NR508 Week 1 Discussion 1, 2 & 3 Latest 2017 November
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Week 1: Discussion Part One
1414 unread replies.7272 replies.
Emily, a relatively healthy 5’5”, 32-year-old young woman weighing 190 pounds, presents to your clinic with hirsutism, anovulation, oligomenorrhea, and at times amenorrhea. Biochemical blood tests reveal elevated luteinizing hormone (LH, without a mid-cycle surge) and androgen elevation.
She mentions that she also has a family history of irregular cycles, and that her grandmother experienced early menopause. She also states that she is sexually active, occasionally smokes (1 pack/month), and desires to be prescribed one medication to mitigate her symptoms, as well as, prevent her from becoming pregnant.
- Please provide a list of differential diagnoses, as well as an indication of your primary diagnosis.
- Once this has been completed, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.
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Week 1: Discussion Part Two
1212 unread replies.6767 replies.
You diagnose Emily with polycystic ovarian syndrome (PCOS) and decide to prescribe drospirenone-ethinyl-estradiol as a way to control both the PCOS symptoms, as well as to act as an oral contraceptive.
- At what dose should this be prescribed?
- What is the mechanism of drospirenone-ethinyl-estradiol, and why would, because of its mechanism, it be a good choice for her PCOS symptoms (Include the medication-altered physiology)?
- How would you monitor for efficacy and toxicity?
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Week 1: Discussion Part Three
2626 unread replies.4040 replies.
Emily subsequently returns to your clinic 5 months later, and decides to inform you that within the first 3 months after treatment, she struggled with a severe bout of depression. Instead of returning to your clinic to be prescribed, yet another pharmaceutical, she consulted her herbalist who told her about the anti-depressant, over-the-counter, herbal formulation, St. John’s Wort. She decided to begin taking St. John’s Wort in conjunction with her prescribed oral contraceptive medication, and she has now reappeared at your clinic because she is pregnant, and is distraught about how this occurred since she took her oral contraceptive compliantly since its prescription.
- Why then, is she pregnant?
- Please include detailed pharmacological mechanisms of how this occurred, and your subsequent steps in her management.
NR508 Week 2 Discussion 1, 2 & 3 Latest 2017 November
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Week 2: Discussion Part One
1515 unread replies.9090 replies.
Cynthia is a 65-year-old African American female who presents to the clinic for a check-up. Her last examination was ~5 years ago. She has no specific, significant, or urgent complaint. She explains that her only issues are thirst, fatigue, and leg numbness and tingling, which is beginning to occur more often. You decide to do a physical exam, as well as draw labs and receive the following results:
Social history: no smoking or alcohol consumption. |
Physical examination: |
GEN: well nourished, slightly obese female |
VS: BP 180/103 HR 73 RR 13 T 98.4 Weight 90 kg, Height 5’6” |
HEENT: PERRLA |
COR: RRR, NMRG |
CHEST: CTA |
NEURO: monofilament test shows decreased peripheral sensation |
EXT: normal |
|
Laboratory (fasting): |
Na 139 mEq/L |
K 3.8 mEq/L |
ALT 34 U/L |
Ca 9.1 mg/dL |
CL 102 mmol/L |
HCO3 22 mEq/L |
AST 39 U/L |
TP 6 g/dL |
BUN 33 mg/dL |
SCr 2.0 mg/dL |
Alb 4.1 g/dL |
Cholesterol 254 mg/dL |
BG 300 mg/dL |
TSH 0.12 mU/mL |
UA: SG 1.013 mg/24h, pH 6.5, +++ protein |
- What are the major problems in this patient, and what diagnoses do these values indicate?
- Additionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action?
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Week 2: Discussion Part Two
No unread replies.4747 replies.
Cynthia has been prescribed a plethora of medications.
- How will you properly monitor each medication for efficacy and toxicity?
- Are you concerned with any drug-drug interactions?
- If so, what are they, and what is the mechanism of the interaction?
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Week 2: Discussion Part Three
66 unread replies.3636 replies.
Given Cynthia’s increased creatinine and renal deterioration, metformin is probably not optimal in this case. Therefore, upon subsequent visits, you decide to start her on a sulfonylurea. She reappears in your clinic fairly soon there after with complaints of shakiness, sweating, chills, clamminess, lightheadedness, and a moderately severe headache.
- What is the diagnosis given these symptoms and the medications she is currently taking from Parts One and Two, and how would you proceed?
- At this point, please also be sure to also provide an accurate summary of Cynthia’s medication plan.
NR508 Week 3 Discussion 1 & 2 Latest 2017 November
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Week 3: Discussion Part One
4949 unread replies.8383 replies.
Elliot is a 74 year-old male who presents to your clinic with complaints of frequent nosebleeds (4 in the past week) and several severe bruises scattered variously throughout his anatomy. The patient is also complaining of a runny nose, cough, and head/chest congestion. He has a history of chronic atrial fibrillation and is currently prescribed and taking warfarin. Approximately 3 weeks previously, he started taking over-the-counter cimetidine for heartburn he was experiencing. Below is a list of the patient’s medications, his physical examination, and his laboratory findings:
Medications |
Digoxin 0.25 mg QD | Cimetidine OTC BID |
Pseudoephedrine SR 120 BID | Warfarin 7 mg QD |
Allergies: NKDA | |
Physical Examination | |
VS: BP: 180/95, HR 75, irregularly irregular, RR 17 Weight: 95 kg | HEENT: WNL |
ABD: + Bowel Sounds | EXT: Bruising on arms and legs |
NEURO: Alert & Oriented x 3 | GEN: Well developed, well-nourished male |
ECG: atrial fibrillation | |
Laboratory | |
Na 143 mEq/L | K 4.5 mEq/L |
Cl 99 mmol/L | CO2 25 mEq/L |
BUN 18 mg/dL | SCr 0.9 mg/dL |
INR 4.8 | Hct 42% |
Hbg 15 mg/dL | Digoxin 3.8 ng/ml |
- What problems should be identified in this patient?
- What are the precise mechanisms of action of each drug?
- What do you think is contributing to the patient’s hypertension?
- Are there any drug interactions that you can identify as associated with this current drug regimen, and if so how, mechanistically, are they occurring?
- What is the clinical significance of these interactions?
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Week 3: Discussion Part Two
2727 unread replies.7474 replies.
You have decided to have him stop the pseudoephedrine related to his hypertension, as well as the cimetidine related to its interaction with warfarin. The patient returns for his monthly follow-up appointment, and it is noticed that his blood pressure (195/80) has not come under control. You decide to start him on hydrochlorothiazide.
- Is there a better medication than a thiazide, and if so what dose should you initiate this medication?
- How would you proceed, and how you would monitor for efficacy and toxicity?
NR508 Week 5 Discussion 1 ,2 & 3Latest 2017 November
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Week 5: Discussion Part One
1111 unread replies.5050 replies.
Leroy is a 70 year-old-man, whose wife passed away 5 years ago, and whose 2 children live out-of–state. His neighbor caretaker (Ms. Webb, a middle-aged retired CNA, whom his children hired to provide home care to him 3x/week) brings him to your clinic. He presents with quite severe confusion, incidentally to very minor changes in his environment, which provokes some violence (a symptom which startles Ms. Webb), increasingly impaired judgment, and increasing repetitiousness and inconsistencies in his usual behavior. Upon initial work-up and physical exam, you notice an increased respiratory rate, a slight fever (100°F), and costovertebral angle tenderness on his right side.
- Please provide a list of differential diagnoses, as well as an indication of your primary diagnosis.
- What additional tests would you order to confirm a diagnosis? Once this has been completed, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.
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Week 5: Discussion Part Two
66 unread replies.1010 replies.The patient is diagnosed with a severe urinary tract infection (pyelonephritis), and you decide to prescribe him sulfamethoxazole/trimethoprim (SMX/TMP) 800/160mg one tab PO Q12h x14 days Over the next couple of weeks, the symptoms associated with his UTI diminish, and his mental status improves. However, Ms. Webb brings him back to your clinic with symptoms, which scare her yet again, and she explains that she thinks he may have a relapse of his UTI. These symptoms include a high fever (103.6°F) and tachypnea, and upon pulmonary examination at your clinic, you hear crackles, and find classic findings of lung consolidation.
- What laboratory tests should you order, and what is your primary diagnosis at this point and subsequent steps in his treatment and management?
- Once explained, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.
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Week 5: Discussion Part Three
1919 unread replies.3838 replies.Upon receipt of laboratory results, you notice that his eGFR is ~40mL/min, his serum creatinine is 3.0 mg/dl, and his BUN is 50 mg/dl.
- How will the medication regimen(s) have to be adjusted given these new laboratory findings, and how should you be monitoring for efficacy and toxicity of this patient’s pharmacological profile with a summary of where this patient currently stands in his medical treatment?
NR508 Week 6 Discussion 1, 2 & 3 Latest 2017 November
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Week 6: Discussion Part One
2727 unread replies.7070 replies.
Jonathon is a 56 year-old retired automobile mechanic who has not been to the doctor in approximately 6-7 years. He presents to your office complaining that three weeks ago he was awoken with severe pain and inflammation in his knee, which has been consistent since that initial night. Upon physical examination of his knee, it appears swollen and erythematous with periarticular involvement. Upon physical examination and laboratory results you notice the following:
Physical examination: |
GEN: well nourished, obese male (310 pounds) |
VS: BP 191/112 HR 75 RR 15 T 98.6, HT 5’8” |
EXT: Knee joint inflammation |
|
Laboratory (fasting): |
Na 139 mEq/L |
K 3.8 mEq/L |
Ca 9.1 mg/dL |
CL 102 mmol/L |
HCO3 22 mEq/L |
BUN 10 mg/dL |
SCr 0.9 mg/dL |
Serum Uric Acid 6.5 mg/dL |
Alb 4.1 g/dL |
Cholesterol 300 mg/dL |
UA: pH 6.8, uric acid 250 mg/24h |
What problems can be identified in this patient? Please provide a list of differential diagnoses, as well as indication of your primary diagnosis.
What is your pharmacological plan for your primary diagnosis including the medication, dose, and mechanism of action?
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Week 6: Discussion Part Two
3131 unread replies.4848 replies.
He returns to your clinic for follow-up blood work, and four values catch your attention:
AST 430 U/L |
ALT 535 U/L |
Bilirubin 41 mg/dl |
BG 60 mg/dl |
He admits to a history of moderate-to-high alcohol intake (>12 drinks/week for >10 years). He is slightly febrile (99.7°F) and has abdominal tenderness. He also admits to taking several, different over-the-counter pain relievers of different brands daily and continuously to combat the pain in his knee, in addition to his prescription(s) in Part One. You decide to run a toxicology lab, and it reveals a blood acetaminophen concentration of 58 µg/mL.
- What is the diagnosis at this point in his case? Please explain the mechanism for how this occurs/occurred, and the antidote’s mechanism of action.
- What is the subsequent management and treatment for this individual related to the diagnosis in Part One.
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Week 6: Discussion Part Three
2929 unread replies.3535 replies.
This is your third time seeing this patient, and he reports the NSAID that he has been prescribed is not addressing his pain. He reports his pain is a 10 out of 10, HR 108, talking extremely fast, he is diaphoretic, unshaved, his clothes are a bit wrinkled and he is requesting that you prescribe him Percocet because he doesn’t think Tramadol, that you are considering prescribing, will work.
- What are the possible signs of prescription drug abuse?
- What should the NP do when a patient has continued to return?
NR508 Week 7 Reflection Latest 2017 November
Week 7: Reflection
99 unread replies.3737 replies.
Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #3, MSN Essential IX, and NP Core Competencies # 5
Program Outcome #3:
Use contemporary communication modalities effectively in advanced nursing roles
MSN Essential IX: Master’s-Level Nursing Practice
Recognizes that nursing practice, at the master’s level, is broadly defined as any form of nursing intervention that influences healthcare outcomes for individuals, populations, or systems. Master’s-level nursing graduates must have an advanced level of understanding of nursing and relevant sciences as well as the ability to integrate this knowledge into practice. Nursing practice interventions include both direct and indirect care components.
Nurse Practitioner Core Competencies
#5 Technology and Information Literacy Competencies
1. Integrates appropriate technologies for knowledge management to improve health care.
2. Translates technical and scientific health information appropriate for various users’ needs.
2a). Assesses the patient’s and caregiver’s educational needs to provide effective, personalized
health care.
2b). Coaches the patient and caregiver for positive behavioral change.
3. Demonstrates information literacy skills in complex decision making.
4. Contributes to the design of clinical information systems that promote safe, quality and cost effective
care.
5. Uses technology systems that capture data on variables for the evaluation of nursing care. |
