Clinical Assignment Discussion Paper

Pharmacology Made Easy 4.0: Repro/GU

Problem Based Scenario – Infertility

 

Directions: With your small group, complete this worksheet utilizing information from your Module Worksheet, the Active Medication Templates, and class lecture.

 

Clinical Scenario: Jennifer P, 37-year-old female, and her 37-year-old husband, David, present with the complaint of a possible fertility problem. The couple has been married for 2 years. The patient has a 4-year-old daughter from a previous relationship. The patient used birth control pills until one-and-a- half-years-ago. The couple has been trying to conceive since then and report a high degree of stress related to their lack of success. Jennifer reports good health and no problems in conceiving her previous pregnancy or in the vaginal delivery of her daughter. She reports that her periods were regular on the birth control pill, but have been irregular since she discontinued taking them. She reports having periods every 5-7 weeks. Past history is remarkable only for mild depression. Imipramine 150 mg qhs for the last 8 months is her only medication. Jennifer works as a cashier, runs 12-24 miles each week for the last 2 years, and has no history of STDs, abnormal Paps, smoking, alcohol or other drugs. She has had no surgery. Clinical Assignment Discussion Paper

David also reports good health and reports no problems with erection, ejaculation or pain with intercourse. He has had no prior urogenital infections or exposure to STDs. He has had unprotected sex prior to his current relationship, but has not knowingly conceived. He has no medical problems or past surgery. David works as a long-distance truck driver and is on the road 2-3 weeks each month. He smokes a pack of cigarettes a day since age 18 and drinks 2-3 cans of beer 3-4 times a week when he’s not driving. He occasionally uses amphetamines to stay awake while driving at night. The couple has vaginal intercourse 3-5 times per week when he is at home.

 

1. What is the definition of infertility?

 

 

2. What are some etiologies of infertility?

 

 

 

 

3. Complete the menstrual cycle process, filling in the correct endocrine glands and the target tissues – estrogen/progesterone, hypothalamus, ovary, pituitary, and uterus.

 

 

 

 

Noticing:

4. Evaluation of client’s medical history: Describe any abnormal findings/potential issues related to Jennifer/David’s infertility etiology and describe your thoughts about these findings. Clinical Assignment Discussion Paper

 

 

 

 

 

5. Interpreting: What is the initial work-up for infertile couples and what tests would you add for this couple?

Patient	Partner

 

 

 

 

 

 

 

 

 

 

 

 

Interpreting:

6. What contraindications should healthcare personnel screen for prior to the use of clomiphene?

 

Clinical Scenario Progression: It has been found that Jennifer has primary ovarian insufficiency. She is prescribed clomiphene 50 mg PO every day for five days, starting on day 3 of menstrual period.

 

Interpret:

7. When discussing administration of clomiphene with the couple, what information should be included?

 

 

Responding:

8. When starting fertility treatment with clomiphene, it is important to discuss possible adverse reactions with Jennifer and David. Complete the following chart with information related to interventions and which reactions should be reported to the provider.

Adverse drug reactions to clomiphene	Patient and/or Nursing interventions	Report to provider (yes/no)
Breast engorgement
Nausea, abdominal discomfort
Vasomotor instability (hot flashes)
Ovarian hyperstimulation
Multiple gestation
Blurred vision, flashes of light, dizzyness

 

 

Reflecting:

9. Couples who are experiencing infertility issues often require other specific interventions and/or nursing considerations. In relation to Jennifer and David’s situation, what particular nursing care topics should be addressed?

 

 

 

 

 

Problem Based Scenario – BPH

 

Client’s Chief Complaint:

“It is getting more and more difficult to urinate. When I do urinate it seems like I can’t empty my bladder and it gets painful. I am always waking up at night to urinate too.”

 

Clinical Scenario:

Mr. B.H. is a 52 year old white male who was referred to the urology clinic by his primary care physician after complaining of his inability to urinate, painful urination and incomplete bladder emptying. Mr. B.H. symptoms have been getting increasingly worse over the past 3 months. Most recently Mr. B.H. has noticed an increase in pain and unequal stream flow of urine while urinating. He indicates that his problems seem to be worse at night and that the pain is greater during urination after waking from sleep. Clinical Assignment Discussion Paper

Past Medical History:

· Hernia operation at birth

· Left forearm break, age 14

· Right knee ACL repair, age 19

· Right shoulder rotator cuff repair, age 20

· Hypertension diagnosis, age 41

· UTI x 2, age 50 and 52

 

Pertinent Family History:

· Father alive, age 76 years, Smoker, CAD, HTN, COPD, BPH, prostate CA

· Mother alive, age 76 years, Smoker, CAD, HTN, MI with cardiac stents at age 64

· Brother alive, age 46, HTN

· Sister alive and well at age 39 years

· Father diagnosed with BPH at age of 57

 

Pertinent Social History:

· Marine Corps Veteran with 2 tours in Iraq, 1991-1998

· Has worked full-time as a real-estate agent for 15 years

· Hobbies include woodwork, weight lifting, surfing and boating

· Frequently spends time in the Pacific Ocean surfing, at least 3 times a week

· Smoker x 20 years

· Drinks approximately 3 beers 2-3 times a week

· Diet high in cholesterol

 

Allergies:

· NKA

Current Medications:

· Atenolol 25 mg PO BID

 

Focused Physical Assessment:

 

Vital Signs:

T: (oral) 98.2˚F

P: (regular) 82 /min

R: (regular) 18 /min

BP: 155/88 (sitting)

02 sat: 98% (room air)

 

Abdomen/Scrotum/Rectum

· Bladder distended

· Abdomen tender to palpation at lower quadrants

· Digital rectal examination reveals enlarged, asymmetrical prostate gland; no tenderness; no masses; no nodules

 

 

Testing/Lab Results:

 

Basic Metabolic Panel (BMP)	Result		Complete Blood Count (CBC)	Result
Sodium (135-145 mEq/L)	140		WBC (3.4-9.6 K/uL)	7.6
Potassium (3.5-5.0 mEq/L)	3.9		RBC (4.35-5.65 M/uL)	5.22
Chloride (95-105 mEq/L)	97		Hematocrit (38.3-48.6 %)	46.8
Glucose (70-110 mg/dL)	106		Hemoglobin (13.2-16.6 g/dL)	14.7
Calcium (8.4-10.2 mg/dL)	8.9		Platelets (135-317 K/uL)	290
BUN (7-25 mg/dL)	24
Creatinine (0.6-1.2 mg/dL)	1.0

 

 

 

Urinalysis	Result		Other Testing	Result
Color (yellow)	Yellow		Prostate Specific Antigen	5.2 ng/mL
Clarity (clear)	Clear		Void with post void residual u/s	350mL
Specific Gravity (1.015-1.030)	1.026
Protein (neg)	Neg
Glucose (neg)	Neg
Ketones (neg)	Neg
Bilirubin (neg)	Neg
Blood (neg)	Trace
Nitrite (neg)	Neg

 

 

 

 

 

Noticing:

 

10. When reviewing the client’s chief complaint, along with the history and physical, what are the most significant findings and why? Which lab and test results are most concerning and why?

 

 

 

· Is there any other information (assessment data, testing, etc.) that would be helpful for determining the significance of the findings thus far?

 

 

 

 

Interpreting:

 

11. What is most likely occurring? What led you to this hypothesis?

 

 

 

 

12. What are the desired outcomes related to your hypothesis (give at least 2)?

 

 

 

 

13. What will happen if this condition is not treated?

 

 

 

 

Clinical Scenario Progression: Mr. B.H. is diagnosed with benign prostatic hyperplasia. He is started on finasteride 5mg PO once a day. He is also started on doxazosin 1mg PO once a day.

 

Responding:

 

14. What teaching should be provided to Mr. B.H. about his two new medications, finasteride and doxazosin? What are the major nursing considerations for each medication?

 

 

 

 

 

Drug Name	finasteride	doxazosin
Drug Classification
Pharmacologic Action
Adverse Effects
Administration
Nursing Considerations
Interactions

 

 

 

15. What other teaching should be included for the client about his condition?

 

 

 

 

Reflecting:

 

16. What findings would demonstrate that the pharmacologic therapy is working? What follow-up data is needed?

 

 

 

 

 

17. If the pharmacologic therapy is ineffective, describe (2) procedures or surgical interventions that could be offered to Mr. B.H. for his condition.

 

 

 

 

 

Problem Based Scenario – Menopause

 

Clinical Scenario: Zoila Lopez is a married, 55-year old woman living in suburban Los Angeles with her husband of 28 y+ears. She comes to the office today for her annual gyn/physical exam. Her LMP was 12 months ago. She smoked ½ pack of cigarettes daily from age 19-30 until she quit when she became pregnant with her first child. Her OB history is: G3 T2 P0 A1 L2. Her second and last child was born when Zoila was 35. She breastfed both of her children for one year each. Zoila’s past medical history is significant for arthroscopic knee surgery 10 years ago and migraines which she treats with good effect with ibuprofen 600 mg. Family history is significant for Pulmonary Embolism (father) at age 60 and hypertension (mother) and breast cancer (mother) at age 70. Her father is still living and her mother is deceased after a broken hip and pneumonia. No history available for siblings or grandparents.

Zoila reports some friction within her relationship with her husband as her sex drive has diminished over the last year or so. She also reports an increase in anxiety and irritability.

 

1. What is the definition of menopause?

 

 

2. What are some of the health risks associated with menopause?

 

 

3. Describe some of the clinical manifestations a woman may experience related to perimenopause/menopause.

 

 

 

Noticing:

 

4. Evaluation of client’s medical history: Describe which of Zoila’s symptoms may be related to menopause.

 

 

 

5. What are some other symptoms that you should ask Zoila about relating to menopause?

 

 

Interpreting:

 

6. List the diagnostic tests that you would expect may be ordered related to determining perimenopause/menopause confirmation?

 

 

 

Clinical Scenario Progression: Diagnostic labs confirm that Zoila is menopausal.

 

 

Interpreting:

 

7. What contraindications should healthcare personnel screen for prior to the use of (combined) medroxyprogesterone acetate and conjugated estrogen (Prempro)?

 

 

 

Interpreting:

 

8. When starting HRT treatment with medroxyprogesterone acetate for symptoms of menopause it is important to discuss possible adverse reactions with the client. Complete the following chart with information related to interventions and which reactions should be reported to the provider.

 

Adverse drug reactions to (combined) conjugated estrogen and medroxyprogesterone acetate	Patient and/or Nursing interventions	Report to provider (yes/no)

 

 

Responding:

 

9. What are some of the benefits to beginning low-dose HRT soon after menopause?

Reflecting:

 

10. Are there alternate options that may be offered to Zoila if she chooses to not use HRT that will help relieve her symptoms? List some of the symptoms she may be experiencing and options for alleviating these symptoms:

 

Menopausal symptoms Zoila would like to relieve	Alternative therapies

 

 

Reflecting:

 

11. Zoila conveys to you that she feels that she is no longer attractive and that she has lost her femininity. What nursing interventions will you implement to help Zoila with this?

 

12. What is your priority of care for the woman experiencing menopause who has low self-esteem?

 

13. What health promotion interventions will be a priority for the patient entering menopause?

 

14. What nutritional and exercise behaviors would you promote for the woman in menopause? Explain your answer.

 

 

 

 

GnRH

 

 

LH/ FSH

Pharmacology Made Easy 4.0: Perfusion

Problem Based Scenario

Directions: With your small group, complete this worksheet utilizing information from your Module Worksheet, the Active Medication Templates and class lecture.

Clinical Scenario:

Jacob Jameson is a 67-year old retired teacher, who presents to the emergency room with complaints of difficulty breathing, fatigue, dizziness and abdominal pain. Patient has a history of congestive heart failure and complains of heaviness to his chest. He reports feeling increasing fatigue, and dyspnea on exertion over the last 24 hours. Patient with a past medical history of hyperlipidemia. He frequently consumes a diet high in fat and smokes two packs of cigarettes per day.

Noticing:

1. What are some risk factors for coronary artery disease (CAD) based on Mr. Jameson clinical scenario?

 

 

 

 

 

2. What diagnostic test is necessary based on the patient clinical scenario?

 

 

 

 

 

3. What are the manifestations of a myocardial infarction that Mr. Jameson might be presenting with?

 

 

 

 

 

 

Interpreting Client Chart:

Last documented VS:

T: (oral) 98.9o

P:(regular)112/min

R:(regular)22/min

BP: 169/90

O2 sat: 94%

 

 

 

 

 

 

 

Last documented Assessment:
GENERAL APPEARANCE:	Resting in bed, sitting upright
RESP:	Breath sounds diminished in the lower bases, crackles noted on auscultation in upper lobes.
CARDIAC:	Pink, warm & dry, heart sounds regular with no abnormal beats, pulses strong. Patient with 2+ pitting edema noted to bilateral lower extremity.
NEURO:	Alert and oriented with periods of confusion
GI:	Abdomen soft/nontender, bowel sounds audible per auscultation in all four quadrants. Client reports that he is having intermittent episodes of abdominal pain.
GU:	Urinating clear yellow urine.
SKIN:	Warm, dry, and intact. Decreased skin turgor

 

 

 

Basic Metabolic Panel (BMP:)	Current:
Sodium (135–145 mEq/L)	138
Potassium (3.5–5.0 mEq/L)	3.2
Chloride (95–105 mEq/L)	99
Glucose (70–110 mg/dL)	100
Calcium (8.4–10.2 mg/dL)	8.8
BUN (7–25 mg/dl)	34
Creatinine (0.6–1.2 mg/dL)	1.2

 

 

 

 

 

 

Complete Blood Count (CBC)	Current:
WBC (4500-10,000/ml)	5400
Hgb (12-18)	11.5
Hct (42-52%)	37
Platelets (150-400,000/ml)	229,000

 

 

 

 

 

 

 

Cardiac markers	Current:
Troponin(<0.4mg/ml)	1.8
CPK total (38-174U/I)	594
Ck-mb (<5%)	55
BNP less than 100pg	1150

 

 

 

 

 

 

 

 

Evaluation of clients’ chart: Describe abnormal findings and describe your thoughts about these findings?

 

 

 

 

Noticing: Is there a finding that requires immediate follow up? If so, which finding did you notice?

 

 

 

 

 

 

Noticing: Which risk factors are modifiable or nonmodifiable for CAD based on reviewing the patient client scenario?

 

 

 

 

 

 

 

 

Interpreting: For each potential nursing intervention, click to specify whether the intervention is indicated, nonessential, or contraindicated for the care of the client (Place an “x” in the necessary boxes):

 

	Indicated	Nonessential	Contraindicated
Obtain a 12 lead EKG per facility policy
Place the patient on bed rest
Administer oxygen via 2 liters NC
Administer morphine sulfate 4m IV push for pain unrelieved by nitroglycerin
Assess vital signs

 

 

 

The health care provider prescribes the following medication orders for Jacob:

Medication	Why was this ordered for Jacob?
Administer nitroglycerin 0.4 mg sublingually every 5 minutes for a maximum of 3 doses for chest pain.
Insert 2 peripheral IV’S
Oxygen at 2 liters via nasal cannula to maintain O2 sat >95%
Administer Aspirin 325 mg by mouth X 1

 

 

Clinical Scenario Progression:

The next day Jacob Jameson is transferred to the medical surgical unit. Jacob has been diagnosed with myocardial infarction and worsening coronary artery disease. The patient requires education for both myocardial infarction prevention and managing coronary artery disease.

Interpret: Mr. Jameson has been prescribed the medications below. Complete the chart:

Medication	Dose, Route, Frequency	Why is this medication ordered for Jacob?
Atorvastatin	40 mg by mouth daily @ bedtime
Amlodipine	10 mg by mouth daily
Aspirin	325 mg by mouth daily
Nitroglycerin	0.4 mg SL prn for max of 3 doses
Morphine Sulfate	4 mg IV for chest pain unrelieved by nitroglycerin

 

Responding: Mr. Jameson starts to complain of chest pain as you enter the room. What will be your first nursing response and why?

 

 

Responding: Which of the following prescribed medication(s) would you administer and why?

Medication	Dose, Route, Frequency
Atorvastatin	40 mg by mouth daily @ bedtime
Amlodipine	10 mg by mouth daily
Aspirin	325 mg by mouth daily
Nitroglycerin	0.4 mg SL (sublingually) prn

 

Responding: You are preparing to administer the medication for chest pain. What is an important nursing action prior to administering this medication? Clinical Assignment Discussion Paper

 

 

 

Interpreting: What instructions should be provided for a client taking nitroglycerin?

 

 

Reflecting: What is your next nursing action after administering the nitroglycerin for the patient’s chest pain?

 

 

What contraindications are there for the use of nitroglycerin?

 

What instructions should be provided to a patient taking aspirin and what are some contraindications?

 

Interpret: Upon entering Jacob Jameson’s room, you assess that he is confused, and the patient’s telemetry reading is showing an ST-Segment elevation.

Interpreting: Below is the patient’s EKG

 

 

 

Noticing:

Why is it necessary to do a 12-lead EKG?

 

What does an ST-Segment elevation indicates?

 

 

Responding: What was your decision? How did you come to that conclusion?

 

Reflecting

Based on what you have learned about coronary artery disease and myocardial infarction, what would be your discharge teaching instructions to Mr. Jameson?

 

 

 

Describe the differences between stable, prinzmetal (variant) and unstable angina?

 

 

What would be your teaching to Mr. Jameson about side effects of taking atorvastatin and when he would need to notify his physician?

 

 

 

What instructions should the nurse include when teaching Mr. Jacob about using sublingual nitroglycerin?

 

 

 

What important patient information regarding side effects of cholesterol lowering medication, such as atorvastatin, should be included in the discharge teaching?

Pharmacology Made Easy 4.0: The Reproductive and Genitourinary System

Module Worksheet

Directions: This worksheet should be completed while viewing the ATI Reproductive and Genitourinary System Pharmacology Made Easy Module. Answers must be in your own words.

 

Female Reproductive System (FRS)

1. Name the 4 main different parts of the female reproductive system.

2. Using your own words, describe the hormonal cycle of the FRS.

 

Male Reproductive System (MRS)

1. Name the 6 main parts of the male reproductive system.

2. Using your own words, describe the hormonal cycle of the MRS.

 

Urinary Tract

1. In your own words, describe how urine is produced and the process by which it is expelled from the body.

 

Goals for Drug Therapy

I. FEMALE REPRODUCTIVE DISORDERS

What are the goals for drug therapy for Female Reproductive Disorders?

 

a. Contraception

 

 

b. Menopause

 

 

c. Endometrial Hyperplasia and Endometriosis

 

d. Infertility

 

 

e. Inducing Uterine Contractions

 

 

f. Stopping Uterine Contractions

 

 

g. Accelerating Fetal Lung Maturity

 

 

h. Preventing and Treating Seizure Activity

 

 

 

II. MALE REPRODUCTIVE DISORDERS AND GENITOURINARY DISORDERS

What are the goals for drug therapy for Male Reproductive Disorders and Genitourinary Disorders?

a. Male hypogonadism

 

 

b. Benign Prostatic Hypertrophy

 

 

c. Erectile Dysfunction

 

 

III. GENITOURINARY DISORDERS (MALE AND/OR FEMALE)

What are the goals for drug therapy for Genitourinary Disorders (Male and/or Female)?

 

a. Urinary Incontinence/Overactive Bladder (OAB)

 

 

b. Urinary Retention

 

 

Active Stack Flashcards:

Complete the 175 flashcards for the Reproductive and Genitourinary System Drugs.

 

Activities:

For each question from the active stack flashcards you answered incorrectly, write out a description of the information for your own learning. Clinical Assignment Discussion Paper

 

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