NSG 6005 All Week Discussions Latest from SU

NSG 6005 Week 1 Assignment 2 Discussion

Select one of the two questions from the discussion questions listed below .By Week 1, Day 3, respond to the selected discussion question and submit your response to this Discussion Area .

Start reviewing and responding to the postings of your classmates as early in the week as possible .Respond to at least two of your classmates’ posts .Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion .

Discussion Question 1

Interview a pharmacist and ask for his or her thoughts on your role as an APN .Ask the pharmacist to share his or her opinion about how well prepared APNs should be for this responsibility and what suggestions he or she may have for your future success .In your response, talk about who the pharmacist was, what was his or her educational background, and where he or she works and list the questions you asked .Reflect upon his or her words and ideas and discuss how you feel about his or her opinion and how this might help you in your future role .

Discussion Question 2

Informatics has provided multiple avenues for APNs to improve their practice .Identify one electronic source that can help you prescribe medications .Name the source and explain why this will be helpful to you in the clinical setting .List the types of information this resource provides and its limitations .Is there a cost associated with its use? If so, does the cost seem reasonable? Discuss the limitations, if any, the program has .Discuss why this program seems useful for you .

NSG 6005 Week 2 Assignment 1 Discussion

Select one of the two questions from the discussion questions listed below .By Week 2, Day 3, respond to the selected discussion question and submit your response to this Discussion Area .

Discussion Question 1

Many patients ask for nonprescription medications to use for various health problems, such as insomnia, depression, pain, memory, and anxiety .Select one patient complaint (for example, insomnia) and review the major herbs that have been recommended for treatment .Go to the South University Online Library and locate at least one peer-reviewed research article designed to study the effects of one of these substances .Describe the study and results and explain how this would influence your action as an APN .

Discussion Question 2

Go to the Internet and locate the website for any medication of interest to you .Go to the prescribing directions and locate the section that reports the pharmacology of the medication .Describe the information presented on pharmacodynamics and pharmacokinetics of that drug .Explain all of the areas that are reported in this document, including enzyme activity; medication onset and duration of action; area under the curve; and absorption and distribution, including maximal plasma concentrations .Describe if the medication should be taken with or without food and why .To adequately respond to this question, you must look at the package insert from the company; no other sources will contain the extent of information you need .

NSG 6005 All Week Discussions Latest from SU

NSG 6005 Week 3 Assignment 1 Discussion

Select one of the two questions from the discussion questions listed below .By Week 3, Day 3, respond to the selected discussion question and submit your response to this Discussion Area .

Discussion Question 1

CF is a sixty-year-old African American male who presents as a new patient for initial evaluation and follow-up .He has been diagnosed with hypertension for the last twelve years and Type 2 diabetes for the same period of time .His current blood pressure is 162/90, with a pulse of 76 .His body mass index (BMI) is 32 .He is currently taking Maxzide 37 .5/25 mg every morning .This is the only antihypertensive medication he has taken .

For this question, focus on the treatment of hypertension .Discuss the influences of his age, gender, and ethnicity on hypertensive medications .On the basis of an analysis of those factors, provide one option for improvement of his blood pressure and provide a clear and specific justification for that choice .Be sure to include dosage and scheduling .Include highlights of patient teaching and/or recommendations for any lifestyle changes .Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication .

Discussion Question 2

MT is a fifty-six-year-old obese (BMI 31 .5) Caucasian female with a significant family history of cardiovascular disease .She has uncontrolled hypertension and is currently taking metoprolol 50 mg twice daily .She has dyslipidemia and is taking exetimibe 10 mg daily and garlic .Her current cholesterol is 240 mg/dL, HDL is 41 mg/dL, LDL is 163 mg/dL, and triglycerides are 183 mg/dL .Her blood pressure today is 174/94, and her pulse is 90 .

Review the medications she is taking for hypertension and dyslipidemia .Evaluate the efficacy of these medications .Review them in terms of her age, gender, and ethnicity .Suggest any changes you would recommend, with clear justification for those choices .For medications, include dosages and schedules .Include highlights of patient teaching and/or lifestyle alterations .Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication .

NSG 6005 Week 4 Assignment 1 Discussion

Select one of the two questions from the discussion questions listed below .By Week 4, Day 3, respond to the selected discussion question and submit your response to this Discussion Area .

Discussion Question 1

SE is a twenty-two-year-old Caucasian woman who was diagnosed with asthma at age seven .According to her medical record, she has “mild persistent” asthma .Today, she reports that she has been using her albuterol metered-dose inhaler (MDI) approximately three to four days per week over the last two months .Over the past week, she admits to using albuterol once daily .She has been awakened by a cough three nights during the last month .She states she especially becomes short of breath when she exercises .However, she also admits that the shortness of breath is not always brought on by exercise .She also has a fluticasone MDI, which she uses “most days of the week .” She has been hospitalized twice in the last year for poorly controlled asthma and has been to the emergency department (ED) three times in the last six months for the same problem .Her lab work is all within normal limits, with the exception of a positive human chorionic gonadotropin (HCG) .Answer the following questions:

What information in the case study suggests that her asthma is not well controlled?

What factors could possibly lead to this?

How would you classify the symptoms based upon the National Institutes of Health (NIH) guidelines?

With the recognition that she is pregnant, how would you alter her treatment for asthma?

Support your responses with guidelines, including the NIH guidelines, for management of asthma during pregnancy .Use other peer-reviewed articles as needed to support specific aspects of your plan .

Discussion Question 2

TJ is a fifty-five-year-old police officer who presents to the clinic with complaints of epigastric pain for two weeks .He has been taking over-the-counter (OTC) Zantac without relief .He was diagnosed about a year ago with a bleeding ulcer, and he expresses concerns that the current symptoms remind him of that event .At that time, he was given “multiple prescriptions” for his stomach, but he did not complete the course of therapy because he began to feel better .He also has osteoarthritis in his wrists and hips, for which he takes OTC NSAIDs .He smokes one to two packs per week and drinks an average of one alcoholic beverage daily .His vital signs and blood work are all within normal limits .Answer the following questions:

What additional testing would you suggest at this point?

Describe any and all variables that could be contributing to his symptoms .

What alterations would you suggest in his treatment? Be sure to consider additional diagnoses and whether prophylaxis would be appropriate for NSAID-induced ulcers .

Support your responses with guidelines you locate in the literature and peer-reviewed articles as needed to support your ideas .

NSG 6005 All Week Discussions Latest from SU

NSG 6005 Week 5 Assignment 1 Discussion

Select one of the two questions from the discussion questions listed below .By Week 5, Day 3, respond to the selected discussion question and submit your response to this Discussion Area .

Discussion Question 1

GF is a forty-one-year-old woman who arrives for her first visit at the clinic .She reports that she has been feeling sad and depressed, with crying spells, trouble sleeping, increased appetite, impaired concentration, and fatigue .She has experienced depression in the past but was able to overcome the symptoms without medication .Upon physical exam, she appears to be poorly groomed and with minimal facial expression .She is slow to respond to questions .She admits to being very anxious and worried about “everything .” She denies any current suicidal ideation .However, she expresses concerns about the future and that it may not be an improvement .She has tried over-the-counter medications to help with sleep, but they have not been effective .Answer the following questions:

What additional information would you like before making a decision about what to do with GF?

What approach would you suggest for this patient? Which of her symptoms would concern you and require intervention?

Does she need to be referred to another provider, or can she be managed in a primary care setting?

Are there any nonpharmacological strategies that might be appropriate for her?

For medications, include dosages and schedules .Include highlights of patient teaching and/or lifestyle alterations .Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication .

Discussion Question 2

ST is a twenty-five-year-old male who presents to the clinic with a major complaint of insomnia .He has been experiencing problems sleeping for the past month .He has been “borrowing” medication from his mother and friends, such as diazepam and alprazolam, and he finds that these are helpful in allowing him to sleep .He was also diagnosed with asthma at the age of ten .He has been using an inhaler, as needed, but he cannot recall the name of the inhaler .He is currently working part-time through a temporary agency, and he has not been able to find any full-time work .Answer the following questions:

What additional information would you like to obtain from ST?

What are the possible reasons for his insomnia?

What are the possible strategies you can use to help him with the insomnia?

NSG 6005 All Week Discussions Latest from SU

NSG 6005 Week 6 Assignment 1 Discussion

Assignment 1: Discussion Questions

Select one of the two questions from the discussion questions listed below .By Week 6, Day 3, respond to the selected discussion question and submit your response to this Discussion Area .

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Discussion Question 1

MP is a sixty-five-year-old male who has recently retired .He is coming in today for a complaint about pain in his back, knees, and hips .He reports that he has been experiencing this pain for the past six months, and he has been able to control the symptoms with OTC Advil .He describes the pain as stiffness and occasional shooting and aching pains radiating all over .He denies any swelling of his joints .However, the OTC medications are not working well, and he is here to see whether there are any other options he might try .On physical exam, he has tenderness on palpation on the right and left hips and both knees are positive for crepitus .All blood work is within normal limits .Answer the following questions:

What additional information would you like to have? Does MP need any additional testing?

What possible issues could contribute to his symptoms?

He asks about injections to both knees to increase his comfort .How would you respond to that?

What would your treatment plan be?

Discussion Question 2

EP is a twenty-five-year-old African American female who has just moved to town and comes to the clinic for her first visit .She has been diagnosed with fibromyalgia .She reports that her previous primary care physician (PCP) was treating her with opiates only .She has been taking hydrocodone/ibuprofen 7 .5 mg/200 mg four times daily but notes that this is not helping her .She is asking you for a refill of this medication and any additional treatment you can advise .On physical exam, she is in moderate distress and reports pain when being touched .Answer the following questions:

How would you validate the diagnosis of fibromyalgia?

How would you handle EP’s request for ongoing hydrocodone? Locate any evidence of the efficacy of this treatment for fibromyalgia .

Assuming that the diagnosis is , what would your treatment plan be?

Would you recommend any nontraditional therapies?

NSG 6005 All Week Discussions Latest from SU

NSG 6005 Week 7 Assignment 1 Discussion

Select one of the two questions from the discussion questions listed below .By Week 7, Day 3, respond to the selected discussion question and submit your response to this Discussion Area .

Discussion Question 1

EP is a fifty-year-old woman who reports experiencing two to three hot flashes per day, occasionally associated with insomnia .She also states she is awakened from sleep about two to three times per week, needing to change her bedclothes and linens due to sweating .Her symptoms began about three months ago, and over that time, her symptoms have worsened to the point where they have become very bothersome .She is concerned about starting any hormonal treatment because she has read news stories that the medication is not safe .She has been successfully treated for depression and is currently doing well on paroxetine .Her current medications include omeprazole 20 mg daily, paroxetine 20 mg, Synthroid 0 .075 mg daily, and hydrochlorothiazide 25 mg daily .Her physical exam is normal; her blood pressure is 128/86, her pulse is 78, and her body mass index (BMI) is 30 .5 .Answer the following questions:

Is there any additional information you would want to collect?

What are the variables you would take into account before deciding how to help her?

What treatment will you recommend?

What nonpharmacological treatment would you suggest?

For medications, include dosages and schedules .Include highlights of patient teaching and/or lifestyle alterations . Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication .

Discussion Question 2

VG is a thirty-one-year-old female who comes in for a routine follow-up .She reports that she has been feeling excessive fatigue over the last month .She also notes that she is having some problems at work, not only because of her fatigue but also because of difficulty concentrating .She also notes that she has gained 10 pounds over the last month, and she is unable to identify the cause of the weight gain .She also notes that her periods are a little heavier and more irregular .She is currently taking daily ferrous sulfate and over-the-counter calcium .According to her medical record, she had a TSH level of 4 .2 mIL/L about a year ago .Although this is slightly elevated, no further follow-up was deemed necessary at the time .Repeat blood work today reveals a TSH level of 9 .8 mIL/L and a free T4 of 0 .72 ng/dL .Answer the following questions:

What additional findings on the physical exam would you look for?

What implication does the previous TSH level have?

What therapy would you institute?

If VG becomes pregnant, what adjustment, if any, would be needed in her thyroid medication?

NSG 6005 All Week Discussions Latest from SU

NSG 6005 Week 8 Assignment 1 Discussion

Select one of the two questions from the discussion questions listed below .By Week 8, Day 3, respond to the selected discussion question and submit your response to this Discussion Area .

Discussion Question 1

There are multiple issues to consider in caring for someone with diabetes II .Your course textbook lists these as:

Race and Ethnic Group

Obesity

Coronary Artery Disease and Heart Failure

Hyperlipidemia

Hypertension

Nephropathy

Neuropathy

Retinopathy

From this group, select two specific issues and explain the importance of that variable in the treatment of diabetes .Explain how a provider needs to approach the patient and how these considerations would influence the selection of agents for the treatment of diabetes and related complications .

Discussion Question 2

AG is a sixty-nine-year-old male who presents for an initial visit with a complaint of blurred vision, fatigue, and lack of energy .He is currently being treated for hypertension, hypothyroidism, and gouty arthritis .He is currently retired and married, with three adult children .His vital signs are unremarkable, with a body mass index (BMI) of 30 .His current medications include lisinopril 20 mg daily, allopurinol 300 mg daily, and levothyroxine 0 .088 mg daily .

As per his blood work today, his A1c level is 7 .8%, his fasting blood sugar is 202, his total cholesterol is 180 mg/dL, his high-density lipoprotein (HDL) is 27 mg/dL, his low-density lipoprotein (LDL) is 193 mg/dL, and his triglycerides are 302 mg/dL .Answer the following questions:

What additional blood work would you like to complete at this point? Is there any additional information that should be collected from the patient?

Evaluate the current therapy and make recommendations concerning any needed changes .

What lifestyle modifications or changes do you think would be appropriate for this patient?

NSG 6005 All Week Discussions Latest from SU

NSG 6005 Week 9 Assignment 1 Discussion

Select one of the two questions from the discussion questions listed below .By Week 9, Day 3, respond to the selected discussion question and submit your response to this Discussion Area .

Be sure to respond to the question using the lessons and vocabulary found in the reading .Justify your answers using examples and reasoning .Support your answers with examples and research and cite your research using APA format .In addition to your textbook, consult the Sanford Guide to help you identify appropriate treatment for specific infections .

Discussion Question 1

JT is a fifty-five-year-old man with a three-day history of worsening shortness of breath, fever, chills, right-sided chest pain, and productive cough .He states that the initial symptoms started approximately one week ago .He has been taking over-the-counter (OTC) medications to control the fever and the cough .He comes in today because he feels that he is getting worse .He is coughing up rust-colored mucus, and the chest pain has started to make breathing even more difficult .His physical exam is normal, with the exception of tachypnea, labored breathing, coarse rhonchi through the right lung field, and decreased breath sounds on the right .Answer the following questions:

What additional laboratory or radiological tests would be indicated and why? What would you expect to find?

What is your diagnosis?

What medication would be given and for what period of time?

Discussion Question 2

LN is a twenty-six-year-old married woman who presents at the clinic with symptoms of dysuria, frequency, and urgency .Further history yields two days of these symptoms but no fever, chills, or flank pain .She describes a burning discomfort during and immediately following urination and feeling the need to void every half hour .There is no vaginal discharge, itching, or odor .She is not using birth control at this time .She requests “a urine culture and some sulfa pills .” When asked to explain, she says she has had many “bladder infections” over the past three years and “sulfa pills usually work .” She was evaluated approximately five years ago with an IV pyelography and cystogram, and “nothing was wrong .” All her vital signs are normal .Answer the following questions:

What additional information would you like to collect?

What is your working diagnosis?

What are the contributing factors to this potential diagnosis?

What treatment would you implement and why?

What type of follow-up would you recommend?

NSG 6005 All Week Discussions Latest from SU

NSG 6005 Week 10 Assignment 1 Discussion

Select one of the two questions from the discussion questions listed below .By Week 10, Day 3, respond to the selected discussion question and submit your response to this Discussion Area .

Discussion Question 1

SJ is a sixteen-month-old boy who is brought to the clinic with a one-day history of tugging at his right ear and crying and a two-day history of decreased appetite, decreased playfulness, and difficulty sleeping .His mother has documented a fever, so she has been giving him 5 mL of ibuprofen every twelve hours .He was diagnosed with acute otitis media (AOM) at the age of four months; he has had the same diagnosis three times since .

On physical exam, his vital signs are normal with the exception of a temperature of 102°F .His weight is 10 kg .Both tympanic membranes (TMs) are erythematous, with the right one more than the left one .The right TM is bulging with limited mobility, copious cerumen, and purulent fluid behind the TM .The left TM appears normal .The right TM landmarks are difficult to visualize .Answer the following questions:

Of the information provided, what data support the diagnosis of AOM and what would be inconclusive?

How would you distinguish AOM and otitis media with effusion (OME)?

What treatment would you suggest?

What types of cautions or instructions would you provide to his mother?

Discussion Question 2

Administration of ophthalmological medications requires some explanation .What are the important points that you would review with a patient when teaching how to instill ophthalmic drops and when teaching how to instill ointment? What are the differences you would need to consider if the patient was a child or if the patient is a geriatric patient? Search the literature to see whether you are able to locate any guidelines to support this teaching .