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Homework answers / question archive / Week 9 Pharmacology Discussion (Hematology) due July 29 Week 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part I As an advanced practice nurse, you will likely encounter many disorders associated with women’s and men’s health, such as hormone deficiencies, cancers, and other functional and structural abnormalities

Week 9 Pharmacology Discussion (Hematology) due July 29 Week 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part I As an advanced practice nurse, you will likely encounter many disorders associated with women’s and men’s health, such as hormone deficiencies, cancers, and other functional and structural abnormalities

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Week 9 Pharmacology Discussion (Hematology) due July 29 Week 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part I As an advanced practice nurse, you will likely encounter many disorders associated with women’s and men’s health, such as hormone deficiencies, cancers, and other functional and structural abnormalities. Disorders such as these not only result in physiological consequences but also psychological consequences, such as embarrassment, guilt, or profound disappointment for patients. For these reasons, the provider-patient relationship must be carefully managed. During evaluations, patients must feel comfortable answering questions so that you, as a key health-care provider, will be able to diagnose and recommend appropriate treatment options. Advanced practice nurses must be able to educate patients on these disorders and help relieve associated stigmas and concerns. This week, you examine women’s and men’s health concerns as well as the types of drugs used to treat disorders that affect women’s and men’s health. You also explore how to treat aspects of these disorders on other health systems. Learning Objectives • • • • Students will: Evaluate patients for treatment of complex health issues Evaluate patients for treatment of infections Evaluate patients for treatment of hematologic disorders Analyze patient education strategies for the management and treatment of complex comorbidities RESPONSE TO 2 STUDENTS: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes? For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes. Photo Credit: Getty Images • To Prepare Review the Resources for this module and reflect on the different health needs and body systems presented. • Your Instructor will assign you a complex case study to focus on for this Discussion. • Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected. By Day 3 of Week 9 Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples. By Day 6 of Week 10 Tutor will respond to studendS REPLY TO YOUR of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples, please. Professor sent this email down below Week 9: Supplemental Resources New Posted by professor XXXXX at Tuesday, July 27, 2021 11:21:25 AM Please find attached supplemental resources. As you know, it's important that NP's utilize Evidence-Based Guidelines as you develop your treatment plans. Although this course relates to the pharmacology portion of the treatment plan, I've found that introducing you to the related guidelines and medications enhances understanding. Warm Regards, Dr. XXXX • • • • • • • • Attached Files: (Tutor Copy and paste in your computer Anemia alg and explanation .pdf(129.9kb) Anemia Algorithm .pdf(55.2kb) AntiplateletMedsPostTIAStrokeBMJ1901.pdf(1181.0kb) Blood Thinners Education.pdf(345.0kb) Drugs Affecting the Hematopoietic System Chart.docx(15.3kb) Hemolytic Anemia’s .pdf(154.8kb) heparin bridge algorithm pic.png(8.9kb) searching browser) Learning Resources Required Readings (click to expand/reduce) • • • • • • • • • • • • • • Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 364–371) Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396) Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436) Chapter 51, “Birth Control” (pp. 437–446) Chapter 52, “Androgens” (pp. 447–453) Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466) Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661) Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662– 668) Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694) Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699) Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714) Chapter 79, “Antifungal Agents” (pp. 715–722) Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723– 743) Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770) Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5–15. doi:10.3109/13685538.2015.1004049 This article presents recommendations on the diagnosis, treatment, and monitoring of hypogonadism in men. Reflect on the concepts presented and consider how this might impact your role as an advanced practice nurse in treating men’s health disorders. Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting. PLoS ONE, 9(2), e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872 This study examines HAART therapy and its sustainability and profound populationlevel decrease in morbidity, mortality, and HIV transmission. Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. .https://doi.org/10.1016/j.maturitas.2016.01.007 This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition. Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelinesrecommendations/guide/section2.html This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, and counseling. Required Media (click to expand/reduce) Rubric Detail Tutor MUST CHECK! Select Grid View or List View to change the rubric's layout. Name: NURS_6521_Week9_Discussion_Rubric Exit Excellent Main Posting 45 (45%) - 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Excellent Main Post: Timeliness 10 (10%) - 10 (10%) Posts main post by day 3 First Response 17 (17%) - 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Second Response 16 (16%) - 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Excellent Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Participation 5 (5%) - 5 (5%) Meets requirements for participation by posting on three different days. Total Points: 100 Name: NURS_6521_Week9_Discussion_Rubric Week 9 Discussion, MY DISCUSSION tutor to read my discussion Case Study 1 HH is a 68 yo M who has been admitted to the medical ward with communityacquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting. Ht: 5’8” Wt: 89 kg Allergies: Penicillin (rash) The patient is a male, aged 68, who was admitted after acquiring pneumonia from his environment. PMH was significant for diabetes, COPD, HTN and hyperlipidemia. The patient is still on empiric antibiotics. His health condition has been improving gradually since he was admitted three days ago. I will keep patient in a unit that be able to monitor the patient’s condition closely. I will maintained the patient connected to the ECG monitors for hourly recording of vital signs. I will check the temperature at least every 4 hour. The case indicate that his oxygen saturation has improved, as less oxygen amount has been titrated down, but he has started experiencing nausea and vomiting accompanied by poor appetite. Patient’s health needs Hydration status and treatment. Since the patient has been experiencing vomiting (V) and nausea (N), it is essential to maintain the hydration levels of the patient. This is because the patient may become dehydrated, leading to a tightening monitoring of inputs and outputs measurements (I&Os) (Chou et al., 2019). To me it is imperative to observe the color of the emesis the amount. Keep in mind that the patient is diabetic and is at high risk for hypoglycemia, and hypokalemia due to the vomiting. The color of the emesis can reflect the etiology of it, for instance if it is bilious can be a high bowel obstruction. In addition, I will control the nausea and vomiting to avoid for possible aspiration pneumonia that can aggravate the clinical picture. As a APRN I will order zofran 4 mg IV every 6 hr PRN to mitigate nausea, and vomiting. If the patient is not tolerating the oral route then I will start the patient on continuous IV fluid such as NS 0.9% at 75 ml/hour. I can estimate the fluid amount by the formula; Cumulative fluid issued per day [weight (kg) x20ml//kg/day] = 20x89 =1780ml the Infusion rate= total fluid volume per day/ 24hrs = 74.1 ml/hr. I will be assessing for fluid overload as evidenced by crackles sounds to the lungs that may be a reason to stop fluid therapy. Another important thing about keeping patient well hydrated is to facilitate to loose secretions so that the patient be able to cough and clear his airway with ease. I will document the urinary output closely if the urinary output decrease less than 30 ml/hr and is dark concentrated in color that may indicate to me that the hydration status is inadequate. Labs BMP to check for electrolytes imbalance, if potassium is lost it will need replacement with KCL 10 mEq in 100 ml NS 0.9% IVPG x4 doses as per potassium level. Accu-checks before meals to monitor for glucose level if the glucose is below 150 mg/dl no coverage is necessary at this time. can be done. Nutrition report, and treatment. The patient is not tolerating diet, which may be directly related to nausea and vomiting that he is experiencing. When the patient first complained of vomiting and nausea, a clear relationship could not be drawn between the symptoms the patient was experiencing and CAP. It is well known that some patient while in the hospitalization can developed stress ulcer that can cause these symptoms of nausea and vomiting. I will start the patient on prophylactic famotidine 10 mg IV daily. Famotidine is a Histamine2 receptor antagonist that is very effective in preventing and treating stress ulcers (Chou et al., 2019). The symptoms can either be due to a side effect to the antibiotic or possible intestinal bacterial flora inhibition (Padhani et al., 2020). A further physical examination, and labs needs to be done to determine the actual cause of the patient is experiencing nausea and vomiting. It is is fine to place patient in NPO if vomiting continuous until well control and patient start asking for meals.. Start on clear liquid diet and advance to regular diet as tolerated. Many nutritional supplement and formulas can be added, including probiotic yogurt for enhancing the intestinal microbial flora. I will consult with nutritionist to evaluate the specific diet and follow the calories intake. I will order serum proteins panel that will include albumin, transferring, prealbumin to measure the nutrional status. Length of IV antibiotic therapy. IDSA, through its guidelines to physicians, recommends treating CAP patients who have been admitted for a period of between 5 to 7 days with empiric antibiotics ceftrixone 1g IV daily x 5 days and azithromycin 500 mg IV daily x5 days. The patients should be assessed on the fifth and seventh day before the health practitioners stop administering the antibiotics. In case need be, the treatment duration can be extended to ensure the patients are progressing steadily. If condition does not improve I may order a sputum culture to evaluate for any resistant bacteria in the lung that requires changing the antibiotics treatment, and consulting with infection disease doctor. I will order CBC every morning for elevated WBC above 10/L. I will try to discontinue the antibiotics as soon as possible to prevent multidrug resistant organism, and any complication such as clostridium difficile infection. I would advise the current antibiotics dose that is being administered to be kept up until day 7. After that, the patient should be reevaluated before the prescription is stopped. Since the patient's status has been improving gradually since he was administered, I don't think there is a need to change the antibiotics dose currently being administered. Apart from that, he also needs less oxygen. Research has shown the most appropriate medication is to reconcile COPD medication to prevent COPD exacerbation. COPD exacerbation in severe cases can significantly increase the risk of mortality. Treatment Regimen I will also optimize the slide-scale insulin to treat the patient's blood sugar as per glucose test result. I would also reconcile the regular medications that patient is on. Patient has a pass medical history of hypertension I will evaluate the actual blood pressure medication to see if is prudent to continue with his medication already taking at home. I will start on any statin medication as well, to start taking at bed time. I would recommend leveraging an incentive spirometer to enable the patient to take deep breaths (Eltorai et al., 2019). It will be important in opening up airways and preventing mucus from cleating in the lungs. In the unit I will ordered possible portable chest x-ray one view to evaluate for pneumonia resolution, also if necessary ABG to evaluate PaCO2 since COPD patient needs to have their CO2 around 50 mm Hg. To keep respiratory status well balanced. Education I will educate the patient on using IS and the health benefits he enjoys from using it. To improve hydration and nutrition status, I will advise the patient to stay calm. I will offer the patient-relevant information on how to prevent pneumonia, strategies he can use to control blood glucose level, and education for hyperlipidemia and hypertension. I will also advise the patient to get a pneumonia vaccine before being discharged to go back home to reduce his risk of exposure to the disease (Eltorai et al., 2019). References Chou C.C., Shen C.F., Chen S.J., Chen H.M, Wang Y.C. (2019). Recommendations and Guidelines for Treatment of Pneumonia in Taiwan, Journal of Microbiology, Immunology, and Infection (52)1. Eltorai A.E., Baird G.L., Eltorai A.S., Healey T.T. (2019). Effect of an Incentive Spirometer Patient Reminder after Coronary Artery Bypass Grafting: A Randomized Clinical Trial, JAMA Surgery 154. Padhani Z.A., Moazzam Z., Ashraf A., Salam R. (2020). Vitamin C Supplementation for Prevention and Treatment of Pneumonia, Cochrane Database of Systematic Reviews. STUDENT #1 SV “TUTOR TO RESPOND to STUDENTS 1 AND 2” Case Study 2, Initial Post C OLLA PSE A Brief Description of a Patient's Health Needs Case Study 2 A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago. The assigned case study includes a 46-year-old 230lb woman with a complaint of hot flushing, night sweats, and genitourinary symptoms for one month. The patient's history includes hypertension and an abnormal pap smear with an atypical squamous cell of undetermined significance (ASCUS) diagnosis about 5 years ago. This patient has a family history of breast cancer, and her last menstrual period was one month ago. Detail history of this patient is critical to recommend additional medication. According to the national cancer institute (2021), ASCUS may occur due to human papillomavirus or yeast infection, or an inflammation related to low hormonal changes, or a benign cyst or polyp in menopausal women. Usually, natural menopause starts at about age 51 to 52 years, but 95% of women go into menopause between the age of 45 and 55 years (Rosenthal & Burchum, 2019). Estrogen and progestin hormones are essential for the maintenance of healthy reproductive organs among females (Rosenthal & Burchum, 2019). Physiological changes in ovaries causing decreased levels of estrogen and patients may report vasomotor and urogenital atrophy symptoms.

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