NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Sample Answer for NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders Included After Question

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.

A Sample Answer For the Assignment: NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Title: NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Case Study

HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.

Ht: 5’8” Wt: 89 kg

Allergies: Penicillin (rash)

Discussion

Community-acquired pneumonia remains the single most common cause of death from infectious diseases in the elderly population. Adults aged over 65 years are a rapidly expanding cohort with growth rates more than twice that of younger populations with an expected 20% of the world’s population reaching elderly status by 2050, the burden of CAP will be even more significant in the coming years. Moreover, the annual incidence of CAP in elderly patients is estimated to be 25–44 cases per 1000 persons (Stupak et al., 2009). In the above case study patient is an elderly 68yrs old who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days with his PMH is significant for COPD, HTN, hyperlipidemia, and diabetes who remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements however he is not tolerating a diet at this time with complaints of nausea and vomiting. Therefore, the following treatment and health needs are important.

Patient’s Health needs

  • Treatment and need for longer hospitalization stay with longer IV ABX treatment

Mr. HH is 68ys old elderly patient and he is at risk of infection for a longer period. To prevent the spread of infection, he might need more than 7days of IV ABX treatment even though he is improving. Moreover, he is not tolerating the diet currently and complains of nausea and vomiting. Therefore, he may require a longer hospitalization stay with a longer duration of parenteral IV ABX therapy before switching to an oral antibiotic along with antiemetic medication. The oral course of ABX can be started once his nausea/vomiting stop and able to tolerate the diet. Moreover, Pharmacists should evaluate medication choices, check for allergies and interactions, and educate patients about side effects and the importance of compliance.

  • Need for treatment of his co-morbidities

Mr. HH has other significant co-morbidities like COPD, HTN, hyperlipidemia, and diabetes and should be treated with a bronchodilator and steroids for COPD, anti-hypertensive for HTN, Statin and Cholesterol for hyperlipidemia and Metformin or insulin for diabetes along with treatment of community-acquired pneumonia.

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  • NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
    NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

    Need for hydration and nutritional diet

Particular attention should also be paid to nutritional status, fluid administration, functional status, and comorbidity stabilizing therapy in this group of frail patients (Simonetti et al., 2014).

Mr. HH is an elderly patient and risk of malnutrition since he is not tolerating his diet and complain of nausea and vomiting. Continuous iv fluids should be given for hydration and a nutritionist Consult should be done and parenteral nutrition should be started according to the needs of the patient.

  • Need for financial support

The patient’s financial status for treatment should be assessed by the case manager. If a Patient has Medicare or Medicaid, it will be covered by insurance but if the patient does not have insurance or financial support then the hospital should provide financial support via a charity fund or a discount should be given if possible.

 

  • Need for physical and psychological support

Physical support should be given by providing physical and occupational therapy to increase the activity of daily living, breathing exercises, and self-care. Help patient to maintain hygiene throughout the hospital stay. Similarly, emotional support should be provided by allowing him to express his feeling and allowing family time for emotional support that prevents depression.

Recommended Treatment

  • In the presence of comorbid illness (chronic heart disease excluding hypertension; chronic lung disease – COPD and asthma; chronic liver disease; chronic alcohol use disorder; diabetes mellitus; smoking; splenectomy; HIV or other immunosuppression), a respiratory fluoroquinolone (high-dose levofloxacin, moxifloxacin, gemifloxacin) or a combination of oral beta-lactam (high dose amoxicillin or amoxicillin-clavulanate, cefuroxime, cefpodoxime) and macrolide is recommended (Regunath & Oba, 2022).
  • For patients with a CURB 65 score of greater than or equal to 2, inpatient management is recommended. A respiratory fluoroquinolone monotherapy or combination therapy with beta-lactam (cefotaxime, ceftriaxone, ampicillin-sulbactam, or ertapenem) and macrolide are recommended options for nonintensive care settings (Regunath & Oba, 2022).
  • The pneumonia severity index score can be used to assess the severity and need for more hospitalization in patients with community-acquired pneumonia
  • Diagnostic tests like chest X-ray, CT, or MRI can be done to identify infiltration or effusion
  • A complete blood count with differentials, serum electrolytes, and renal and liver function tests are indicated for confirming evidence of inflammation and assessing severity.
  • A chest x-ray will be needed to identify an infiltrate or effusion, which, if present, will improve diagnostic accuracy.
  • Blood and sputum cultures should be collected, preferably before the institution of antimicrobial therapy, but without delay in treatment.
  • Urine for Legionella and pneumococcal antigens must be considered as they aid in diagnosis when cultures are negative.
  • Influenza testing is recommended during the winter season. If available, testing for respiratory viruses on nasopharyngeal swabs by molecular methods can be considered. CURB 65 (confusion, urea greater than or equal to 20 mg/dL, respiratory rate greater than or equal to 30/min, blood pressure systolic less than 90 mmHg or diastolic less than 60 mmHg),
  • Pneumonia Severity Index (PSI) are tools for severity assessment to determine the treatment setting, such as outpatient versus inpatient, but accuracy is limited when used alone or in the absence of effective clinical judgment.
  • Serology for tularemia, endemic mycoses, or psittacican be sent in the presence of epidemiologic clues

Education Strategy

The interpersonal level communication helps to use the community volunteer to alert the surrounding people about health hygiene, the impact of community-acquired pneumonia, treatment, antibiotic therapy, diagnosis, tests, and other health care services. Which can be conveyed even by conducting small-group educational programs. Moreover, elderly patients like HH should be provided education on the following topic:

The following education strategy for the Community-acquired Pneumonia

  • Staying compliance with medication helps in full recovery
  • Vaccination
  • All adults 65 years and older and those considered at risk for pneumonia must receive the pneumococcal vaccination. There are two vaccines available: PPSV 23 and PCV 13.
  • For all unvaccinated adults 65 years or older, first vaccinate with PCV 13, followed by PPSV 23 at least a year later for immune-competent patients and at least eight weeks or more apart for patients who are immune-compromised or asplenic.
  • Influenza vaccination is recommended for all adult patients at risk for complications from influenza. Inactivated flu shots (trivalent or quadrivalent, egg-based or recombinant) are usually recommended for adults.
  • Cessation of smoking: – Smoking is injurious to health and will damage the lungs by deteriorating their health condition. Educate patient on smoking cessation therapy and offer therapy like nicotine treatment
  • Hand Hygiene and mask

Proper hand hygiene and the use of a face mask while traveling in crowded places helps to prevent the transmission of disease and encouraged to wash hand with soap water or hand sanitizer

  • Diet and exercise: – Eating a well balanced diet like protein-rich food, and green leafy vegetables help to increase the immune system and prevent infection as well as malnutrition. Breathing exercise helps to improve respiration
  • Follow up with PCP to monitor the health status

 

Reference

Regunath H, Oba Y. Community-Acquired Pneumonia. [Updated 2022 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430749/

Stupka, J. E., Mortensen, E. M., Anzueto, A., & Restrepo, M. I. (2009). Community-acquired pneumonia in elderly patients. Aging health, 5(6), 763–774. https://doi.org/10.2217/ahe.09.74Links to an external site.

Simonetti, A. F., Viasus, D., Garcia-Vidal, C., & Carratalà, J. (2014). Management of community-acquired pneumonia in older adults. Therapeutic advances in infectious disease, 2(1), 3–16. https://doi.org/10.1177/2049936113518041

A Sample Answer 2 For the Assignment: NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Title: NURS 6521 Women’s and Men’s Health, Infectious Disease, and 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 3 For the Assignment: NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Title: NURS 6521 Women’s and Men’s Health, Infectious Disease, and 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.