NU636 Advanced Pharmacology
Unit 1 Discussion
Alternative Modalities
In the Online Nursing Orientation resource module you were introduced to our graduate nursing certification success platform – the ‘3 Vs’ – ‘Vision, Value, Victory’. For those of you who also completed their graduate nursing theory and research courses in our program additional information was conveyed about our certification success framework.
Certification success thinking starts with your ‘vision’ to enter the program. Through the ‘3 Vs’ we hope to focus students’ thoughts about the ‘value’ that each course in the program brings to movement toward certification success. And ‘victory’ comes with success is achieved by success on planned certification exams.
Other ‘models’ that have the potential to impact your perspective on the ‘value’ of your course work have been provided for those of you who completed theory and research as a part of our program. Another model is examined in this course.
First utilized in the 1920s and often viewed as a model to view/guide process improvement model is the PDSA model (Plan, Do, Study, Act). The model parallels the tenants of action research in education and can be used to guide development of treatment plans for patients (or self) as well.
Unit 1 DB img.jpg
One of the aims of the ‘3 Vs’ is to convey how ‘models’ thinking contributes to the development of your critical decision making processes. Here we will apply the PDSA model to what may be an everyday circumstance. Our goal, however, is that you gain an understanding of the value of models and come to see them as a part of your everyday decision making rather than as nebulous ideology.
In this unit you will be reading about complementary, alternative and integrative health care approaches.
Review information about those therapies on the NCCIH website accessed through the link below.
https://nccih.nih.gov/health/integrative-health (Links to an external site.)
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
NU636 Advanced Pharmacology
Unit 2 Discussion
DQ1 Treating Hypertensive Urgencies
You have a 57 year old mixed race male (black and Asian) who comes into your office for a screening to participate in a study to evaluate the effectiveness of a home cervical traction device on neck pain and intervertebral disc space. He has a history of neck pain and was diagnosed six years ago with spinal stenosis at the C5-C6 level.
During the screening the gentleman is found to have a BP of 217/109. When you question him about this BP measurement he reports to you that he knows that his blood pressure has been in that range for about the last decade. He reports he has not seen a health care professional about his elevated blood pressure and does not have a health care professional that he sees on a routine basis. He is a healthcare professional at the provider level.
Based on the blood pressure measurement he does not meet the inclusion criterion for the cervical traction device research study.
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
DQ2 Treating Hyperlipidemia
You are seeing a 62 year old white female for her annual visit. Presented below are some pertinent subjective and objective data that you elicited during your comprehensive assessment session with the patient (note – this is not the entire subjective and objective data set for this office visit).
PMH: HTN, Hyperlipidemia
Social History: divorced, employed full time as a graduate nursing program professor, no smoking history, reports on a rare occasion she may have a 2 - 3 ounces of wine when dining out [less than 6 times a year]
Health Maintenance Activities: 1 ½ to 2 hours of exercise every morning [45 – 60 minutes of yoga, 45 – 60 minutes of step aerobics]; low glycemic Pescatarian; has not engaged with recommended colonoscopy, does not have screening mammograms, does not get a flu shot and has not had any other recommended adult immunizations
Review of Systems
Cardiovascular: reports hypertension diagnosed at 27 years of age, controlled on 5mg Lisinopril daily; reports elevated total cholesterol level for the last decade or so with no pharmacologic treatment; denies chest pains, palpitations, lower extremity edema
Physical Exam
Constitutional – Ht. 64 inches, Wt. 127 pounds [BMI 21.8], BP 112/60, P 68, T 97.9 temporal, R 16, SpO2 99%
Integument – pink, warm and dry to touch
Eyes – no arcus senilis
Cardiovascular – heart regular rate and rhythm, S1 and S2; no S3 or S4, murmur or gallop; no carotid bruits; radial pulses palpable and pedal pulses 2+; no lower extremity edema; capillary refill < 3 seconds bilateral
Lipid panel – Total cholesterol 302, HDL 117, Triglycerides 45
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly literature. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
NU636 Advanced Pharmacology
Unit 3 Discussion
DQ1 Treatment of COPD
Scenario: You are seeing an 89-year-old male who has a history of smoking 2 packs of cigarettes a day for 69 years.
He quit smoking cold turkey when he was 78 years old.
He is in your office for a general health evaluation. He reports ongoing challenges with ‘belching’ but other than that he conveys that he is feeling pretty good.
He is on no routine medications.
During your interview with the patient you note that he utilizes pursed lip breathing. At times you note a faint ‘whistling’ sound associated with his respiratory effort.
In conducting your review of systems he reports a cough, particularly in the mornings, productive for thick clear to white sputum.
When queried about shortness of breath he does indicate that he gets SOB more easily than he used to.
His breath sounds are course and diminished in the lower lobes bilaterally.
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
DQ2 Treatment of URI
Scenario: You are seeing a 34-year-old multi-race female who is a school counselor.
She reports a 3-day history of a sore throat, rhinorrhea, nasal stuffiness and postnasal drip.
She states she thinks she may be running a low-grade fever but reports she has not actually taken her temperature.
She reports feeling tired.
She has a history of migraine headaches for which she utilizes ibuprofen as needed. She has a script for Maxalt if needed however reports she hasn’t used that in several years.
She is on hormonal contraceptive management. BP 112/66, P 68, Resp 18, Temp 98.7, SpO2 99% on RA
On your exam you note clear nasal discharge, tympanic membranes are pearly gray, posterior pharynx is erythematous, no tonsillar enlargement noted.
Breath sounds are clear bilateral.
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
NU636 Advanced Pharmacology
Unit 4 Discussion
DQ1 Diabetes Management
Scenario:
You are seeing a 64-year-old Hispanic male for his diabetes management. He reports that his morning capillary blood sugar readings are ranging in the 150 to 190 range.
Last month his Hgb A1C was 7.4
He is on Metformin 1000mg twice a day and Glipizide 5mg daily.
He walks a couple miles three to five times a week.
A dietary review reveals that his daily total carbohydrate intake is in the range of 75 to 100 grams.
Last eye exam did not reveal any problems. He wears reading glasses when needed.
He does report some intermittent burning sensation in his feet.
Ht 6’2”, Wt 200 lbs, BP 118/72, P 72, R 17
Heart regular rhythm, without murmur or gallop
Lungs clear
Monifilament testing does not reveal any decreased sensation in the feet
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
DQ2 Treatment of Hypothyroidism
Scenario: You are evaluating a 53-year-old white female who wants to talk to you about lab work that she had done recently at “Any Lab Test Now”.
She wanted to have lab work done because she was feeling tired and unmotivated. Additionally, she had put on about 15 pounds even though she has been teaching yoga 2-3 times a week for the last few years.
The lab results reveal a TSH of 93.
She reports her last menstrual period was about 3 years ago. She experienced some menopausal symptoms of hot flashes and night sweats. However, she states they weren’t too much of a problem and those resolved a couple years ago.
She denies any difficulty swallowing or neck pain/tenderness.
Constitutional exam: 5’5” tall, 154 pounds, BP 145/88, P 60, R 16, Temp 97.2
Neck – nontender, mild goiter with right side of thyroid larger than the left side
Heart – regular rhythm without murmur or gallop
Lungs – clear
Skin – dry on extremities with some flaking noted
A slowness of the relaxation phase of the Achilles tendon reflex is noted
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
NU636 Advanced Pharmacology
Unit 5 Discussion
DQ1 PUD and Anemia
Scenario: The family of a 62-year-old white female call your office and ask if you can see their family member. The person being requested to be seen is known to you for the last twenty years.
She is your former supervisor and a fellow FNP.
The family reports your colleague is demonstrating signs of dementia.
They note that she has not been eating much for the past few weeks reporting she has a gnawing pain in her stomach. If she does eat she reports getting ‘full’ very quickly. She reports feeling mildly nauseous for the last few weeks.
Your friend sustained a fall injury about 9 months ago from a ladder. She shattered some teeth and developed an infection. She is under the care of an oral surgeon.
You have seen a few of her patients in your practice over the last couple weeks because ‘she is never in her office or available’ over the last few weeks.
You reflect on your last few conversations with your colleague and think to yourself that you also thought she seemed ‘off her game’.
You recommend her family take her to Urgent Care and you convince your colleague this is in her best interest.
Labs drawn at Urgent Care reveal a Hgb of 8 and HCT of 24.
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
DQ2 Anti-coagulant Therapy
Scenario: A 77-year-old white male comes into your office complaining of feeling dizzy, short of breath, easily fatigued and having a sensation of his heart ‘skipping beats’.
He reports he has had these same symptoms numerous times over the last year or so, but they only lasted for about a day.
He thought since he has been experiencing them now for about 3 days he should come in and get checked out.
He was diagnosed with type 2 diabetes twenty years ago and hypertension fifteen years ago.
Current medications include Lisinopril 20 mg daily and Metformin 1000 mg daily.
BP 172/100, P 123 irregularly irregular, R 20
Skin is warm, pale with a slight gray cast; lungs are clear to auscultation; heart irregular rhythm
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
NU636 Advanced Pharmacology
Unit 6 Discussion
Allergies
Scenario:
A 31-year-old white male comes in for an evaluation of his allergic rhinitis.
He is known to your practice for the last decade.
Presently he is on Flonase nasal spray and Zyrtec daily for his allergic rhinitis.
He owns his own business ‘Dr. Vinyl’ where he specializes in repair of vinyl in automobiles, boats, recreational vehicles, etc.
Exposure to the smell of several of the products he works with has resulted in dissatisfactory management of his typical allergic rhinitis.
On numerous occasions over the last decade he has requested and been given an ‘allergy shot’.
A review of his medical record reveals to you this ‘shot’ has been a steroid injection.
BP 122/74, P 76, R 18
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
NU636 Advanced Pharmacology
Unit 7 Discussion
DQ1 Anxiety
Scenario:
A 32-year-old white female is in the office today with a chief complaint “I have to force myself to go to work and other than that I don’t want to leave my house.”
She reports that last week she tried to go to a Pampered Chef party one of her coworkers was having and she only got about three blocks from her house and had to turn around and go back home.
She admits that being anxious is not new for her but feels as though lately those feelings are negatively impacting her life.
Her medical history is inclusive for a diagnosis of psoriasis.
She is married and has a 4-year-old son.
She is presently on no routine medications. She takes an over-the-counter B-50 vitamin to help her manage stress associated with marital strife and childcare challenges secondary to her work schedule.
Her last menstrual period was two weeks ago.
BP 100/58, P 66, R 18
Large raised silvery-white scaly patch noted posterior occipital region of scalp; no thyroid enlargement or tenderness with palpation; heart -regular rate and rhythm; lungs are clear to auscultation
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources.
Please be sure to validate your opinions and ideas with citations and references in APA format.
The post and responses are valued at 40 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria.
Estimated time to complete: 2 hours
DQ2 Migraine
Scenario:
A 46-year-old white male comes in for evaluation of his migraine headache management.
His medical history is inclusive for hypertension and a myocardial infarction at the age of 39. He was diagnosed with migraine headaches three years ago.
Current medications include Losartan 50 mg a day, verapamil SR 100 mg at bedtime, Carvedilol 25 mg a day, Lipitor 40 mg a day, Topamax 50mg a day
He has been admitted to the hospital for migraine management 3 times over the last 6 months. Inpatient admissions have ranged anywhere from 3 to 6 days. Management strategies utilized during the hospitalization include IV corticosteroids, IV Dilaudid and IV magnesium sulfate.
BP 132/84, P 82, R 15
Skin: pink, warm, dry
Neuro: alert and oriented, CNs II – XII intact
Cardio: radial and pedal pulses 2+, heart regular rate and rhythm without murmur or gallop
Lungs: clear to auscultation
Abdomen: large, non-distended, active bowel sounds all quadrants, non-tender to palpation
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
NU636 Advanced Pharmacology
Unit 8 Discussion
Reflection
Instructions:
For each of the learning objectives, provide an analysis of how the course supported each objective.
Discriminate among the mechanisms of action for the major classes of drugs/medications
Critique evidence that supports proposed pharmacotherapeutic protocols for appropriateness of application across the lifespan
Integrate the teaching-learning needs of clients across the lifespan when proposing pharmacotherapies
Propose prescriptive therapies for selected clients evaluating safety factors while utilizing knowledge of how current health status, age, gender, culture, genetic factors, ethical concerns and prescriptive authority impact decision making
Explain how the material learned in this course, based upon the objectives, will be applicable to professional application.
Provide evidence (citations and references) to support your statements and opinions.
All references and citations should in APA format.
This unit 8 discussion post does not require any peer responses and must be submitted by Tuesday at 11:59am of week 8.
NU636 Advanced Pharmacology
Unit 1 Assignment
Instructions
Estimated time to complete: 2 hours
Case Study
Mrs. A is a 71 year old widow with CHF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother's ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:
Furosemide 40 mg daily in the morning
Digoxin 250 micrograms daily
Paracetamol 500 mg, 1-2 tablets 4-hourly PRN
Piroxicam 20 mg at night
Mylanta suspension, 20 ml PRN
Coloxyl 120 mg, 1-2 tablets at night
Assignment Questions
Critically discuss this case study in terms of the problematic nature of this patient's pharmacological management.
Outline some pharmacokinetic changes in the geriatric population that may affect drug disposition.
Outline how changes in renal and hepatic function may affect treatment strategies.
In the drug regimen presented above – discuss potential side effects and potential interactions, if any?
Your response should include a discussion of the problems of polypharmacy as it is related to this case study and the assessment/management and educational strategies which could have been implemented to improve the outcome of Mrs. A.
Instructions
Prepare and submit a 3-4 page paper [total] in length (not including APA format).
Answer all the questions above.
Support your position with examples.
Please review the rubric to ensure that your assignment meets criteria.
Submit the following documents to the Submit Assignments/Assessments area:
NU636 Advanced Pharmacology
Unit 2 Assignment
Instructions
Health Interview Survey (NHIS) were findings that 38% of adults use CAM [complementary and alternative medical] health care modalities.
Construct a professional paper that outlines how the use of the following CAM health care modalities impacts the cardiovascular system.
Ginseng
Hawthorn
L-Arginine
St. John’s Wort
For each of the modalities the discussion must include:
effect on the cardiovascular system
anticipated benefits
any identified risks or adverse effects
relative patient education
supporting reference from scholarly literature.
Instructions
Prepare and submit a minimum of a 6 page paper pages [excluding title and reference pages].
Format consistent with APA style without an abstract page.
Answer all the questions above.
Please review the rubric to ensure that your assignment meets criteria.
Submit the following documents to this assignment area:
Assignment: Cardiac Impact
Estimated time to complete: 2 hours
NU636 Advanced Pharmacology
Unit 5 Assignment
Case Study: Inflammatory Bowel Disease
Case Study
Mrs. Z is a 34-year-old female who come in with a complaint of diarrhea accompanied by abdominal pain. Onset of the symptom was about 4 days ago. She reports thinking she is running a fever but has not taken her temperature. She concerned that she is starting to feel weak.
When asked how about the characteristics and the number of bowel movements a day, she reports increased number of BMs over the last few months. In the last few days she reports averaging about 10 small volume watery stools with varying amounts of blood daily.
She denies recent travel and reportedly has not been on any antibiotics in the past few weeks.
In reviewing her record, you notice that her health history is positive for history of ulcerative colitis. She has not been on any medications for this over the last few years as she had not been symptomatic.
Mrs. Z is on an oral contraceptive. She takes slippery elm capsules and has for the last several years. She reports that she has been taking 2 to 3 doses of Benefiber prebiotic fiber for the last couple days.
Objective data:
BP 116/70 sitting, 100/66 standing; P 92; Temp 100.1
Abdomen – active bowel sounds all 4 quadrants, mild tenderness with palpation
Otherwise her exam is unremarkable for pertinent positives or negatives.
Labs – WBC 14,000; Hgb 11.9; Hct 35.7; Sodium 133; Potassium 3.3
What pharmacologic therapy would you prescribe for Mrs. Z?
How will you evaluate the effectiveness of this therapy?
What patient education would you provide for Mrs. Z relative to the pharmacologic agent you prescribed?
Are there any pharmacogenetic considerations related to what you prescribed for the patient?
Are there any alternative therapies or over-the-counter agents that might be of value to Mrs. Z?
What, if any, lifestyle changes would you recommend?
Instructions: Please prepare and submit a paper 3-4 pages [total] in length (not including APA format) answering the questions below. Please support your position with examples.
NU636 Advanced Pharmacology
Unit 6 Assignment
Antibiotic Stewardship
CDC Antibiotic Stewardship Initiative Discussion Paper
Construct a professional paper that outlines the advanced practice role – as a nurse educator, a nurse leader, or a nurse practitioner – to advance the CDC’s antibiotic resistance initiative. The paper needs to be a minimum of six (6) pages [excluding title and reference pages] consistent with APA style without an abstract page. The paper is worth 40 points.
Please include the following:
Introduction that identifies your advanced practice role and your view of how that role will be able to impact the antibiotic resistance dilemma. Support your discussion with at least two references from the literature.
Review the CDC’s goals and identify one of the CDC’s key strategies that you will be able to promote/support in your advanced practice role. Support your discussion with at least two references from the literature.
Discuss three activities/actions that you will develop to support the promotion of the key strategy that you identified in item 2 above. Each action/activity needs to be well designed and supported with at least one reference from the literature. [For example, if you are a nurse educator student – in what course(s) will you be able to promote your identified key strategies, be specific about what that would look like using example lesson plan(s), identify any active learning strategies you will utilize, etc., and provide justification for your strategies, etc.; if you are a nurse leader student – what program(s) and activities will you engage with relative to your organization, be that existing programs or creation of new programs, reporting mechanisms, development of collaborative committees, etc., and provide justification for your strategies, etc.; if you are a nurse practitioner student – what prescribing practices, patient education practices, monitoring programs, etc., will you engage with, and provide justification for your strategies, etc.
The paper is to be formatted according to APA style
