alcohol, exercising in hot weather, or standing for long periods of time as this will increase your chance of low blood pressure (Vallerand, Deglin, & Sanoski, 2017).

When you first start taking Lisinopril you may notice a change in how things taste, this usually subsides after eight to 12 weeks with continued therapy (Vallerand, Deglin, & Sanoski, 2017).

Do not drink alcohol while taking, or limit your alcohol consumption to less than three glasses if taking one or two doses of Tylenol (Acetaminophen) as this increases hepatoxic effects (Vallerand, Deglin, & Sanoski, 2017).

Do not take Tylenol (Acetaminophen) NSAIDs with this medication as this may further damage your renal system (Vallerand, Deglin, & Sanoski, 2017) Hypertension or COPD Medication Essay Assignment.

Do not exceed 2grams of Tylenol (Acetaminophen) daily to limit your chances of hepatoxicity (Vallerand, Deglin, & Sanoski, 2017).

Do not take Tylenol (Acetaminophen) longer than 10 days unless directed to do so by your primary care provider (Vallerand, Deglin, & Sanoski, 2017).

Stop taking Tylenol (Acetaminophen) if you develop a rash and call the office (Vallerand, Deglin, & Sanoskin, 2017).

Read all over-the-counter medication labels to determine if they contain acetaminophen to avoid taking more than your recommended daily amount (Vallernad, Deglin, & Sanoski, 207).

If you are scheduled for surgery it is important for you to advise the surgeon of use of Lisinopril (Vallerand, Deglin, & Sanoski, 2017).

Weigh daily and contact the office if you gain two to three pounds in one day (Vallerand, Deglin, & Sanoski, 2017).

Do not take any over-the-counter medications, including herbal and vitamin supplements without consulting primary care provider first (Vallerand, Deglin, & Sanoski, 2017).

Contact office if you notice a rash, muscle cramps, weakness, nausea, numbness, dizziness, tingling of extremities (Vallerand, Deglin, & Sanoski, 2017) Hypertension or COPD Medication Essay Assignment.

Monitor your blood sugar closely as this medication may increase your blood sugar (Vallerand, Deglin, & Sanoski, 2017).

Take Demadex (Torsemide) even if you start feeling better, it is not a cure for your hypertension (Vallerand, Deglin, Sanoski, 2017).

It is important that you keep a close watch on your salt intake and decrease this intake, exercise by walking daily, reduce your stress, and avoid drinking alcohol to assist in decreasing your blood pressure (Vallerand, Deglin, & Sanoski, 2017).

Do not take naproxen sodium for your gout pain, take acetaminophen as they can        increase your blood pressure (NSAIDs, n.d.).

 

References

McCance, K. L., & Huether, S. E., Brashers, V. L., Rote, N.S… (2014).
Pathophysiology: the biologic basis for disease in adults and children
. St. Louis, MO: Elsevier

v2n2a7

 

NKF KDOQI GUIDELINES. (n.d.). Retrieved October 28, 2017, from http://www2.kidney.org/professionals/kdoqi/guideline_diabetes/guide3.htm

NSAIDs and Hypertension, (n.d.). Retrieved October 28, 2017, from https://www.uptodate.com/contents/nsaids-and-acetaminophen-effects-on-blood-pressure-and-hypertension

Traynor, K. (2014). New hypertension guidelines may simplify treatment.
American Journal of Health-System Pharmacy,

71
(4), 263-264. doi:10.2146/news140014

Vadivelan, M. (2013). Torsemide: A New Loop Diuretic.
Indian Journal of Clinical Practice,

24
(4), 385-388. Retrieved from medind.nic.in/iaa/t13/i9/iaat13i9p385.pd Hypertension or COPD Medication Essay Assignment.

Vallerand, A. H., Deglin, J. H., & Sanoski, C. A. (2017).
Davis’s drug guide for nurses
. Philadelphia: F.A. Davis Company. Hypertension or COPD Medication Essay Assignment

NURS 6501 – Pathophysiology of Inflammatory Bowel Disease sample essays

Pathophysiology of Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a term given to chronic and recurring conditions that affect the gastrointestinal tract (Centers for Disease Control & Prevention (CDC), 2017). Irritable bowel syndrome (IBS) is a condition that affects the movement of the intestine (CDC, 2017). Ulcerative colitis and Crohn’s disease are the two most common IBD. In ulcerative colitis lesions are mostly contained in the large intestine especially on the left side. With ulcerative colitis, the crypt of Lieberkuhn in the large bowel becomes infiltrated with T cells that damage the epithelium.  Immunoglublin E and G, along with B cells and plasma cells increase at the site of inflammation and goblet cells release mucus (Basson, 2017). Ulceration occurs in the mucosa with rare narrowing of the lumen of the large intestine; polyps form throughout the large intestine (Dudley-Brown & Huether, 2012).  Crohn disease lesions may range from the mouth to the anus called skip lesions. The inflammation of Crohn disease is thought to be triggered by cell-mediated response and increased levels of interferon-gamma and tumor necrosis factor alpha.    In IBD, Crohn disease, the increase in interferon-gamma and tumor necrosis factor-alpha, along with stimulation of Th1 cells, produces inflammation throughout the small and large intestine mucosa and serosa layers. NURS 6501 – Pathophysiology of Inflammatory Bowel Disease sample essays. Injury to bowel tissue occurs as neutrophils and macrophages infiltrate the site of inflammation.  Granuloma ulcerations occur in some areas of the bowel and skip other areas (Dudley-Brown & Huether, 2012).

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Pathophysiology of Irritable Bowel Syndrome

Irritable bowel syndrome is a functional gastrointestinal bowel disorder causing increased contractions of the colon.  IBS is diagnosed by characteristic cluster of symptoms without detectable structural abnormalities. The pathophysiology of IBS is complex and involves a number of factors.  Hypersensitivity to pain in the visceral gut occurs by either malfunctioning of the central nervous system or receptors in the wall of the gut; known as the brain-gut axis.  Malfunction of the brain-gut axis can increase gastrointestinal motility causing diarrhea or decease gastrointestinal motility causing constipation.  A decreased transit time is, also, associated with normal intestinal flora overgrowth.  Individuals with IBS have minimal intestinal inflammation, permeability alterations, and decreased immune response in the gut.  Intolerance or allergy to certain foods stimulate an immune response in the mucosa, change the normal gut flora and increase visceral hypersensitivity.  Furthermore, changes in the brain-gut axis and pain perception increase with psychosocial issues such as stress (Dudley-Brown & Huether, 2012).

 

Similarities/Differences with Inflammatory Bowel Disorder and Irritable Bowel Syndrome

Similarities and differences between IBS and IBD can be addressed by the interactions of the gut immune system and the central nervous system. Both inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS) have similar symptoms of altered bowel patterns associated with abdominal pain or discomfort. Both diseases share pathophysiologic mechanisms include altered mucosal permeability; the mucosal immune system alters the interaction of luminal flora, mucosal immune triggering, gut motility alterations, and severe, prolonged life stressors in symptom alteration.  IBD is characterized by inflammation or ulcerations in the small or large intestine; thus these changes are not linked with IBS. Classic signs and symptoms of the inflammatory process in the gastrointestinal tract are diarrhea, rectal bleeding, weight loss, and fever, sometimes related with extra intestinal signs.  Usually, abdominal pain is not the most obvious symptom in IBD, whereas, the main symptom in IBS is abdominal pain.  Unlike IBS, the cause of IBD is caused by genetic predisposition, environmental factors, infectious agents, altered gut epithelial permeability, and impaired immune responses. NURS 6501 – Pathophysiology of Inflammatory Bowel Disease sample essays.

Treatments for Inflammatory Bowel Disorder and Irritable Bowel Syndrome

Diagnosis and treatment of Irritable Bowel Disease is based on clinical presentation, history, physical and exclusion of other causes of symptoms (Huether & McCance, 2017). To rule out other causes of the symptoms, endoscopies, CT scans, blood tests, abdominal ultrasounds and tests to rule out illnesses such as lactose intolerance and celiac disease could be done (Huether & McCance, 2017). The patient is diagnosed using the Rome III criteria which basically says that the patient has abdominal pain or discomfort for at least 3 days per month for the past 3 months with at least two incidences if improvement with bowel movement, change in frequency of stool or change in appearance of stool (Huether & McCance, 2017). Mesalamine products are often prescribed; steroids and aminosalicylates are used to suppress the inflammatory response and help to alleviate cramping pain. Immunosuppressants and immunomodulatory agents may induce and maintain remission. For severe cases, hospital admission for the administration of intravenous fluids and steroids may be needed. Surgical intervention to manage complications may also be necessary. There is no cure for IBS and the treatment is not specific, but based on each patient symptoms and is often started with incorporation of fiber in the diet. Laxatives, anti-diarrheals, antispasmodics and analgesics are often a part of the treatment plan (Huether & McCance, 2017). Evaluations for food allergies, parasites, and bacterial infections are also performed. Alternative therapies may include: probiotics, hypnosis, acupuncture, and psychotherapy. The treatment of IBD and IBS are very different and cannot be used interchangeably.

 

Genetics Impact on
Inflammatory Bowel Disorder and Irritable Bowel Syndrome

There is a strong genetic factor with IBD with a positive family history. UC is more predominate in the white population and is associated with other auto immune disorders. CD includes genetic factor with positive family history and altered immune responses (Huether & McCance, 2017). According to McPhee & Hammer (2014), “a combination of genetic risk and environmental factors are recognized key elements in the pathogenesis of inflammatory bowel disease. There are many newly recognizable genes that are susceptible for both Crohn’s disease and ulcerative colitis. It is postulated that the stigma associated with IBS led to relatives not sharing information with others, resulting in underestimates of familial aggregation of IBS (Saito, et al., 2008).  An estimated 33 percent of individuals with IBS have a positive family history of the disorder (p. 790).  A positive family history of any of these disorders can alarm the examining practitioner and can lead to early diagnosis and treatment.

References

Basson, M. (2017). Ulcerative colitis. Retrieved from 
http://emedicine.medscape.com/ article/183084-overview# aw2aab6b2b4aa
.

Centers for Disease Control and Prevention. (2017). Inflammatory bowel disease. Retrieved from
www.cdc.gov/ibd/

 

Dudley-Brown, S. & Huether, S. (2012). Alterations of digestive function. In S.J. Huether & K.L. McCance (Eds.). 
Understanding pathophysiology
 (5
th
 ed, p. 894-937). St. Louis, MO: Mosby.

Heitkemper, M., Kohen, R., Jun, S., & Jarrett, M. (2011). Genetics and gastrointestinal symptoms. 
Annual Review Of Nursing Research
, 
29
261-280. doi:10.1891/0739-6686.29.261

Huether, S. E., & McCance, K. L. (2017). 
Understanding pathophysiology 
(6th ed.). St. Louis, MO: Mosby.

Hammer, G. G. , & McPhee, S. (2014). 
Pathophysiology of disease: An introduction to clinical medicine
. (7th ed.) New York, NY: McGraw-Hill Education.

Saito, Y., Zimmerman, J., Harmsen, W., De Andrade, M., Locke, G., Petersen, G., & Talley, N. (2008). Irritable bowel syndrome aggregates strongly in families: a family-based case-control study. Neurogastroenterology And Motility, 20, 790-797. NURS 6501 – Pathophysiology of Inflammatory Bowel Disease sample essays.

 

Pathophysiology of Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS)

WEEK 8 DISCUSSION

As we know all know, our gastrointestinal tract which extends from the mouth to anus is a hallow organ (Huether &Re McCance, 2017, p. 906).  Sometimes, it may often be challenging to come up with a diagnosis of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) due to the presence of overlapping mechanism which still makes both as separate conditions. IBD is divided into two types of condition namely ulcerative colitis and Crohn disease. NURS 6501 – Pathophysiology of Inflammatory Bowel Disease sample essays. According to rectum (Dudley-Brown and Huether, ulcerative colitis is a chronic inflammatory disease that causes an ulceration of the colon and rectum. It is characterized with a period of remission followed with relapse.  According to (Hammer & McPhee, 2014, p. 372).  It is unknown what triggers inflammatory bowel disease. Ulcerative colitis is superficial and most likely developed in the colonic mucosa While crohn diseases granulomatous and is located throughout the gastrointestinal tract (Hammer & McPhee, 2014). Patient with crohn disease may exhibit symptoms such as diarrhea, rectal bleeding, weight loss and abdominal pain along with vitamin b12 and vitamin D malabsorption, while those patients with ulcerative colitis may present with fever, tachycardia, dehydration, weight loss, bleeding and inflammation (Huether & McCance, 2017).

Pathophysiology of IBD

(Huether & McCance, 2017).

Pathophysiological Mechanisms of Inflammatory Bowel Disorder and Irritable Bowel Syndrome

It is unclear what the triggers are for inflammatory bowel disease (IBD), but what we do know is that there are two forms; Crohn disease and ulcerative colitis (Hammer & McPhee, 2014, p. 372).  Crohn disease (CD) is transmural and granulomatous which can be found throughout the GI track, whereas ulcerative colitis (UC) is superficial and limited to the colonic mucosa (Hammer & McPhee, 2014).  CD symptoms include diarrhea, rectal bleeding, weight loss and abdominal pain along with vitamin b12 and vitamin D malabsorption (Huether & McCance, 2017).  In UC a patient may experience fever, tachycardia, dehydration, weight loss, bleeding and inflammation (Huether & McCance, 2017) NURS 6501 – Pathophysiology of Inflammatory Bowel Disease sample essays.

Pathophysiology of IBD

           
There are two forms of IBD.  Crohn disease “is transmural and granulomatous in character, occurring anywhere along the GI tract while ulcerative colitis is superficial and limited to the colonic mucosa” (Hammer & McPhee, 2014, p. 372).  Under normal circumstances, the intestine is able to control mucosal epithelieum inflammatory responses to dietary and microbial antigens.  In IBD, this process is defective, resulting in uncontrolled inflammation.  Common symptoms for both CD and UC are diarrhea and abdominal pain though it is important to note that constipation may associated with UC.  The diarrhea can be quite severe, resulting in dehydration, malnutrition, and weight loss.  Diarrheal blood loss can result in anemia.

 

Pathophysiology of Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS)

IBD is categorized into two sections: ulcerative colitis and Crohn disease. Ulcerative colitis is a chronic inflammatory disease that causes an ulceration of the colon and rectum (Dudley-Brown and Huether, 2017). Ulcerative colitis is characterized by remition and relapse. According to Stratton (2017), ulcerative colitis results from aberrant immune response to gut luminal antigen in a genetically susceptible individual. Phagocyte’s response to gut flora and secretion of proinflammatory cytokines activates the T cells, causing mucosal inflammation and damage NURS 6501 – Pathophysiology of Inflammatory Bowel Disease sample essays. It is also believed that an abnormal or deficient interleukin (IL)-25 that controls some T helper cell responses is involved in the mechanism of ulcerative colitis. In Crohn disease, the inflammation results from the activation of cell-mediated responses, elevated interferon-gamma, and tumor necrosis factor-alpha. The inflammation originates from the intestinal submucosa and proliferates to the mucosa and serosa. The inflammation and tissue injury seen in this disorder is associated with the activation of neutrophils and marcophages (Dudley-Brown and Huether, 2017) NURS 6501 – Pathophysiology of Inflammatory Bowel Disease sample essays.

 

References

Hammer, G. G., & McPhee, S. (2014).
Pathophysiology of disease: An introduction to clinical medicine
. (7
th
ed.) New York, NY: McGraw-Hill Education

Huether, S. E., & McCance, K. L. (2017).
Understanding pathophysiology
(6
th
ed.). St. Louis, MO: Mosby.

Dudley-Brown, S., & Huether, S. E. (2017). Alterations of digestive function. In Huether, S. E., & McCance, K. L. (2017). 
Understanding pathophysiology
 (6
th
ed.). St. Louis, MO: Mosby NURS 6501 – Pathophysiology of Inflammatory Bowel Disease sample essays

NURS 6501 Pathophysiology Crohn’s Disease essay

Assignment: Pathophysiology Crohn’s Disease

Write a 1500-2000 word APA formatted essay of the following topics: Explain the pathogenesis with common clinical presentation of celiac’s disease Analyze the pathophysiology Crohn’s disease and relate genetic issues Differentiate between hepatitis A, B, C, and viral hepatitis Elaborate on the pathogenesis and pathophysiology of pancreatic cancer Complete Case Study #26 (nausea and vomiting) in the Bruyere textbook

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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. NURS 6501 Pathophysiology Crohn’s Disease essay

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

• The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. NURS 6501 Pathophysiology Crohn’s Disease essay.

GCU NU646E week 3 SBAR Clinical Log Essay Assignment

Assignment: SBAR Clinical Log

Complete the “SBAR Clinical Log” to document your total clinical hours completed to date, a description of observations and tasking completed, and additional comments regarding your practicum Experience. You will also complete the “SBAR,” section of the form related to a patient you have assessed during your clinical experience thus far .GCU NU646E week 3 SBAR Clinical Log GCU NU646E week 3 SBAR Clinical Log Essay Assignment

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You 
must
 proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. GCU NU646E week 3 SBAR Clinical Log Essay Assignment. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.  GCU NU646E week 3 SBAR Clinical Log Essay Assignment

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

SBAR Template  

                                              SBAR Assessment

Situation:

“What is going on with this patient?”

Chief Complaint (what symptoms the patient came to the hospital with):

Patient was involved in MVA going 45 mph and hit a tree.

Diagnosis
_Right Ankle Fracture
          
Vital Signs:
BP-108/71 P-76 Temp- 98.7 F; O2 Sat 99%
   
  

Pain Level___
6
_________  Where_
Rt leg, chest, & rt wrist_
______________

Description_
Acute, somatic, pain in rt leg, thorax, and rt wrist SBAR Template

 

Allergies_
NKA
_

Primary MD__
Gannu
_____________            
Code Status (DNR?)
  N/A (Full code)

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Weight_
76.2
___kgs                                          Isolation_____
N/A
______________

Date of admission__
10/6/18
____________

Background

“What is the clinical

Background?”

PMH (Previous medical history including past surgeries)

Diabetes Mellitus, Smoker, Bipolar, Mood Swings, Depression, Heroin Use

Assessment

 

“Head-to-toe assessment that I am going to chart into the EMR after I review it with my instructor organized by body system.”

 

Respiratory (Resp)

Respiration Rate ______
16
___________   Lung Sounds_____
Clear
_____________

Supplemental Oxygen __
N/A
_______LPM   Oxygen Saturations__
99%___________

 

Incentive Spirometry
__unknown

(I will check EMR next time & collaborate with Respiratory Therapist)

Cardiovascular (CV)

 

Heart Rate:
 
Regular______________

 

IVF’s __
Saline Lock
__________Rate_
N/A
_____________

 

IV Site_
Left mid forearm
______________ Start Date
_10/6/18
_________

 

Edema (where/rate):
rt wrist +1; rt lower limb (unable to assess due to ace bandage & splint)

Pedal Pulses:
Strong on left foot, unable to assess rt foot due to ace bandage & splint

 

Neurovascular (Neuro)

Alert and Oriented X4________ or

Altered mental status___
N/A
______                       Deficits__
N/A
_______

 

Gastrointestinal (GI)

Diet   
Normal
______      Last Bowel Movement___
10/8/18
_________

 

Assistance eating __
no
_______   Bowel Sounds__
Present x 4
_______________

 

Any Drains present____
N/A
________         Accuchecks __
_90
_________________

Genitourinary (GU)

Voiding__
Yes
__________                     Foley Catheter__
N/A
_______

 

Description Of Urine
unknown
___________________________________________

____________________________________________________________________

I and O’s

Input ____
N/A
_______         Output___
N/A
________

 

Musculoskeletal

Activity
_Limited
__________                    Falls Risk Score_
70
______  Falls Risk  Y

SCD’s____
N/A
________

Assistive Devices _
Walker
______________

ROM _
Non-weight bearing right leg, limited ROM

Special Concern’s/Problems/ Scheduled events for the day

Any wounds/ Skin Breakdown Present

Location _
Rt lower limb
__ Dressing type
Ace bandage; unknown dressing type     underneath
__

Presence of drainage from wound or on dressing (describe drainage characteristics)

Unknown due to splint and ace bandage on right lower limb. No visible drainage through the ace bandage. Ace Bandage is dry and intact.

Any diagnostic tests or procedures scheduled for today? No. SBAR Template

10/6/18 -Head CT: No evidence of intercranial hemorrhage or acute findings within the brain.

10/6/18-XR(Pelvic, Rt Knee, Rt Tib/Fib, Chest) Comminuted fracture of the distal fibula & medial malleolus w/o displacement. Bilateral fracture of the first ribs.

Abnormal Labs from 10/9/18-
Hematology:

WBC 12.4 (H)(normal 4-11); monocytes 10.7%(H)(Normal 2-8%);Neutrophils# 8.2(H)(normal 1.5-8);monocyte # 1.3(H) (Normal 0.2-1.0)
Chemistry
: Na 132(L) (normal 135-145);BUN/Crea Ratio 21.0 (H) (normal 10-20)

Physical Therapy_
Yes, educated pt on how to ambulate w/o using NWB right leg
____

Recommendation

(Evaluation)

What do you think should be done to help your patient

This is a summary of your shift’s observations that could assist the next shift in planning  care for the patient

 

Discharge Plan

·         Rest. Limit patient mobility, until right leg can bear weight. Eventual use of CAM boot when ambulating.

·         Place an ice pack on right lower limb in 20 minute increments 6-8 times/day

·         Elevate leg on pillows to help with swelling.

·         Compression. Continue with ACE bandage and splint on right leg for support and to ease swelling.

·         Continue with incentive spirometer 5-10 times every 2 hours. SBAR Template

·         Have patient wiggle toes on right foot often to promote blood flow.

·         Continue with physical therapy to learn how to safely ambulate using walker/crutches due to NWB status of right leg.

·         ROM exercises for unaffected joints of the body.

·         Consult with Social Services and Case Manager. Possible transfer to skilled nursing facility for rehab due to patient’s living situation SBAR Template.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NUR 133 SBAR/Physical Assessment Tool Rubric-

 
 

Student Name:

 

 

Date:

 

Section

Satisfactory

Needs

Improvement

Unsatisfactory

Comments

Basic Information

All areas addressed

Some areas addressed

None of the areas addressed

 

Neurologic

All areas addressed

Some areas addressed

None of the areas addressed

SBAR Template

Skin

All areas addressed

Some areas addressed

None of the areas addressed

 

Head, Eyes, Nose, Throat

All areas addressed

Some areas addressed

None of the areas addressed

 

Respiratory

All areas addressed

Some areas addressed

None of the areas addressed

 

Cardiovascular

All areas addressed

Some areas addressed

None of the areas addressed

 

Gastrointestinal

All areas addressed

Some areas addressed

None of the areas addressed

 

Genitourinary

All areas addressed

Some areas addressed

None of the areas addressed

 

Musculoskeletal

All areas addressed

Some areas addressed

None of the areas addressed

 

Psychosocial

All areas addressed

Some areas addressed

None of the areas addressed

SBAR Template

NURS 4115 Week 1 Discussion – The Role of the Nurse in Global Health

Healthcare burden is a common problem to both developed and developing nations due to shortages in healthcare workforce, high costs incurred for the services and minimal coordination of care among others.  Germany, in particular, provides services compared to India. However, both nations exhibit a rise in chronic diseases such as diabetes and heart disease as well as expensive healthcare services such as medical drugs. These diseases are heightened in the nations due to a…

NURS 4115 Role of the Nurse in Public and Global Health Week 1 Discussion

NURS 4115 Week 1 Discussion

In this week’s media presentation, Dr. Louise Fitzpatrick shared how health and disease are global issues. She pointed out that with the mobility of today’s population, health issues experienced in one area of the world are easily brought to other areas of the world through such means as travel and immigration. They can also be brought to a nation’s doorstep through the migration of animals, insects, and birds. Consider the spread of infectious diseases such as HIV/AIDS, avian flu, H1N1, or SARS. These diseases have quickly crossed oceans and spread to multiple countries. They are a public health concern in the United States as well as other countries. NURS 4115 Week 1 Discussion

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To prepare for this Discussion:

Reflect on Dr. Mancuso’s comments in this week’s media presentation; specifically, on the role of the BSN nurse in public and global health.

Select one health problem that you will use as a basis of comparison between countries.

Identify one developed and one developing country.

Compare and contrast the health problems and countries you selected with the United States in terms of World Health Organization (WHO) outcomes. In your analysis, be sure to include information about workforce availability to deal with the country’s disease burden.

Based on your examination of the research, how well is the United States performing in terms of public health as compared to the developed and developing countries you selected?

Think about what countries with worse outcomes could learn from countries with better outcomes.

Think about why nurses should be concerned with global health issues and what the role of the nurse should be in public health.

By Day 3

Post your analysis of one health problem between one developed and one developing country in comparison with the United States in terms of the WHO outcomes and criteria listed above. State your opinion about how well the United States is doing in terms of public health. Share what you think countries with worse outcomes could learn from countries with better outcomes. Explain the nurse’s role in public and global health and why nurses should be concerned with global health issues. Conclude by summarizing your view of the role of the nurse in public health.

Support your response with references from the professional nursing literature.

 

The Role of the Nurse in Global Health

Healthcare burden is a common problem to both developed and developing nations due to shortages in healthcare workforce, high costs incurred for the services and minimal coordination of care among others.  Germany, in particular, provides services compared to India. However, both nations exhibit a rise in chronic diseases such as diabetes and heart disease as well as expensive healthcare services such as medical drugs. These diseases are heightened in the nations due to a poorly coordinated health care system coupled with a workforce shortage.

High Chronic Infections

Chronic diseases such as cancer, diabetes, respiratory diseases and cardiovascular diseases have resulted in 57 million deaths by the year 2008. These diseases have high mortality, morbidity and risk factors in both Germany and India. However, India exhibits high prevalence rates of chronic infections especially non-communicable diseases by 40% in all hospital stay and 30% of outpatients than Germany due to the inadequate facility. India has higher death rates of chronic diseases of 53% and 44% disabilities due to chronic diseases (Khosla, Patel & Sharma, 2012). There has been dwindling shift of the policy makers to prioritize the healthcare sectors to include prevention approaches as well as a low investment on personnel and formal systems towards such infections amidst every increasing population.  On the other hand, Germany has lower chronic disease prevalence. However, cardiovascular diseases are responsible for 39.7% deaths while new cases of cancers are at 16% which results in 25% of deaths in Germany (Schoen et al., 2010). NURS 4115 Week 1 Discussion

High Healthcare Costs

Both India and Germany exhibit high costs in healthcare services in both the public and private entities. Healthcare in Germany contributes to $ 500 every month for the employed and employers while the self-employed patients experience full payment. The same high costs in healthcare service delivery are experienced in India with worse cases of burden due to higher costs.  For example, the allopathic services provided in India are expensive which cannot be accessed by the common man coupled with high prices on drugs (Khosla, Patel & Sharma, 2012).

Comparison of the Nations with the USA

Comparisons of the nations with the USA reveal similarities. The countries exhibit high rates of chronic infections, and citizens experience high costs in healthcare coupled with low healthcare professionals.  However, German and USA have different coordinated care systems. While the USA face high fragmentation and privatized system in preventive and patient-centered care with no universal access to the healthcare system, Germany has a fairly fragmented system with universal access to the healthcare system. In some cases, the nurses provide uncoordinated healthcare delivery which results in increased healthcare problems (Schoen, et al., 2005). However, these nations have improved healthcare outcome due to proper planning of the limited resources that are channeled towards quality healthcare delivery, proper reorientation of the healthcare system and proper management that are patient centered. The Indian government should implement all these activities that experience poor outcome to exhibit a shift in healthcare outcome regarding higher quality with reduced mortality (Schoen, et al., 2005) NURS 4115 Week 1 Discussion.

Role of Nurse

Nurses are instrumental in ensuring the provision of quality healthcare delivery at the global level. However, the increased burden on the healthcare system is brought about by the high healthcare costs, uncoordinated healthcare delivery and a shortage of nurses which leads to high nurse-patient ratios. Conversely, the nurses should deliver high-quality care through the provision of well-coordinated services (Khosla, Patel & Sharma, 2012).

In conclusion, healthcare problems are exhibited in both developed and developing nations especially in Germany and India. Such burdens are also experienced in the USA though the management of such issues varies in these nations.  Comparisons of the burden in both nations with the USA reveal similarities with differences regarding quality in healthcare delivery. Germany, in particular, has a higher quality of healthcare delivery at low cost compared to the USA while both countries are superior in care provision compared to India. However, the healthcare burden is exhibited in the three nations due to nurse workforce shortage against the high population especially the old age who need care. Thus, the healthcare professional should ensure the provision of well-coordinated healthcare services that are patient-centered NURS 4115 Week 1 Discussion.

References

Khosla, D., Patel, F. D., & Sharma, S. C. (2012). Palliative care in India: current progress and future needs.
Indian Journal of palliative care
,
18
(3), 149.

Schoen, C., Osborn, R., Huynh, P. T., Doty, M., Zapert, K., Peugh, J., & Davis, K. (2005). Taking the pulse of health care systems: experiences of patients with health problems in six countries.
Health Affairs-Millwood VA Then Bethesda MA-
,
24
, W5.

Schoen, C., Osborn, R., Squires, D., Doty, M. M., Pierson, R., & Applebaum, S. (2010). How health insurance design affects access to care and costs, by income, in eleven countries.
Health Affairs
, 10-1377 NURS 4115 Week 1 Discussion.

NURS 4115 Week 3 Discussion-Preventing Disease in Communities

NURS 4115 Role of the Nurse in Public and Global Health Week 3 Discussion

Preventing Disease in Communities: The Role of Public Health, the Silent Sentinel

Week 3 Discussion-Preventing Disease in Communities

In this Discussion, you will visit a site and interview people who work there about risks for disease transmission, then report on your findings.

To prepare, select which site you will visit from the following options:

High school nurse’s office

Water treatment plant

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Public health department

Pediatrician’s office

Create a brief description of your setting, providing some context; for example, how many patients are seen, size or capacity of the facility as applicable, and/or the location of the office or organization. NURS 4115 Week 3 Discussion-Preventing Disease in Communities

Take pictures of the building and surrounding area/neighborhood to provide context. You do not have to include the interior/s of the building/s or people/clients who may be there.

Then, during your site visit, pose the questions listed in the following chart:

High school nurse

What is the school’s policy on giving students advice about birth control?

How often do you get requests for information about birth control or how to protect oneself from an STD?

How do you track vaccination compliance, and what happens to students who fall out of compliance?

Local water treatment plant NURS 4115 Week 3 Discussion-Preventing Disease in Communities

Where does your community’s water come from?

Where is it stored?

How often is it tested for purity?

What safeguards are in place to prevent tampering with the water supply?

Local public health department

Does this department have an STD clinic?

In addition to testing, does the department offer treatment of one party or both parties?

What is the most frequently diagnosed STD? NURS 4115 Week 3 Discussion-Preventing Disease in Communities

A pediatrician’s office

What is your policy on accepting patients who refuse vaccinations?

What are the most common reasons parents decline vaccinations for their children in this particular office?

What is the policy at this office for giving antibiotics to treat viral syndromes?

Now, look at the site you visited through the eyes of the public health nurse (PHN). Imagine you are the PHN and have been asked to investigate an outbreak at this facility.

What questions would you ask?

What suggestions could you make to avoid a disease outbreak at the facility?

What would your role as a change agent be for any deficiencies you find in your on-site inspection?

Our “world” starts with our own community, county, and state, then moves out in concentric rings from that point to include our country and eventually the world. Disease is transmitted from person to person through direct contact, or from a source such as a vector or contaminated water through a variety of means, such as flood waters or even terrorist actions. Individuals with limited or no knowledge of safe sex methods may have unprotected sexual relations and knowingly or unknowingly transmit disease to their partners, then to their partners’ partners, and on and on. Often it is the role of the public health nurse to investigate a disease outbreak, contain it, and then educate others so that the same situation doesn’t happen again NURS 4115 Week 3 Discussion-Preventing Disease in Communities.

By Day 3

Post your brief description and pictures of the site you visited. Share the answers you were given to the questions you posed. Then, respond to the above prompts through the eyes of a PHN asked to investigate an outbreak at this facility.

Support your response with references from the professional nursing literature. Week 3 Discussion-Preventing Disease in Communities NURS 4115 Week 3 Discussion-Preventing Disease in Communities