Westcoast NURS676A Discussions Latest 2021 February (Full)

NURS676A Advanced Pharmacology

Week 1 Discussion

DQ1 Reflect on your experience as Dr. Manning in the Do No Harm interactive exercise. How did this exercise affect your understanding of how to identify and prevent prescription medication misuse?  What tools and techniques did you learn? Can you see yourself realistically using any of them in your practice? Why or why not?

Additionally, choose two of the following to address:

Which patient(s) from the video do you feel you worked well with, and which patient situation could you have handled differently? Explain.

Which patient from the video was the most challenging for you to work with? Why? Do you think you would work with them in “real life” the same way that you worked with them in this simulation?

How realistic did you find the portrayal of the relationship between Dr. Manning and Dr. Edwards? In your experience, do doctors interact in this way? Why do you think their interaction was included in this scenario?

How realistic did you find the portrayal of the relationship between the nurse practitioner and the doctor? In your experience, do doctors and NPs interact in this way? Why do you think their interaction was included in this scenario?

How realistic do you think these patient situations are? In your experience, have you seen a need for increased vigilance in PMM? Explain.

How does PMM awareness and prevention support the Hippocratic Oath? Use one of the patient scenarios to support your answer.

DQ2 Do an Internet search for standardized protocols and procedures for advanced practice registered nurses in an outpatient care or ambulatory care setting. Review the standardized procedures requirements for APRN practice in your state. Answer the following questions:

How do you think these standardized protocols and procedures guide advanced nursing practice?

What are the components that each standardized procedure should include according to your state requirements?

Discuss the difference between a disease-specific standardized procedure and a process protocol.

 

NURS676A Advanced Pharmacology

Week 2 Discussion     

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 using Schedule II substances.

There are a variety of requirements or restrictions states may impose on advanced practice registered nurses (APRNs) who prescribe controlled substances. In your state, discuss the role of the APRN in administering and dispensing drugs under the federal drug classification and schedules. Discuss your state requirements and restrictions, and identify practice barriers to the nurse practitioner role including the administration of controlled substances.

You have determined after a thorough history and examination that your patient’s injury requires treatment using a Schedule II substance. What are the policies for writing a prescription for a Schedule II CS? Can you offer the patient refills? What is the DEA policy on post-dated prescriptions for Schedule II drugs? How can you avoid tampering with prescriptions for controlled substances? This may vary by state. Make sure to research both the federal and state requirements where you practice.

Controlled substances are categorized using a classification system. Define the five different schedules for controlled drugs, and provide examples of drugs in each schedule. Explain the reason why controlled substances need to be categorized. What are the associated controls required in your state for prescribing in each schedule?

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different topic.

 

NURS676A Advanced Pharmacology

Week 3 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 using Schedule II substances.

Della is a 52-year-old female with no medical history who has had difficulty sleeping for the past several months and is experiencing menopausal symptoms. She refuses any type of prescription medication and states, “I don’t trust them at all.” What options should you recommend for her to help alleviate her symptoms and why?

Bridget is a 22-year-old female with a history of controlled asthma. She takes Advair daily. She comes to you for advice on taking vitamin D supplementation. She is considering a vegan diet. She wants to know how much OTC vitamin D she should take, the food sources she should consider, and if she should have a blood test to check her vitamin D levels?

Valerie is a 38-year-old female with a history of adult cystic acne. She has been taking tetracycline 500 mg BID for the past five months with no improvement in symptoms. Further assessment reveals that she has been taking her tetracycline with breakfast and dinner and has recently (three months) started taking daily OTC antacids for her heartburn. Discuss the possible reasons for the failed response of tetracycline. What changes in her medication regimen do you recommend and why?

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

 

 

 

 

 

NURS676A Advanced Pharmacology

Week 4 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 using Schedule II substances.

Mary is 52-year-old female with HTN on Lisinopril 40mg and well controlled. She comes to the office because she has had a sore throat for several days, which is found to be strep negative. She has no fever or cough. What should you recommend for her sore throat and stuffy nose and why? What precautions should you give her regarding over-the-counter medication because of her medical history and why?

Astrid is an 18-year-old Asian female. She is a college freshman and recently went to a party where she had alcohol for the first time. She describes to you “horrible” side effects of facial flushing, nasal congestion, and dizziness. She is convinced she was “drugged.” With what you know about pharmacokinetics and racial differences, how can you help her understand the reaction she had to alcohol? What important education points do you need to provide and why?

John is an 82-year-old male patient with multiple chronic health issues, including mild dementia. He is a well-established patient, but you are seeing him for the first time. He needs all his medications refilled. He cannot remember the names of his medications. The provider who saw him three months ago reconciled his medication list. Is it safe to rely on your colleague’s chart notes? What steps can you take to ensure safe medication prescribing? What are the standards of medication reconciliation by the APRN?

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

 

NURS676A Advanced Pharmacology

Week 5 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 using Schedule II substances.

Jana, a 36-year-old single mother of three children, has a 15-year history of asthma. For the past month, she has been using albuterol every day. Previously, she had been using the inhaler every 3 to 4 months. She is in the office for a refill. What further information is needed to treat this patient and why? What clinical guidelines should you refer to for her medication management and why?

Susan is a 47-year-old female patient in for a follow-up visit to monitor her treatment for type 2 diabetes. Regular insulin was added to her treatment regimen last month. She denies symptoms of hypoglycemia and her glucose levels have been between 60 and 80. She tells you that her visit to her cardiologist went well and she was prescribed a new medication, atenolol. Discuss the possible complications when patients with diabetes are treated with a beta blocker. Are certain beta blockers more likely to create problems more than others are?

Lester is a 67-year-old male who is prescribed Warfarin for his new onset atrial fibrillation. He is concerned about starting this medication and admits he is forgetful about taking meds and doesn’t understand why he has to have follow-up blood tests. Discuss the patient education you would offer about Warfarin (include side effects). How would you address his concerns and questions? How can you ensure your patient education information is accurate and up to date?

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

 

NURS676A Advanced Pharmacology

Week 6 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 using Schedule II substances.

Clara has a five-week history of epigastric pain that is worse after she eats. The pain is minimally relieved by Mylanta or burping. She has come to your office for evaluation and your initial impression is gastritis. What is your recommendation and treatment plan? What clinical guidelines support your decision and why?

April is an 18-year-old female who comes to clinic today for her sports physical and immunizations. Her immunization history notes she has had all her vaccines through age 5 and one dose of the HPV vaccine at age 11. Can she finish the HPV series or will she need to start over? Based on the pharmacotherapeutics of this vaccine, what precautions and contraindications do you need to consider? What are the adverse drug reactions? What is the VIS and why is it important?

Janice is a 64-year-old black female with a history of HTN. She currently takes Lisinopril 20mg daily and Norvasc 10mg daily. Her most recent labs show cholesterol 360, triglycerides 450, LDL 220, and HDL 60. Her CR is 1.2 and GFR is normal. Her current blood pressure is 150/90. Do you think Janice’s treatment plan is optimal? What other information would you like to obtain? Discuss how you would guide Janice’s treatment plan using evidence-based guidelines.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

 

NURS676A Advanced Pharmacology

Week 7 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 using Schedule II substances.

Janice is a 64-year-old black female with a history of diabetes and HTN, currently controlled on metformin 1000mg daily, Lisinopril 20mg daily, and Norvasc 10mg daily. Her most recent labs show cholesterol 360, triglycerides 450, LDL 220, and HDL 60. Her CR is 1.2 and GFR is normal. Her current blood pressure is 150/90. Do you think Janice’s treatment plan is optimal? What other information would you like to obtain? Discuss how will you guide Janice’s treatment plan and provide evidence for your rationale.

 

Darren is a 46-year-old African American male with a history of HTN and hypertriglyceridemia. Current medications include ezetimibe 10 mg daily, niacin SR 1,000 mg at bedtime and HCTZ/lisinopril 25/20 mg daily. He complains of lack of energy, core weight gain, and a decrease in erections. Labs reveal testosterone 180 ng/dL (193–836 ng/dL) with normal TSH/Thyroxine, FSH, LH, and PSA. Is this patient a candidate for testosterone therapy? Why or why not? Which, if any, of his medications are contributing to his symptoms?

Tom is 50-year-old male who presents with distal lateral subungual onychomycosis of his left great toe. He has had symptoms for four months. On exam, he also appears to have interdigital tinea pedis. Referring to clinical guidelines, what is the first-line treatment for both tinea pedis and onychomycosis in adults? What medication precautions does the patient need to be educated on? What kind of follow-up does the patient require?

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

 

NURS676A Advanced Pharmacology

Week 8 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 using Schedule II substances.

Clementine is a 48-year-old female who has had right ear pain and fullness for the past week that is worsening. She has felt hot but has not taken her temperature. In the office, her temperature is 101, and her TM is red, bulging, and painful to examination. The canal is red and stenosed. Your impression is otitis media and externa. What is your treatment plan for her and why? What patient teaching should you provide? Why did you choose this teaching?

Matt is a 15-year-old male who presents with complaints of ankle pain x 4 hours after “twisting” his foot while playing soccer. His x-ray is negative and examination is consistent with a moderate ankle sprain. He rates his pain 8/10 (1-10 pain scale). What pain medication options can you offer Matt? What side effects of your prescribed regimen does he need to be educated on? Should his parents be involved in your discussion?

Maria is a 26-year-old female with a 2-week history of cough and congestion, which started out as a “normal cold” and now “feels worse.” She took 3 days of antibiotics her mother gave her from Mexico (name unknown). No change in symptoms. NKDA. Notes green mucous and nasal discharge. Positive exam findings include temperature of 100.0°F, greenish postnasal drainage, swollen turbinates, and frontal sinuses tenderness. What is your recommendation for treatment and why? When should the patient expect to feel better? Are there any OTC remedies to consider?

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.