NURS 6521 Week 9 Discussion: Pharmacotherapy for 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.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEK 9 RESOURCES

 

WEEK 10 RESOURCES

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.Links to an external site.
• 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.

You will respond to your colleagues’ posts in Week 10.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

BY DAY 6 OF WEEK 10

Read a selection 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.

Discussion: Pharmacotherapy for Hematologic Disorders

In the 1970s, the average lifespan for patients diagnosed
with sickle cell disease was 14 years. Today, the average lifespan has
increased to 50 years and beyond (TriHealth, 2012). The patient prognosis for
many other hematologic disorders such as hemophilia and cancer continue to
improve as well. This can be attributed to advancements in medical care—specifically
drug therapy and treatment. When managing drug therapies for patients, it is
essential to continuously examine current treatments and evaluate the impact of
patient factors on drug effectiveness. To prepare for your role as an advanced
practice nurse, you must become familiar with common drug treatments for
various hematologic disorders seen in clinical settings.

To prepare:

Select one of the following hematologic disorders: anemia,
hemophilia, cancer, sickle cell anemia, thalassemia, thrombolytic disorders, or
white blood cell disorders. Consider the types of drugs that would be
prescribed to patients to treat symptoms associated with this disorder.

Select one of the following factors: genetics, gender,
ethnicity, age, or behavior. Reflect on how this factor might impact the
effects of prescribed drugs, as well as any measures you might take to help

reduce negative side effects.

With these thoughts in mind:

By Day 3

Post a description of the hematologic disorder you selected
including types of drugs that would be prescribed to patients to treat
associated symptoms. Then, explain how the factor you selected might impact the
effects of prescribed drugs, as well as any measures you might take to help
reduce negative side effects.

By Day 6

Read a selection of your colleagues’ responses and respond
to at least two of your colleagues on two different days who selected a
different hematologic disorder than you did. Provide recommendations for
alternative drug treatments and patient education strategies for treatment and
management.

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A Sample Answer For the Assignment: NURS 6521 Week 9 Discussion: Pharmacotherapy for Hematologic Disorders

Title: NURS 6521 Week 9 Discussion: Pharmacotherapy for Hematologic Disorders

In this Case study, a 46-year-old patient comes to the clinic with complaints of night sweats, hot flushing, and genitourinary problems. The patient presents with signs of menopause. Headaches sleep issues, mood swings, vasomotor symptoms including hot flashes and night sweats, and anxiety may occur throughout this time because of the decreased ovarian activity and fluctuations of hormone levels (Taebi et al., 2018). Patient also presents a history of ASCUS, which is atypical cells found in the tissue lining the cervix’s outer portion. ASCUS can be a sign of low hormone levels, which may occur in menopausal women.  According to a 2018 study, the incidence of ASCUS was highest in women who were menstruation normally (Misra et al., 2018)

The diagnosis of perimenopause would be given to this patient. For women experiencing perimenopausal and menopausal symptoms, Hormonal Replacement Therapy (HRT) is thought to be an appropriate treatment option. However, the patient has hypertension as well as a family history of breast cancer. A treatment plan should be personalized based on the patient’s past medical history, Thus, HRT would not be beneficial for this patient as it increases the risk of breast cancer and increases blood pressure.

The treatment plan would be to manage the patient’s symptoms. Since we are avoiding HRT, antidepressants would be prescribed to reduce night sweats and improve vasomotor symptoms. SSRIs would be prescribed to help manage the patient’s symptoms, such as Citalopram. Non-hormonal medications such as clonidine, gabapentin, pregabalin, and antidepressants may be a significant effective therapy for vasomotor symptoms (Karanth et al., 2019). To treat her genitourinary symptoms, transdermal estrogen therapy would be beneficial, which is applied directly on the skin and easily absorbs the hormone in systemic circulation. This would be a safer option for such high-risk patients as a transdermal patch bypasses the first pass effect and makes the blood estrogen levels lower than oral administration. A low dose of estrogen would suffice with topical administration.

Side effects and benefits should be discussed with the patient before prescribing the medications. Education on the side effects of Citalopram, such as dizziness, sleepiness, and headache, will be provided. Also, the patient would be educated on adhering to both medication regimens to improve her symptoms over time. The patient will also be educated on monitoring her blood pressure and reporting any adverse effects.

 

Taebi, M., Abdolahian, S., Ozgoli, G., Ebadi, A., & Kariman, N. (2018, July 6). Strategies to improve menopausal quality of life: A systematic review. Journal of education and health promotion. Retrieved January 23, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052783/

Misra, J. S., Srivastava, A. N., & Zaidi, Z. H. (2018). Cervical cytopathological changes associated with onset of Menopause. Journal of mid-life health. Retrieved January 23, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332728/

Karanth, L., Chuni, N., & Nair, N. S. (2019, September 12). Antidepressants for menopausal symptoms. The Cochrane Database of Systematic Reviews. Retrieved January 24, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739239/

A Sample Answer 2 For the Assignment: NURS 6521 Week 9 Discussion: Pharmacotherapy for Hematologic Disorders

Title: NURS 6521 Week 9 Discussion: Pharmacotherapy for Hematologic Disorders

As correctly stated in the discussion, the patient is presented with the signs and symptoms of perimenopause. Perimenopause is a time of menstrual transition. Menstrual transition is when most women begin to get signs and symptoms of menopause. Therefore, the patient needs to be exposed to a treatment that will ease her transition into menopause. As illustrated in the discussion, subjecting the patient to hormone replacement therapy (HRT) is impossible. The perfect solution is to present the patient with a low dose of estrogen combined with progestin. Combining these hormones will help control the patient’s perimenopause symptoms (Roberts & Hickey, 2016). The patient history of hypertension justifies using estrogen and progestin to help eliminate symptoms that include fever, hot flushing, and all the genitourinary symptoms (Rosenthal & Burchum, 2021). The dangers of the treatment proposed are anchored on taking tablets. As a result, the treatment can be offered in the format of injection, eliminating the possible spike of hypertension or the possibility of suffering cancer.

The patient is currently on Norvasc treatment for hypertension. Norvasc treatment is perfect for hypertension and, therefore, cannot be altered (Misra, Srivastava, & Zaidi, 2018). An important aspect to discuss is the use of SSRI to manage the patient’s symptoms, which include hot flushing and fevers.

There is little to no evidence that classes of antidepressants, including SSRIs, contribute to eliminating or preventing symptoms like migraine, headaches, and vomiting. As a result, it would be risky to subject the patient to SSRI as a model of symptom control. A perfect recommendation would be to offer the patient serotonin. The serotonin 1b/1d agonists (triptans) inhibit the release of vasoactive peptides, promote vasoconstriction, and block pain pathways in the brainstem migraine. Even other primary headaches and secondary headaches may also improve with triptan treatment. Serotonin is known to cause vasoconstriction of the nerve endings, thereby eliminating the patient’s pain, including headaches (Schwedt & Garza, 2022). The patient can take Fluoxetine to manage her symptoms. In terms of patient education, the patient can be subjected to an analysis of the side effects of the injected estrogen. She can also be taught effective ways to manage her hypertension. The discussion above illustrates alternative treatments that can help the patient recover. The patient’s pathophysiology, pharmacological conditions, and possible drugs influence the proposed treatment.

References

Misra, JS., Srivastava, AN., & Zaidi, ZH. (2018). Cervical cytopathological changes associated with onset of menopause. Journal of mid-life health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332728/Links to an external site.

Schwedt, TJ., & Garza, I. (2022). Acute treatment of migraine in adults. In RP. Goddeau (Ed.). UpToDate. https://www.uptodate.com/contents/acute-treatment-of-migraine-in-adults?search=serotonin%20and%20headache&topicRef=3348&source=related_linkLinks to an external site.

Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86, p53-58 https://doi.org/10.1016/j.maturitas.2016.01.007 Links to an external site..

Rosenthal, LD. & Burchum, JR. (2021. Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants – E-Book. Elsevier Health Sciences. Kindle Edition.

  Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. (5 points possible per graded thread)	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost	-5 points lost
Total Participation Requirements per discussion thread	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement per discussion thread	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.