Category: Nursing

Pharmacology Case Studies

M.T. is an 18-month-old, 20-kg male who presents to the emergency department in status epilepticus, which has continued for approximately 20 minutes. He was brought to the emergency department from a small community via a family vehicle. He has not received any care at this point. The nursing staff has attempted several intravenous line insertions but were unable to gain access. M.T. continues to convulse without interruption.

Which of the following would be the most appropriate route of administration for an anticonvulsant to consider for M.T. and why?

Intramuscular

Percutaneous

Subcutaneous

Rectal

 

Midazolam is a benzodiazepine that can be used effectively for status epilepticus. Which of the following routes of administration has been used effectively for the delivery of midazolam when intravenous access in unobtainable?

Percutaneous

Mucosal

Oral

Subcutaneous

 

Which of the following is true regarding the percutaneous absorption of medications?

The absorption of compounds is inversely related to the thickness of the skin

The absorption of compounds is inversely related to the hydration of the skin

Body surface area (BSA) is decreased, relative to body mass, in the infant and young child when compared with older children and adults

The percutaneous administration of medications is reliable and safe in the infant and young child.

 

What are the advantages of utilizing the mucosal route of administration?

Some medications have very good absorption and systemic effect when administered by nasal spray

Nasal (mucosal) administration avoids the trauma of intravenous line placement

Nasal administration of medication is typically less expensive than intravenous administration

All of the above are advantages of the mucosal route of administration

 

K.F. is a 23-year-old female with a history of acne and bipolar disorder. She currently takes lithium to treat her bipolar disorder and isotretinoin (Accutane) for her acne. She also occasionally takes famotidine for reflux.

Should K.F. become pregnant, which of the following would be considered safe for her to continue taking? Why? Why are the others considered unsafe during pregnancy (pregnancy rating, potential adverse fetal and maternal effects)?

Accutane

Lithium

Famotidine

 

One year later, K.F. is seen again in your clinic. Her acne and bipolare medications have been discontinued and she now presents 4 months pregnant with a complaint of pain and rising fever over the last 5 days. Lab tests show gram-negative bacilli and Widal test comes out positive. Which of the following drugs will most likely be administered and why? Why will the other drugs not be administered?

Ampicillin

Ciprofloxacin

Levofloxacin

Tetracycline

 

 

 

 

 

 

 

 

 

 

 

 

 

R.S. is an 85-year-old female who has congestive heart failure. Over the past 3 months, she has had four hospitalizations. Like many older adults, R.S. is experiencing difficulty swallowing and psychologic changes affecting her medication absorption.

Which of the following would be an appropriate starting point for identifying causes for R.S.’’s frequency of hospitalizations?

Simply ask if she is taking her medications as directed

Assume that her frequent hospitalizations are secondary to expected changes, which are normal parts of aging

Examine all of R.S.’s medication vials to complete an assessment including pill count for adherence

Assume that her frequent hospitalizations are the result of undertreating her conditions.

 

In determining the most appropriate course of treatment for R.S., assessing her life expectancy should never be taken into account. Rather, the same course of treatment should be pursued without regard for life expectancy. WHY?

True

False

 

Which of the following best describes a concern that R.S. is taking OTCs, which may impact her cardiac function?

Assume that if R.S. has not discussed her taking OTCs with her health care providers that this is most likely not an issue

Assume because older adults typically do not take OTCs that this is not an issue with R.S.

Because older adults take a significant number of OTCs without knowledge of their physicians, that R.S.’s use if best assessed through a home visit and the asking of open-ended questions

 

 

 

 

 

 

 

 

 

 

 

 

L.L. is a 67-year-old male who has been diagnosed with benign prostatic hypertrophy (BPH). He is having difficulty with urination. He is currently on Cozaar 100 mg qd for HTN and his BP is well controlled. He is taking no other medications. The doctor has recommended medication for his BPH, but he would like to try an herbal supplement before taking prescription medication.

What herbal supplement should he take?

2 .What is the recommended dosage?

What are possible side effects and/or drug interactions of the herbal supplement?

What warnings should you give L.S. before he starts the herbal supplement?

 

M.C. is a 54-year-old female who presents with menopausal symptoms of hot flashes, mood swings, decreased libido and vaginal dryness. She wishes to try an herbal supplement to reduce her symptoms, as she is concerned about potential side effects of prescription medications.

What herbal supplement would you recommend?

What is the recommended dosage?

What are possible side effects and/or drug interactions of the herbal supplement?

What warnings should you give M.C. before she starts the herbal supplement?

 

P.K. is a 26-year-old female who presents with depression and anxiety. She is hesitant to start prescription antidepressants as she feels their use will negatively affect her libido and sexual function. She states that she has been taking St. John’s worth for the past couple of weeks and wishes to know if this supplement is okay to use.

What are possible side effects and/or drug interactions of the herbal supplement?

What warnings should you give P.K. about the herbal supplement?

Safety of Food from Carcinogens Essay

The Office of Food Additive Safety (OFAS) at the Center for Food Safety and Applied Nutrition (CFSAN) of FDA is charged with, among other responsibilities, regulating industry to ensure that food contact substances and food additives are safe.

Using your course textbook, the South University Online Library, and the Internet, research on major regulations related to food safety. On the basis of your research, answer the following questions:

What are the ten microbiological agents that are implicated in food-borne illness? What are the measures for preventing food-borne illness?

Describe practical methods for the prevention of food-borne illness and indicate how you apply them in your home or business.

What are the procedures that a local health department might use for investigating an outbreak of food-borne illness?

Explain a major regulation for protecting food from carcinogens and discuss its purpose. Do you think there should be any change in this regulation? Why or why not?

What is the intended impact of food safety–related law on your local community?

please support with apa referance page

Nursing Interventions

Nursing interventions that would be appropriate for Ms J during her admission to the ICU would include the following:

Continuous monitoring of VS and oxygen saturation after nasal O2 is applied – if saturations do not improve change to mask and do not rule out possible intubation – elevate HOB to a semi-fowlers position to facilitate easier effort of breathing

Assess for changes in her alertness or signs of confusion or hypoxia

 Observe rhythm for increased ventricular rate with atrial fib and deterioration in cardiac status with ectopy or onset of chest pain

Provide an environment that allows for rest and decreased anxiety – organize nursing care to facilitate rest periods

Monitor intake and output for cardiac stability as well as dehydration from the onset of the flu

Auscultate chest more frequently for  breath sounds to determine improvement or deterioration in status

Administer medications as ordered and  assess for prn meds to facilitate reduction in fever, generalized achiness from flu, decrease anxiety and promote rest

Rationale for the following meds
 
 
(“Heart Failure Treatments and Drugs”, 2017):

 LASIX IV – Produces diuresis in the kidneys and dilation in the venous system to promote a preload reducing effect that is seen within minutes once administered.  Promotes excretion of water from the body and decreases fluid in the lungs to improve breathing

VASOTEC – an Angiotensin-Converting Enzyme (ACE) inhibitor is a vasodilator that increases the blood vessels to lower blood pressure, improve blood flow and decrease the workload on the heart.

LOPRESSOR – A beta blocker that reduces the symptoms of oxygen demand and myocardial ischemia of heart failure, improves the pumping action, and lowers the heart rate and blood pressure. Also increases diastolic relaxation to allow for the heart to fill properly due to wall motion stiffness.

MORPHINE IV – Induces vasodilation and increases venous return to the heart, acts as a mild arterial dilator, decreases myocardial oxygen consumption, centrally suppresses symptoms of breathlessness, decreases anxiety and reduces pain.

Four CV conditions that may lead to heart failure; what medical/nursing interventions can prevent the development of heart failure in each condition:

Coronary Artery Disease/and MI
 is the most common cause of heart failure in which the arteries to the heart that supplies blood become narrowed or blocked.  When blood flow is completely blocked the heart muscle suffers damage and blood supply is reduced and the area around the muscle and blockage dies or suffers loss of blood flow.  If the damage affects the pumping ability, heart failure develops.  Preventative measures to avoid CAD/MI are the lifestyle changes that slow the progression of atherosclerosis or avoided – patient teaching and education regarding a balance diet, exercise, smoking cessation, controlling BP and cholesterol levels.  Patients that have developed CAD should consider the regime of taking an ASA daily, beta blockers to reduce the workload of the heart, routine follow-ups with MD to prevent further advancement of heart failure. Proactive with testing for cardiac catheterization for stent placement and evaluation of coronaries/heart function (Copstead& Banasik, 2012).

Cardiomyopathy
 
 
is a general term describing disease of the heart muscle.  Even though it can be caused by other heart related issues the heart muscle cannot withstand the workload and heart failure develops. Management normally is the treatment with beta blockers and calcium antagonists; both reduce oxygen consumption and slow the heart rate.  Patients with cardiomyopathy are at risk for atrial fib in which treatment and education involves the patient understanding the rhythm, the incidence of stroke with a.fib, and treatment such as cardioversion and medications, other preventative measures focused on reducing symptoms include following a weight loss program, reducing alcohol intake andmoderate exercise.

 
Heart Valve Disease
 
 
forces your heart to work harder to keep blood flowing in the correct direction.   The valves open and close during diastole and systole and prevent backflow of leakage of blood back into the chambers.  A damaged valve can be due to a heart defect, CAD, or a previous MI that involved the valve areas such as papillary muscles or chordae tendineae. Infection known as endocarditis can cause vegetation and damage the valves.  Treatment with antibiotics and preventative measures such as good personal hygiene – dental care is important.

Hypertension
 
 
is another common cause of heart failure.  High blood pressure causes the heart to work harder to pump blood even at rest and the muscle becomes stiff with the inability to pump effectively.   Eventually the heart cannot keep up and symptoms of heart failure over time develop.  Education is important to teach patient about medications – Diet with foods low in sodium, healthy choices from the food groups, and exercise program for maintaining weight. Medical tx may include the use of thiazide diuretics, beta blockers, ACE inhibitors or other meds per the MD’s prescribing (Riley, J. 2015).

Four nursing interventions that can prevent problems caused by multiple drug interactions in older patients – provide rationale

Avoiding what is known as “polypharmacy” in which multiple meds are taken to manage coexisting health issues by multiple healthcare providers. It is important to review each visit the current list of prescribed meds, OTC and supplements for possible duplicates, adverse reactions, or over-dosing (ANA, 2010).

Proper medication reconciliation at time of admission to hospital and at discharge for any changes.  Upon admission many times physicians are unaware of all medications the patient is taking when admitted; at discharge the list should be updated in the discharge papers and reviewed with patients/ family members taking note the correct med, dosage is understood.

 Practice habits using the OTC pill organizers that list the 7 days, am and pm for dispensing meds.  This routine will assist in keeping the patient compliant in taking correct medication and an easy tool to identify the meds has been taken as prescribed.  Keep pill box in place that is easily visible. Keep as simple as possible (ANA, 2010).

Avoid doctor shopping and using multiple pharmacies.  Many primary care physicians hand off patients to specialty practices in which further medications are prescribed or the patient may request an additional med that he no longer takes  and is given.  Patients may have several pharmacies they use for shopping or who may home deliver. A monthly visit by home health is an option or follow up with a family member that oversees family care for evaluation.

Best teaching method during a patient stay and/or at discharge

In your experience, what is the best teaching method you use during a patient stay and/or at discharge?  How do you assess your patient understands the information?  Again, this is a teaching / learning session for each of us.

Medical Errors In Healthcare Essay

Be sure to review the Discussion Board grading rubric in the course Syllabus.

For this Discussion Board, a minimum of 300 words is required for the initial response and a minimum of 150 words for responses to your classmates. During this unit, you will discuss the following three questions.

When could patient compliance be considered a medical error? Why might a person consider it such? Defend your answer.

Compare and contrast errors caused by action versus inaction.

Using the aviation industry’s approach to quality improvement, where might it be useful in the U.S. health care system?

Health Care Bill Review Essay

Select an active bill at the state or federal level that impacts the professional practice of nursing. In a 3-4 page paper (excluding the title and reference pages), summarize the provisions of the bill and clearly explain what the bill will accomplish. The paper should be no more than 4 pages, typed in Times New Roman using 12-point font, and double-spaced with 1″ margins.

Your review of a bill paper should:

Discuss the major provisions of the bill.

Demonstrate an in-depth understanding of the legislation by explaining the background and all relevant facts.

Discuss any relevant history related to the legislation, pertinent votes, and issues that are stalling the legislation, etc.

Use primary sources for this information.

Identify key supporters and those who do not support the bill. Explain why some of these individuals support the bill and why some do not.

Explore the positions of the key stakeholders in the bill, both pros and cons. Do not make assumptions about potential key stakeholders. Examine this area carefully so you are correctly reflecting the stakeholders positions.

Discuss how the bill would impact a nurse’s ability to provide safe and quality care or to practice to the highest scope of the nursing license.

Explain specific actions that nurses can take to assist with the passage or defeat of the legislation

Use APA format, headings and references as appropriate.

The IOM Report Writing Essay Assignment 

Download a copy of the IOM Report future of nursing document; Read part 1 pages 21-46 the document and then construct a one page paper discussing:

Provide brief description of the IOM report

Reflect on the purpose of the IOM report and what it means for nursing

Discuss the pro and cons (if any) of the IOM’s plans for nursing

 
Writing Assignment Guidelines: The IOM Report Writing Essay Assignment must be typed with appropriate punctuation, spelling, sentence structure and APA format for citing of reference and reference page.

Incorrect placement of commas, incorrect capitalization, spaces where none are allowed are examples of APA errors and points will be deducted. Papers are to be submitted hard copy, must be stapled, and NOT be enclosed in folders. Written work should be submitted with a cover page according to APA cover page guidelines. If writing requirements are not followed precisely, your grade on written materials may begin with a grade of 91.

Specific The IOM Report Writing Essay Assignment Writing Requirements

Use precise APA format that includes correct punctuation, spelling, sentence structure and references. The “easy” on-line APA software has errors and should not be used.

Type must be Times Roman, 12-point font, and double spaced

Use the spell check function on your computer (will help with #1)

Use a COVER page following APA guidelines

DO NOT use a folder. Staple all assignments. Assignments are to be hard copy-not via email. Save your work as you may be asked to submit a back-up email as needed.

Papers turned in past the due date will receive an automatic deduction of 10 points with the grade starting at 89 (B) unless prior arrangements have been made with the professor

For this IOM Report Writing Essay Assignment, pages that exceed the limit will not be read and further points may be removed if critical content was included on the excess pages

Mucormycosis Diagnosis

Mucormycosis (previously called zygomycosiss ) is a life-threatening fungal infection that occurs in immunocompromised patients.

These infections are becoming increasingly common, yet survival remains very poor. Fungi of the order Mucorales are causes of mucormycosis, a life-threatening fungal infection almost uniformly affecting immunocompromised hosts in either developing or industrialized countries.

Mucor is mainly found in soil, digestive systems, plants   surfaces and rotting vegetable matter. It is a microbial genus of molds that   can cause infection to human  beings. Upon inhaling fungal spores from the environment, one can develop infections   in the lungs, sinuses, eyes as well as face. The infection can be developed through cutaneous routes, the fungi can enter the   skin via cuts, scrapes, puncture wounds, or other forms of trauma to the skin.

In the hospitals this can happen through catheters and other invasive   procedures. It is noted that this infection is becoming more of a nosocomial   infection. Mucormycosis does not spread from person to person thus not   contagious. People suffering from diabetes, extensive burns, and immunosuppression symptoms associated with AIDS and other afflictions, organ transplants, or those who are intravenous drug users, appear to be most   susceptible to Mucor infections.

The genus Mucor contains several species. The most common   ones are Mucor amphibiorum, M. circinelloides, M. hiemalis, M. indicus, M.  racemosus, and M. ramosissimus. To cause disease, the agents of mucormycosis   must scavenge from the host sufficient iron for growth, must evade host phagocytic defense mechanisms. Mucor after gaining entrance to host, invades the alveoli.  Then the  spores begins to   penetration into spaces between the cells before spreading to adjacent cells. With   fungi in the lungs, the patient’s body reacts by activating its immune system resulting in an increase in leucocytes. The leakage of fluids from blood   vessels to alveoli results in pneumonia.

With pneumonia we are looking at impaired airway and gas exchange issues, so patient will benefit from oxygen therapy. Keep the head of the bed elevated for better oxygenation and aspiration precaution.  Frequent monitoring of vital signs and oxygen   saturation should be initiated.  Assess patient   for pain and discomfort and treat as ordered. Initiate use of incentive   spirometer as soon as   possible to aid in the recovery of the lungs.

The abnormal lab values include WBC- 15,200/mm3-indicating   infection, PH of 7.50, PaO2 of 59mg, HCO3 of 29, and PaCO2 of 25 -indicated the   body is alkaline but partially compensated – through hyperventilation and   Lymphocytes 10%- the patient is immunocompromised.

It is now clear that iron metabolism plays a central role in regulating mucormycosis infections and that deferoxamine predisposes patients to mucormycosis by inappropriately supplying the fungus with iron. These  findings raise the possibility that iron chelator therapy may be useful to  treat the infection as long as the chelator does not inappropriately supply the  fungus with iron. Recent data support the concept that high-dose liposomal amphotericin is the preferred monotherapy for mucormycosis.  These options include combination therapy   using lipid-based amphotericin with an echinocandin or with an azole (largely  itraconazole or posaconazole) or with all three. The underlying principles of   therapy for this disease remain rapid diagnosis, reversal of underlying   predisposition, and urgent surgical debridement.

Lipid formulations of Amphotericin B deoxycholate (LAmB) are significantly less nephrotoxic and can safely be administered at higher doses for a longer period (Spellberg, 2010).

Amphotericin B deoxycholate (AmB) has been effective in treating mucormycosis and is more affordable than other drugs. Dosage is 1-1.5 mg/kg/d with a total of 2.5-3 g for the whole therapy.

Posaconazole 400 mg BID (total 800 mg/d). This has been effective in those patients who fail treatment with Amphotericin B or used conjunctively after the initial Amphotericin B treatment.

It is also important to address the predisposing condition of  the   susceptible patient. Those with diabetic ketoacidosis need insulin, hydration,   and sodium bicarbonate to reverse the condition.  Colony stimulating factors for those with neutropenia.  Weaning  off immunosuppressive drugs can help boost treatment.

The Barbara Lumpkin Prescribing Act Essay Assignment

Download a copy of the Barbara Lumpkin Prescribing Act; Read the document and then construct a one page paper discussing:Provide brief description of the Bill

Reflect on what it means for APRNS in Florida to have this privilege

Discuss the pro and cons (if any) of the bill as it is currently enforced

ORDER A CUSTOM WRITTEN PAPER

The Barbara Lumpkin Prescribing Act Essay Assignment Writing Guidelines: Assignment must be typed with appropriate punctuation, spelling, sentence structure and APA format for citing of reference and reference page.

Incorrect placement of commas, incorrect capitalization, spaces where none are allowed are examples of APA errors and points will be deducted. Papers are to be submitted hard copy, must be stapled, and NOT be enclosed in folders. Written work should be submitted with a cover page according to APA cover page guidelines. If writing requirements are not followed precisely, your grade on written materials may begin with a grade of 91.

Specific Writing Requirements:   Rewrites are NOT allowed. 

Use precise APA format that includes correct punctuation, spelling, sentence structure and references. The “easy” on-line APA software has errors and should not be used.

Type must be Times Roman, 12-point font, and double spaced

Use the spell check function on your computer (will help with #1)

Use a COVER page following APA guidelines

DO NOT use a folder. Staple all assignments. Assignments are to be hard copy-not via email. Save your work as you may be asked to submit a back-up email as needed.

Papers turned in past the due date will receive an automatic deduction of 10 points with the grade starting at 89 (B) unless prior arrangements have been made with the professor

If the page numbers are limited, pages that exceed the limit will not be read and further points may be removed if critical content was included on the excess pages

What is Mucormycosis Infection?

Mucormycosis is a fungal infection caused by a group of molds known as mucormycetes (CDC, 2015).  Patients come in contact with the mold spores in soil or compost and inhale the spores into the lungs.  People with weakened immune systems are at greater risk to developing Mucor pneumonia; this includes patients with uncontrolled diabetes, prolonged corticosteroid use, burns, IDU and premature infants (CDC, 2015).  Nursing interventions include appropriate antifungal treatment, proper oral care, incentive spirometry and proper positioning to allow for more effective coughing (semi-fowlers or high-fowlers).

 

WBC elevated related to infection, lymphocytes 10% due to compromised immune system, PaO2 59 mg the patient is hypoxic on room air; the labs also show that the patient’s ABGs are not WDL.  HCO3 29, PaCO2 25 and pH 7.5 indicates partially compensated respiratory alkalosis likely due to poor breathing pattern.

 

Patients will be treated with an antifungal agent such as amphoteracin B, posaconazole or isavuconazole (CDC, 2015).  Treatments might include hyperbaric O2 therapy and/or debridement or resection of the infected tissue (CDC, 2015).