Monthly Archives: May 2023

How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?

Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.

This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 1, “Prescriptive Authority” (pp. 1–3)
Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)
Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)
Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)
Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)
Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767
American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

This website details key aspects of drug registration.

Fowler, M. D. M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application (2nd ed.). Silver Spring, Maryland: American Nurses Association.

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

This article provides NPs with information regarding state-based laws for NP prescribing.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association ofNursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

 Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples. 

At least 2 citations APA format 7th edition

FU

One patient case from my experience that addresses the principles of pharmacokinetics and pharmacodynamics is where my patient was a 55 years old female, of African American decent, had a history of diabetes, hyperlipidemia, and hypertension. The patient was presented to our hospital with severe nausea, vomiting and abdominal pain. Assessment and lab work showed the patient’s blood glucose was 605mg/dL, HgA1C 8.5%, cholesterol 180 mg/dl, weight 290 lbs, height 68inches, BP 90/75, pulse 118, Respiration 23 bpm. Patient stated she had been very stressed lately and had mostly been dining out at fast-food restaurants and has not had the time to exercise. Patient had been prescribed insulin however, she stated she has not been checking her blood glucose level like she should have. 

This patient was presenting with symptoms of diabetic ketoacidosis (DKA). DKA is a medical emergency that occurs when the body is unable to produce adequate insulin to decrease blood glucose level and leads to the production of high levels of acids in the blood called ketones (Alshammari et. al., 2017). This was a medical emergency that required immediate intervention of fluid repletion and the administration of insulin. It also involved the frequent monitoring of patient’s vital signs, glucose levels, and electrolyte levels. 

Factors that might have influenced pharmacokinetics of insulin the patient was receiving are diet (eating fatty foods or foods high in carbohydrates increases glucose levels in the body), stress (cortisol increases insulin resistance), and lack of exercise. Eating a balanced diet decreases the likelihood that the patient will consume mostly foods high in fats and carbohydrates. When someone is stressed, the body produces stress hormones called cortisol which to a diabetic patient can significantly affect their health because it causes the body to release more glucose and to become resistant to the insulin the patient needs to reduce that blood glucose to a healthy level (Alshammari et. al., 2017). Exercise redistributes and lowers the blood glucose level. It could cause patients to go into hypoglycemia that is why it is important to check glucose levels before, during, and after exercise.

The personalized care plan that I would develop for this patient would include; a Dietary and lifestyle change plan – here the patient will be educated on how to count her carbohydrates and caloric intake. The Center for Disease Control has dietary guidelines for the different age groups. The site also provides “My Food Diary” (CDC, 2019) a flow sheet to help individuals keep a day-to-day record of how much food is consumed for breakfast, snacks, lunch, and dinner. I would also recommend she exercise regularly but that to check her blood glucose before, during and after exercise. “The adoption and maintenance of physical activity are critical foci for blood glucose management and overall health in individuals with diabetes” (Colberg, 2016). Also, I would suggest she check her blood glucose before each insulin administration, as this may affect the dosage to be administered.

References

Alshammari, A. A., Alahdal, L. M., Jawi, J. T., Alnofaie, H. A., Aldossari, N. A., AbdulazizAlassaf, H. M., Ramel, A. I., Almshikhess, S. H., Felemban, A. S., Alanazi, S. A., Joharji, R. N., Alzahrani, A. M. B., Almaghamsi, S. A. D., Alalawi, M. S. M., Alasmari, H. I., Abduljabbar, A. M., & alzahrani, A. fahad. (2017). First Line Management of Adult Diabetic Ketoacidosis Patients. Egyptian Journal of Hospital Medicine, 67(2), 571–577. https://doi-org.ezp.waldenulibrary.org/10.12816/0037808

Centers fo Disease Control and Prevention [CDC], 2019. Eating Out. Retrieved from https://www.cdc.gov/diabetes/managing/eat-well.html

Colberg, S.R., Sigal, R. J., Yardley, J. E., Riddle, M.C., Dunstan, D.W., Dempsey, P.C., … & Tate, D.F. (2016). Physical activities/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes care, 39(11), 2065-2079

The purpose of Reflection-in-Action is to reflect upon what one has learned or how one has performed as compared with one’s expectations or goals. This assignment will provide an opportunity for students to share their experiences, thoughts, feelings and learning moments from this course. 

Self understanding through reflection on life experiences, feelings, etc., is a core concept in Dr. Jean Watson’s Theory of Human Caring.  

The Reflection for this course must address at least three (3) of the following topics:

• Learning moments or activities from this course
• Thoughts on evidence-based practice
• Evidence supporting Jean Watson’s Theory of Human Caring
• Ethics in research
• Protecting human subjects in quality improvement or evidence-based practice projects
• Understanding or comfort level with statistics in nursing research and other research reports
• Perception of MSN graduates’ role in nursing research
• Creating and sustaining an Evidence-Based nursing environment
• Asking compelling, clinical questions
• Lessons learned while conducting evidence-based literature review

Expectaton

Length: 3 pages (excluding the title and reference pages).  Submissions not meeting the minimum and maximum page requirements will receive a grade of zero. 

• Format: Formal paper, APA 7th ed format for body of paper and all citations.  
• The purpose of Reflection-in-Action is to reflect upon what one has learned or how one has performed as compared with one’s expectations or goals. This assignment will provide an opportunity for students to share their experiences, thoughts, feelings and learning moments from this course. 
• The Reflection for this course must address at least three (3) of the following topics:

 How effectively do you think the Coyne et al. study and the Messina et al. study both used their review of literature to help the reader understand why the research question was asked? How could they have done it more effectively? please include in-text citation and references.

Community Assessment, Analysis, Diagnosis, Plan, and Evaluation

Weekly Objective 4 is addressed in this assignment.

Needed Document: Final Paper Template

This activity is intended for undergraduate nursing students. In this activity, you will observe, think critically about, and report health issues in diverse community environments.

Community health nursing can improve access to care for the most vulnerable and hard-to-reach groups in any country. The community health nurse should combine knowledge of major indicators of health, social factors that contribute to declining health status, and public programs designed to address problems of health care. Efforts should encompass all levels of prevention (primary, secondary, tertiary) and should address the needs of the individual, family, aggregate, and community.

You will submit a formal APA Paper (see instructions in the template and the rubric).

Utilizing the information gathered on your selected community in from eight Sentinel City subsystems you have been working on throughout this class, write your assessment, analysis, nursing diagnosis, plan, and evaluation method (per the rubric) in APA 7th edition format.

You do not need an abstract. The order of the paper is as follows: the title page, the body of the paper (5-10 pages), a reference page. See the sample template provided.

Please summarise the attached in one page  

 Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared. 

Activity Learning Outcomes 

Through this discussion, the student will demonstrate the ability to: 

1. Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care (CO1) 
2. Apply concepts of person-centered care to nursing practice situations (CO2) 
3. Analyze essential skills needed to lead within the context of complex systems (CO3) 
4. Explore the process of scholarship engagement to improve health and healthcare outcomes in various settings (CO4) 

Discussion Criteria

I.   Application of Course Knowledge: of Course Knowledge: 

The student post contributes unique perspectives or insights gleaned from personal experience or examples from the healthcare field. The student must accurately and fully discuss the topic for the week in addition to providing personal or professional examples. The student must completely answer the entire initial question. 

II.  Engagement in Meaningful Dialogue: I. The student responds to a student peer and course faculty to further dialogue.

a. Peer Response: The student responds substantively to at least one topic-related post by a student peer. A substantive post adds content or insights or asks a question that will add to the learning experience and/or generate discussion.  

• A post of “I agree” with a repeat of the other student’s post does not count as a substantive post. A collection of shallow posts does not equal a substantive post.
• The peer response must occur on a separate day from the initial posting.
• The peer response must occur before Sunday, 11:59 p.m. MT.
• The peer response does not require a scholarly citation and reference unless the information is paraphrased and/or direct quotes are used, in which APA style standards then apply.

Faculty Response: The student responds substantively to at least one question by course faculty. The faculty question may be directed to the student, to another student, or to the entire class.

• A post of “I agree” with a repeat of the faculty’s post does not count as a substantive post. A collection of shallow posts does not equal a substantive post.
• The faculty response must occur on a separate day from the initial posting.
• Responses to the faculty member must occur by Sunday, 11:59 p.m. MT.
• This response does not require a scholarly citation and reference unless the information is paraphrased and/or direct quotes are used, in which APA style standards then apply.

III.  Integration of Evidence: The student post provides support from a minimum of one scholarly in-text citation with a matching reference AND assigned readings OR online lessons, per discussion topic per week.

1. What is a scholarly resource? A scholarly resource is one that comes from a professional, peer-reviewed publication (e.g., journals and government reports such as those from the FDA or CDC).
   • Contains references for sources cited
   • Written by a professional or scholar in the field and indicates credentials of the author(s)
   • Is no more than 5 years old for clinical or research article
2. What is not considered a scholarly resource?
   • Newspaper articles and layperson literature (e.g., Readers Digest, Healthy Life Magazine, Food, and Fitness)
   • Information from Wikipedia or any wiki
   • Textbooks
   • Website homepages
   • The weekly lesson
   • Articles in healthcare and nursing-oriented trade magazines, such as Nursing Made Incredibly Easy and RNMagazine (Source: What is a scholarly article.docx; Created 06/09 CK/CL Revised: 02/17/11, 09/02/11 nlh/clm)
3. Can the lesson for the week be used as a scholarly source?
   • Information from the weekly lesson can be cited in a posting; however, it is not to be the sole source used in the post.
4. Are resources provided from CU acceptable sources (e.g., the readings for the week)?
   • Not as a sole source within the post. The textbook and/or assigned (required) articles for the week can be used, but another outside source must be cited for full credit. Textbooks are not considered scholarly sources for the purpose of discussions.
5. Are websites acceptable as scholarly resources for discussions?
   • Yes, if they are documents or data cited from credible websites. Credible websites usually end in .gov or .edu; however, some .org sites that belong to professional associations (e.g., American Heart Association, National League for Nursing, American Diabetes Association) are also considered credible websites. Websites ending with .com are not to be used as scholarly resources

IV.  Professionalism in Communication: The post presents information in logical, meaningful, and understandable sequence, and is clearly relevant to the discussion topic. Grammar, spelling, and/or punctuation are accurate.

V.  Wednesday Participation Requirement: The student provides a substantive response to the graded discussion question(s) or topic(s), posted by the course faculty (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.

VI.  Total Participation Requirement: The student provides at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.

Resource:

 DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Jones & Bartlett Learning. 

 American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). American Psychological Association. 

Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion

Read handout The Death of Ivan Ilych, a novella by Leo Tolstoy Reflection one page on what you think are the most important aspects of how Ivan Ilych dies, and how that death is woven into the life Ivan led

Each week you will be expected to provide the following information to your community practice instructor through your journal entries:

1. What are your upcoming week’s specific learning goals and objectives?
2. What is your upcoming week’s detailed schedule at your community practice experience placement?
3. Were there any placement items/issues that occurred this week that you feel your instructor should be aware of that are private in nature and are more appropriately shared here than in the discussion board with your classmates?
4. Give a brief description of an objective you worked on this week. Make sure to cite at least one reference showing how your objective relates to the public health knowledge you’ve studied during this course or the public health course. You may choose to reference your e-text, journal articles, or videos you’ve studied during these courses or you may find an outside reference on your own to further enhance your public health knowledge and practices.

Remember, your journal entries are an important aspect of clinical learning as they serve to help you reflect upon and get the most out of your community practice experience. Therefore, your journal entry should include the who, what, where, and when of your community practice experience. Remember, this should simulate a dialogue that would normally take place face-to-face with your community practice experience instructor.

When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.

In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.

To Prepare:

• Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.
• Review the health policy you identified and reflect on the background and development of this health policy.

By Day 3 of Week 7

Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.

This also comes with two posts that will each need a reply and at least two references all in APA 7 format. the rubric is attached below please meet the standards.  

Discussion 1 TY

Health Policy: COVID Research Act of 2020

MAIN QUESTION POST- Health policy is essential in nursing. According to Liao (2019), “policies reflect public opinion as well as evidence-based data” (p.90). The health policy I want to discuss is the COVID Research Act of 2020 or also known as the Computing Opportunities to Vanquish Infectious Diseases Research Act of 2020 (“H.R.6599 – 116th Congress (2019-2020): COVID research Act of 2020,” 2020). This policy is to help address the issue of infectious diseases and how to prepare for them. COVID-19 has taken a toll on the health and economy throughout the world. This policy would create a group to be responsible for dealing with pandemics.  A group to prepare for pandemic outbreaks and to help create strategies to address challenges during a health crisis is essential (“H.R.6599 – 116th Congress (2019-2020): COVID research Act of 2020,” 2020). Using evidence-based research will allow this policy to help prepare for upcoming pandemics.

I believe there is no better time in society to address this policy than now. The research done by healthcare professionals can help policymakers understand essential information (Hebda, 2019). APRNs and research groups can work together to help address and improve health policies. With COVID-19 being a significant concern, this supports why this policy needs addressed. Evidence-based research is required to help create a plan of action for the current and emerging pandemics. By creating a group dedicated to this policy will help the overall health of the population. For example, there is a need for a vaccine for COVID-19. With this policy in place, they could have predicted COVID-19 and been preparing a vaccine. Research on the spread and severity could have begun before the COVID-19 pandemic and helped decrease worldwide exposure rates. There is strong evidence to support the COVID Research Act of 2020 based on the worldwide pandemic status. Throughout history, pandemics have taken a toll on the health of the country. For example, the Influenza pandemic has led to annual flu shots starting in October (the peak season).  The COVID Research Act of 2020 health policy would benefit healthcare now and in the future.

References

Hebda. T.. (2019). The impact of EHRs, big data, and evidence-informed practice. In J. A. Milstead,  & N. M. Short (Eds.), Health policy and politics: A nurse’s guide (6th ed., pp 133-150). Burlington, MA: Jones & Bartlett Learning

H.R.6599 – 116th Congress (2019-2020): COVID research Act of 2020. (2020, April 23). Congress.gov | Library of Congress. https://www.congress.gov/bill/116th-congress/house-bill/6599?q=%7B%22search%22%3A%5B%22health+policy%22%5D%7D&s=3&r=86 

Liao, C. (2019). Public policy design. In J. A. Milstead,  & N. M. Short (Eds.), Health policy and politics: A nurse’s guide (6th ed., pp 87-99). Burlington, MA: Jones & Bartlett Learning

Discussion 2 ML

Week 7 Discussion Post

            I found and reviewed the Sexual Assault Victims Protection Act of 2019 on the congress.gov. The summary includes,

“This bill requires the Department of Health and Human Services (HHS) to conduct a series of activities relating to sexual assault evidence and treatment. Among other things, HHS must establish a task force to improve forensic evidence collection related to sexual assault, maintain a website with resources and best practices related to the treatment of individuals for sexual assault, and host an annual meeting to address gaps in health care relating to sexual assault. In addition, the Centers for Medicare & Medicaid Services must require Medicare-participating hospitals, in their community call plans relating to on-call coverage, to specifically delineate coverage responsibilities with respect to screening and treatment related to sexual assault.”( Congress,2020).

As a nurse in the emergency room I find that this proposed health policy would be beneficial in the way healthcare teams are required to treat possible sexually assault victims. I know that my hospital in the past did not have any specially trained individuals to conduct the assessment and collection of forensics in these cases. With this being the case, nurses were not comfortable at doing this and things could get missed or mishandle with patient. Policy and procedures have changed for much improvement in this practice that now we have SANE nurses who conduct all assessments and collection of forensics. “Sexual Assault Nurse Examiners (SANE) are registered nurses who have completed specialized education and clinical preparation in the medical forensic care of the patient who has experienced sexual assault or abuse. “(International Association of Forensic Nurses,2014-2020). I believe that there is evidence based on the need for the policy and changes in the health care practice from personal experience. For example, I had a pediatric patient in ER that mother brought in with possible sexual abuse. I do not feel properly trained to conduct this investigation on this child and would not want to say or do the wrong thing during such a sensitive time. At that point I call the SANE nurse on call that comes in and does everything needed for that patient. Even the provider does not go see the patient before the SANE nurse arrives and collection all information and data. Having policies in place for facilities to provide access to specialty trained nurse will provide better patient care and less traumatic care.

References

Congress.gov. (2020). H.R.4758 – Sexual Assault Victims Protection Act of 2019. Retrieved on October 11, 2020 from  https://www.congress.gov/bill/116th-congress/house-bill/4758/all-info?r=5&s=7

International Association of Forensic Nurses. (2014-2020). Sexual Assault Nurse Examiners. Retrieved on October 11, 2020 from https://www.forensicnurses.org/page/aboutSANE