Nursing

Topic 1 DQ 2
Discuss what resources are often necessary for nonacute care for cardiorespiratory issues. Explain how they support patient independence and decrease readmission.
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Solution
Resources Necessary for Nonacute Care for Cardiorespiratory Issues
According to the American Heart Association (AHA), cardiovascular complications account for approximately one-third of the total deaths globally. Cardiorespiratory issues, on the other hand, are even worse when they occur together in the form of diseases and injuries to both the lungs and the heart (Czeisler et al., 2020). However, several researchers and clinical guidelines, through evidence-based practice, have proposed effective interventions that can help promote well-being and reduce the mortality rates among patients with cardiorespiratory issues. Non-acute care for such patients thus aims at improving the functioning of the patient heart and lungs, to reduce the burden of the disease (Czeisler et al., 2020). For instance, clinicians recommend regular exercises and lifestyle modification such as avoiding smoking, and adequate sleep among other factors that increases the risks associated with cardiorespiratory complications.
In the United States, several healthcare organizations in addition to the state’s healthcare sector have made sure that adequate resources are available to promote non-acute care for patients with cardiovascular and respiratory problems. Such resources are mainly based on the provision of prehospital care, long-term care, home health care, community care, and ambulatory care services, depending on the severity of the patient’s condition (Bornstein et al., 2019). Necessary resources include American Heart Association (www.heart.org), National Heart, Lung, and Blood Institute ( www.nhlbi.nih.gov/health-topics/education-and-awareness/heart-truth), American Society for Preventive Cardiology, World Heart Federation,COPD Foundation (www.copdfoundation.org), and US National Library of Medicine, MedlinePlus among others.
The above resources are crucial in promoting patient independence and decreasing the rates of readmission. For instance, the educational materials help patients promote self-management of the heart and lung conditions after being discharged from the hospital. Automated follow-up communication resources help remind the patient to show up for scheduled appointments, health screenings, and check-ups to avoid readmission (Lang et al., 2018). Surveys are also utilized to monitor the progress of the disease, to promote timely interventions in case of complications.
References
Bornstein, D. B., Grieve, G. L., Clennin, M. N., McLain, A. C., Whitsel, L. P., Beets, M. W., … &Sarzynski, M. A. (2019). Which US states pose the greatest threats to military readiness and public health? Public health policy implications for a cross-sectional investigation of cardiorespiratory fitness, body mass index, and injuries among US Army recruits. Journal of public health management and practice, 25(1), 36-44. https://doi.org/10.1097/PHH.0000000000000778
Czeisler, M. É., Marynak, K., Clarke, K. E., Salah, Z., Shakya, I., Thierry, J. M., … & Howard, M. E. (2020). Delay or avoidance of medical care because of COVID-19–related concerns—United States, June 2020. Morbidity and mortality weekly report, 69(36), 1250. https://doi.org/10.15585/mmwr.mm6936a4
Lang, J. J., Phillips, E. W., Orpana, H. M., Tremblay, M. S., Ross, R., Ortega, F. B., … & Tomkinson, G. R. (2018). Field-based measurement of cardiorespiratory fitness to evaluate physical activity interventions. Bulletin of the World Health Organization, 96(11), 794. https://doi.org/10.2471/BLT.18.213728

Applied analysis-Public Health Nurse- Classmate Response (1): Topic 6 DQ 1
Topic 6 DQ 1-QUESTION- Given the limited amount of statistical calculations required by some public health positions, explain why it is important for you to know how to utilize appropriate software to analyze public health data. Support your ideas with reasons, facts, and examples
Classmate (Wanda)Response
While there may be limited statistical calculations that are required some public health positions, there is a need to understand a large amount of data. Public health decisions are made by the output performed by statistical software. As a public health leader, having an understanding of the software process is important when determining your company/study budget, what data you are trying to provide and whom will be receiving the output of your data. The research data, one’s technological expertise, and one’s own personal preferences will play a role in which software will work best (Sewell, 2019).
Public health and all fields of science rely heavily on computers. It is almost impossible understand research without having even a basic knowledge of statistics. In order to do that, it is important to have some level of understanding of statistical software. For example, while there are many types of software out there, SPSS (Statistical Package for the Social Sciences) has become a very important type of software used in statistical analysis. This software can perform the simplest analysis to the more complex (Arkkelin, 2014).
References:
Arkkelin, D. (2014). Using SPSS to understand research and data analysis. Retrieved from https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1000&context=psych_oer
Sewell, A. (2019). Stata vs. R vs. SPSS for Data Analysis. Retrieved from http://publish.illinois.edu/commonsknowledge/2019/12/05/stata-vs-r-vs-spss-for-data-analysis/
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Solution
Classmate (Wanda) Response
I agree with you that data is essential in conducting valid and effective public health programs. Public health practitioners can therefore rely on data to evaluate the impact of the various programs they implement. Public health professionals can also rely on data to determine the ideal public health interventions for a given community and to monitor the progress of various implemented interventions. Public health practitioners can also rely on data to determine the populations that should be targeted with specific interventions, evaluate the barriers of care in given communities and influence public policy in different ways (Pastorino et al., 2019).
I also agree with you that SPSS (Statistical Package for the Social Sciences) is one of the most effective tools that public health practitioners can rely on for statistical analysis and process various types of data that they can utilize to inform public interventions. SPSS is, therefore, an important data analysis tool in public health because it can perform highly complex data manipulation and analysis through simple instructions. In this regard, the SPSS software can extract data from any type of file and utilize such data to generate charts, tabulated reports, trends, and plots of distributions, complexity sequel analysis, and descriptive statistics (Masuadi et al., 2021). The different types of data produced by the SPSS program can therefore form the basis of public health programs understanding the public health needs and the necessary public health interventions required in a given community. As a statistical software, the SPSS will be beneficial to the public health discipline because of the ability of software to analyze both quantitative and qualitative data (Masuadi et al., 2021). Public health practitioners, therefore, need to rely on both qualitative and quantitative data to conduct various public health interventions.
References
Masuadi, E., Mohamud, M., Almutairi, M., Alsunaidi, A., Alswayed, A. K., & Aldhafeeri, O. F. (2021). Trends in the Usage of Statistical Software and Their Associated Study Designs in Health Sciences Research: A Bibliometric Analysis. Cureus. Published. https://doi.org/10.7759/cureus.12639
Pastorino, R., de Vito, C., Migliara, G., Glocker, K., Binenbaum, I., Ricciardi, W., & Boccia, S. (2019). Benefits and challenges of Big Data in healthcare: an overview of the European initiatives. European Journal of Public Health, 29(Supplement_3), 23–27. https://doi.org/10.1093/eurpub/ckz168

Summary of case summary
Case Study:
A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.
Instructions:
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.
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.
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Solution
Case Study
Considering the patient’s symptoms in the case study, who is a 46-year-old woman, her main health needs include managing menopausal symptoms, controlling blood pressure, and maintaining a healthy weight. The patient weighs 230 lbs., which is quite excess weight considering that the patient has a history of hypertension. The patient’s blood pressure also appears to be a bit high, considering that the current blood pressure measurement is 150/90. Finally, the patient appears to be suffering from menopausal symptoms because she complains of having night sweats, hot flashes, and genitourinary symptoms, which are all menopausal symptoms (Palacios et al., 2019).
In the case study of the 46-year-old woman, critical decision-making will be applied to prescribe the appropriate drugs for the patient’s treatment. Considering the patient’s history of hypertension, hormone replacement therapy that she would receive to manage her menopausal symptoms would need to be safe and not interfere with her blood pressure. The treatment regimen for the patient would include hormone replacement therapy to manage her menopausal symptoms (Palacios et al., 2019). Increasing her hydrochlorothiazide dose from 25 mg to 50 mg daily would also help control her blood pressure (Burnier et al., 2019). Finally, providing dietary and exercise counseling to help the patient lose weight would also assist significantly in controlling blood pressure (Jurik & Stastny, 2019).
Cenestin, an estrogen pill, would be the most suitable drug to help the 46-year old patient manage her menopausal symptoms with little or no effect on her blood pressure (Palacios et al., 2019). On the other hand, the ideal patient education strategy for the 46-year-old woman would be a referral to a trained peer educator. A trained educator would have sufficient time to guide the 46-year-old patient with the ideal physical activity and dietary changes to help her manage her weight (Jurik & Stastny, 2019.
References
Burnier, M., Bakris, G., & Williams, B. (2019). Redefining diuretics use in hypertension. Journal of Hypertension, 37(8), 1574–1586. https://doi.org/10.1097/hjh.0000000000002088
Jurik, & Stastny. (2019). Role of Nutrition and Exercise Programs in Reducing Blood Pressure: A Systematic Review. Journal of Clinical Medicine, 8(9), 1393. https://doi.org/10.3390/jcm8091393
Palacios, S., Stevenson, J. C., Schaudig, K., Lukasiewicz, M., & Graziottin, A. (2019). Hormone therapy for first-line management of menopausal symptoms: Practical recommendations. Women’s Health, 15, 174550651986400. https://doi.org/10.1177/1745506519864009

NUR 602 Milestone one for MR X Pharmacology
NUR 602 Final Project Unfolding Scenario Part One
Mr. X is a 63-year-old, married, African American male who presents to the primary care office where you are working as a master’s-prepared nurse.
He is relatively new to your practice. Until recently, he had not received primary healthcare for some time due to lack of health insurance. He lives with his wife and three children. He works for the U.S. Postal Service as a mail clerk. He does not smoke and he consumes alcohol only on rare social occasions. He walks daily for his job and claims to eat healthily, though he admits to eating a lot of red meat, canned foods, and soda. When asked, Mr. X admits he is under a fair amount of stress at home and work.
Previous blood pressure readings taken over the past two weeks were: 176/108 mm Hg in the right and left arms, while seated and supine, during his first office visit; and 172/110 mm Hg in both arms, while seated and standing, during his second encounter.
Today, he reports that he has occasional episodes of exertional chest pain and has been taking sublingual nitroglycerin prn for relief. He states, “I seem to be getting these episodes more frequently over the past month or so.” He also describes a remote history of migraine headaches but in recent months only suffers with one about two to three times per month.
Medications: naproxen 440mg daily prn, Tylenol 625mg daily prn, multivitamin
Drug Allergies: NKDA
Past Medical History (PMH): migraines, basal cell carcinoma
Past Surgical History (PSH): laparoscopic cholecystectomy (2006); basal cell carcinoma excision on back (2011)
NUR 602 Milestone one for MR X Pharmacology
Family History (FH):
Mother: alive at 84, hypertension (HTN)
Father: deceased at 78 from myocardial infarction (MI), HTN, type 2 diabetes (T2DM), hyperlipidemia
4 siblings: one brother and one sister with HTN, others healthy as far as he knows
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NUR 602 Final Project Unfolding Scenario Part Two
BP 170/100 mm Hg in both arms, seated and standing; BP 186/106 mm Hg both legs, supine. Pulse: 86/min, regular. Respirations: 18/min, unlabored. Temperature: 98°F PO. His height is 74” and he weighs 212 lbs (96.4 kg).
Eye examination reveals visual acuity of 20/25 OU, uncorrected. Pupils are equal, round, regular, and react to light and accommodation. Fundoscopic examination reveals AV nicking and narrowing of arterioles, but no exudates, hemorrhages, or papilledema. Thyroid is smooth, non-tender, without thyromegaly. No JVD or carotid bruit is noted. Cardiac examination reveals a regular rate and rhythm at 86 BPM. S1 and S2 are of equal intensity; an S4 is audible. No murmur, rub, or thrill is appreciated. Chest is clear to auscultation and percussion. Abdomen is soft, non-tender, non-distended, with normoactive bowel sounds in all quadrants. No aortic, renal, iliac, or femoral bruits are noted. No hepatosplenomegaly or masses. The lower extremities are pink, warm, and dry without asymmetry, clubbing, or cyanosis. 1+ pedal edema is present bilaterally. Neurological exam is non-focal.
Today, his EKG shows no evidence of ischemia; there are no Q-waves, but it does show mild LVH. Laboratory testing reveals a serum creatinine of 1.6 mg/dl. (elevated); a serum potassium of 3.8; a sodium of 130, and FBS of 100 mg/dl, LDL is 172, HDL 40, triglycerides 184. CBC, U/A and LFTs are within normal limits.
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Example 1
Milestone One: Introductory Analysis of Subject Mr. X
Overview
A fairly new patient, Mr. X has presented to the office for follow-up visit. Mr. X is a 63 year old African American male. He is married with three children. Works for the United States Post Office, a non-smoker, occasional alcohol drinker. His exercise regimen is the walking he does at his job. Mr. X’s diet consists of red meat, processed and canned foods and soda. He admits to stress in his job and home life, and has not had regular visits to a physician due to lack of healthcare (NUR 602 Final project unfolding scenario part one, 2020). Mr. X’s medical history includes: No known drug allergies
Medications: naproxen 440mg daily prn(reason for prescription not given),Tylenol 625mg daily prn,( reason for use not given) Multivitamin( type, dose and frequency not stated) and sublingual nitroglycerin prn for chest pain (no dose or frequency stated)
Past Medical History (PMH): migraines, basal cell carcinoma
Past Surgical History (PSH): 2006- laparoscopic cholecystectomy
2011- Basal cell carcinoma excision on back
Family Medical History (FMH): Mother: alive, Hypertension (HTN)
Father: deceased at age 78 from myocardial infarction (MI), HTN, type 2 Diabetes, hyperlipidemia
Siblings: four one male & one female have HTN, others healthy
Previous office visits include elevated blood pressures. Visit from two weeks ago was 176/108 mm/HG, one week ago 172/110 mm/Hg in bilateral arms sitting and standing. Complaint of chest pain with exertion, which is relieved with sublingual nitroglycerin, multiple times of the past month. Increased migraine frequency of two-three a month.
Subjective Data
Subjective data is ”information from the patients point of view (“symptoms”), including feelings, perceptions, and concerns obtained through interviews” (Daniels, n.d., Chapter 11). Mr. X informs us:
His diet is healthy, even though his diet consists of processed and canned food, carbonated beverages and large amounts of red meat.
Increased episodes of chest pain on exertion, that is relieved with sublingual nitroglycerin (patient does tell us where he got this drug from).
Migraines are occurring more frequently to two-three times a month.
Has stress at home and work (no explanation of what the stress is).
Objective Data
Objective data is ”observable and measurable (“signs”) obtained through observation, physical examination, and laboratory and diagnostic testing” (Daniels, n.d., Chapter 11).
Elevated blood pressure: over last two visits and today’s visit:
176/108 mm/Hg in bilateral arms in sitting and supine positions from first visit.
172/110 mm/Hg in bilateral arms in sitting and supine positions from second visit.
170/100 mm/Hg in bilateral arms in sitting and supine position and 186/106 mm/Hg
bilateral legs in supine position.
Pulse: 86/min, regular.
Respirations: 18/min, unlabored.
Temperature: 98 degree Fahrenheit, oral
Height 74 inches, weight 212 lbs.
Eye exam: visual acuity: 10/25 OU, uncorrected
pupils: equal, round, regular, reactive to light and accommodation
Fundoscopic: AV nicking and narrowing of arterioles, no exudate, no
papilledema.
Thyroid: smooth, non-tender, no thyromegaly
Cardiac: regular rate & rhythm, S1 & S2 equal intensity, S4 is audible, no murmur,
rub, or thrill. Clear with auscultation and percussion
Abdomen: soft, non-tender, non-distended, positive bowel sounds in all four
quadrants. no aortic, renal, iliac or femoral bruits noted.
Neurological: non-focal
Lower extremities: pink, warm, dry, no asymmetry, clubbing, no cyanosis, 1+ pedal
edema present bilaterally
EKG: no evidence of ischemia, no Q-waves, mild LVH present
Blood Labs: creatinine 1.6 mg/dl (elevated)
potassium 3.8
sodium 130
fasting blood sugar (FBS) 100mg/dl
LDL 172 HDL 40 Triglycerides 184
CBC, UA, LFT’s all WNL (NUR 602 Final project unfolding scenario part one, 2020, p. 1),(NUR 602 final project unfolding scenario part two, 2020, p. 1) .
Analysis
Mr. X’s cultural, demographic and socioeconomic status should also be considered when analyzing his subjective and objective data. Mr. X is African American(AA), older, he works as a postman, didn’t have health insurance for awhile (exact amount of time not given). In the U.S. heart disease is the no.1 killer, and stoke is also a leading cause of death. The “risks of getting those diseases are even higher for African-Americans”(American Heart Association, 2019, para. 1). “The prevalence of hypertension in African-Americans is the highest in the world. It also increases the risk of heart disease and stroke”(American Heart Association, 2019, para. 5). Researchers believe that there is a “genetic difference that predisposes blacks to high blood pressure. They suspect that people who lived in the equatorial Africa developed a genetic predisposition to being salt-sensitive, which means their bodies retain more sodium”(Harvard Health Publishing Harvard Medical School, 2015, para. 4). Those of African American ethnicity have a higher prevalence of traditional risk factors of hypertension (HTN), diabetes , obesity and atherosclerotic cardiovascular risk(Carnethon et al., 2017).
Culturally, AA diets traditionally contain food that is considered ‘soul food’, or a southern style diet(Carnethon et al., 2017). Foods in these type of diets tend to be high in fat (red meat), processed foods, and lead to unhealthy lifestyles. Known risk factors for cardiovascular diseases include: hypercholesterolemia, diabetes, hypertension, obesity and smoking (Wilson, 2017). In looking at all the data, their seems to be a lack of knowledge or education regarding risk factors and how he falls into a high-risk category is as important as starting Mr. X on medications and setting up appointments for follow up visits here and with specialists. “The same lifestyle habits that can help treat coronary artery disease can also help prevent it from developing in the first place”(Mayo Foundation for Medical Education and Research (MFMER), 2019, para. 9).
Personalized medicine strives for “treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations” (Williams, Ravenell, Seyedell, Nayef, & Ogedegbe, 2017, p. 283). The biological profile associated with HTN in blacks is called the low renin physiology. This physiology is linked with a salt-sensitive phenotype with excess effective circulating volume being the mechanism of HTN. These beliefs lead to the current practice of using specific anti-HTN drugs that address volume issues ( dihydropyridine calcium channel blockers and diuretics)(Williams et al., 2017). AA are also at a high risk for chronic kidney disease (CKD). In a study by African American Study of Kidney and Hypertension (AASK), AA patients were placed in a randomized drug therapy of either ramipril or amlodipine for HTN. Amlodipine had a more impressive result of lowest blood pressures, the drug ramipril was more effective in reducing chance of worsening CKD, along with lowering blood pressures(Williams et al., 2017).
References
American Heart Association. (2019). African Americans and heart disease, stroke [fact sheet]. Retrieved from https://www.heart.org>health-topics/African-Americans-and-heart-disease-stoke
Brewer, L. C., & Cooper, L. A. (2014, June). State of the art and science, race discrimination and cardiovascular disease. Virtual Mentor, 16, 455-460. http://dx.doi.org/10.1001/virtualmentor.2014.16.6stcs2-1406
Carnethon, M. R., Pu, J., Howard, G., Albert, M. A., Anderson , C. A., Bertoni, A. G., … Yancy, C. W. (2017, November 21). Cardiovascular health in African Americans: A scientific statement from the American Heart Association. Circulation, 136(21), e393-e423. http://dx.doi.org/10.1161/CIR0000000000000534
Choudhury, T., West, N. E., & El-Omar, M. (2016). ST elevation myocardial infarction. Clinical Medicine, 16(3), 277-282. Retrieved from https://doi.org.ezproxy.snhu.edu/10.7861/clinmedicine16-3-277-282
Daniels, R. (n.d.). Chapter 11: Assessment. In (Ed.), Online companion: Nursing fundamentals: Caring & clinical decision making. Retrieved from https://www.delmarlearning.com/companions/content/0766838366/students/ch11/faq.asp
Division for heart disease and stroke. (2019). Heart disease [fact sheet]. Retrieved from National Center for Chronic Disease Prevention and Health Promotion: https://www.cdc.gov>hus>spotlight>heartdiseasespotlight_2014-0404
Harvard Health Publishing Harvard Medical School. (2015). Race and ethnicity: Clues to your heart disease risk? [educational]. Retrieved from Harvard University: https://www.health/harvard.edu>heart-health>race-and-ehtnicity-clues-to-your-heart-disease-risk?
Know the facts about heart disease [fact sheet]. (2019). Retrieved from National Center for Chronic Disease Prevention and Health Promotion Website: https://www.cdc.gov>hus>spotlight>heartdisesaespotlight_2014_0404
Lippi, G., Sanchis-Gomar, F., & Cervellin, G. (2016, April 13). Chest pain, dyspnea and other symptoms in patients with type 1 and 2 myocardial infarction. A literature review. International journal of Cardiology, 215(), 20-22. http://dx.doi.org/10.1016/j.icard.2016.04.045
Mayo Foundation for Medical Education and Research (MFMER). (2019). Coronary artery disease [educational]. Retrieved from https://www.mayoclinic.org>symptoms-causes>syc-20350613
Muncan, B. (2018, October 18). Cardiovascular disease in racial/ethnic minority populations: illness burden and overview of community-based interventions. Public Health Reviews, 39(32), 1-11. http://dx.doi.org/10.1186/s40985-018-0109-4
NUR 602 Final project unfolding scenario part one [Case Study]. (2020). Retrieved from https://learn.snhu.edu/content/enforced/183470-NUR-602-X4103-OL-TRAD-GR.20TW4/csfiles/home_dir/NUR-602%20Student%20Documents/nur602_part_one_unfolding_scenario.pdf?_&d21SessionVal=D13S49L4GaSoMlqGbvoAdOJtS&ou=183470
NUR 602 final project unfolding scenario part two [case study]. (2020). Retrieved from https://learn.snhu.edu/content/enforced/183470-NUR-602-X4103-OL-TRAD-GR.20TW4/csfiles/home_dir/NUR602%20Student%20Documents/nur602_part_two_unfolding_scenario.pdf?_&d21SessionVal=D13S49L4GaSoMlqGbvoAdOJtS&ou=183470
RNpedia. (2017). Congestive heart failure (CHF) nursing care plan & management [educational]. Retrieved from RNpedia complete nursing notes and community: https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/congestive-heart-failure-chf/nursing-care-plan-management
Saab, K. R., Kendrick, J., Yracheta, J. M., Lanaspa, M. A., Pollard, M., & Johnson, R. J. (2015). New insights on the risk for cardiovascular disease in African Americans: The role of added sugars. Journal of the American Society of Nephrology, 26, 247-257. http://dx.doi.org/10.1681/ASN.2014040393
Williams, S. K., Ravenell, J., Seyedell, S., Nayef, S., & Ogedegbe, G. (2017, November 1). Hypertension treatment in blacks: Discussion of the U.S. clinical practice guidelines. Progress in Cardiovascular Diseases, 59(3), 282-288. http://dx.doi.org/10.1016/j.pcad.201609.004
Wilson, P. W. (2017). Overview of established risk factors for cardiovascular disease. In H.
Libman & B. C. Downey (Ed.), UpToDate. Waltham, Mass. UpToDate. Retrieved from
https://www.uptodate.com
Example 2
NUR 602 – Milestone 1
Mr. X is a 63-year old African American male, who is married with three children. He has not had primary health care for a significant period of time related to lack of insurance. Mr. X has a past medical history notable for migraines, basal cell carcinoma (post excision in 2011), and a laparoscopic cholecystectomy in 2006. He has no known drug allergies, and takes a daily multivitamin, as well as 440mg naproxen, and 625mg Tylenol as needed. Family history is notable for hypertension (mother, father, two siblings), as well as a father with type 2 diabetes and hyperlipidemia, who is deceased related to a myocardial infarction (MI).
Mr. X presented as a new patient with blood pressure readings consistent with stage 2 hypertension – 176/108 at his first office visit, and 172/110 at his second visit two weeks later. Stage 2 hypertension is when an individual’s blood pressure is consistently greater than 140/90 (American Heart Association, 2017).
Mr. X reports occasional episodes of exertional chest pain, which has been responsive to sublingual nitroglycerin tabs. He states that these occurrences have increased in frequency over the last month. Mr. X also reports experiencing migraine headaches two to three times per month. Mr. X states that his work for the US Postal Service affords him the opportunity to walk daily. He states that he is a non-smoker, and that he rarely consumes alcohol. He claims to eat healthy foods, though does state that he eats a lot of red meat, canned foods, and soda pop. Mr. X also reports being under a fair amount of stress at both home and work.
Based on this subjective data, Mr. X should be educated on how culture, ethnicity, and diet, and how they relate to hypertension. African Americans are more prone to have hypertension than Caucasians, with the onset of hypertension occurring earlier in life. This is due to a combination of factors, including lower than average incomes for African Americans, and strong cultural influences regarding food preferences and preparations (Chan, Stamler, & Elliott, 2015).
African American men traditionally eat what is known as a ‘Southern’ diet – fried, processed foods, organ meats, processed meats, foods high in sodium and fats, as well as sugary beverages such as soda. Mr. X endorses a diet which contains many of those staples of the ‘Southern’ diet. Instead, he should be educated on the DASH (dietary approaches to stop hypertension) diet, which includes lean proteins, fruits, vegetables, and whole grains (Howard, et al, 2018). When followed properly, DASH diets are associated with a reduction in blood pressure (Chan, Stamler, & Elliott, 2015).
Mr. X’s blood pressure is currently elevated at 170/100 in his bilateral arms, and 186/106 in his bilateral legs. His remaining vital signs are within normal limits. His BMI calculates to 27.2, which is considered overweight. Ocular exam reveals AV nicking, with narrowing of arterioles. Cardiac auscultation reveals audible S4 heart sounds. Bilateral 1+ pedal edema is noted. EKG shows mild left ventricle hypertrophy. Laboratory testing shows that Mr. X’s creatinine is high at 1.6, sodium is low at 130, LDL cholesterol is high at 172, HDL cholesterol is borderline low at 40, and triglycerides are borderline high at 184. All other parts of his physical exam, laboratory tests, and EKG testing are within normal limits.
The finding of AV nicking with narrowing of arterioles is concerning for hypertensive retinopathy. This rarely causes significant visual loss but can be used as a predictor for a patient being at risk for hypertensive crisis (Modi, 2020). Likewise, Mr. X’s audible S4 heart sound is concerning for a thickening of the left ventricular wall caused by hypertension (Williams, 1990). These findings are consistent with his presentation with consistent stage 2 hypertension.
All in all, Mr. X appears to be an overweight patient with essential hypertension, and hyperlipidemia. As stated, there are numerous socioeconomical, and cultural factors at play here, such as Mr. X being prone to hypertension due to his ethnicity (African American), and culture (‘Southern’ style diet). Mr. X needs extensive education on the health disparities that exist among African Americans, so that he may make lifestyle changes which can help reverse some of the damage which has been done to his body.
His care team should likewise use this information to determine safe, effective, and appropriate pharmacotherapeutics for Mr. X. A recent report from JNC 8 states that there is strong evidence which supports treatment for hypertension for patients 60-years old and over, with a goal blood pressure of less than 150/90. They further report that in the African American hypertensive population, calcium-channel blockers, or a thiazide-type diuretic are recommended as front-line therapies (James, et al, 2014).
It is notable that Mr. X did not receive care for some time due to his lack of insurance. It is therefore reasonable to assume that he may need to be prescribed medications which are available in a low-cost, generic form.
References
American Heart Association. (2017, November 30). Understanding Blood Pressure Readings. Retrieved from https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings
Chan, Q., Stamler, J., & Elliott, P. (2015). Dietary Factors and Higher Blood Pressure in African-Americans. Current Hypertension Reports, 17(2). doi: 10.1007/s11906-014-0517-x
Howard G, Cushman M, Moy CS, et al. (2018). Association of Clinical and Social Factors With Excess Hypertension Risk in Black Compared With White US Adults. JAMA. 320(13):1338–1348. doi:10.1001/jama.2018.13467
James, P. A., Oparil, S., Carter, B., Cushman, W., Dennison-Himmelfarb, C., Handler, J., & Lackland, D. (2014, February 5). 2014 Guideline for Management of High Blood Pressure. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/1791497
Modi, P. (2020, January 8). Hypertensive Retinopathy. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK525980/
Williams, E. S. (1990, January 1). The Fourth Heart Sound. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK344/

Qualitative Analysis Coding- TOPIC 7 Q 2
QUESTION-TOPIC 7 DQ 2
Describe the process of coding qualitative data. Identify the distinguishing factors between inductive and deductive coding..
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Solution
Coding in Qualitative Data
Coding is the process of analyzing data in research. It is crucial to evaluate research data and ensure that the data collected is authentic and standardized for research purposes (Elliott, 2018). In coding, researchers break down the data into subsections and critically analyze the words to form statements before putting them back into meaningful data. Thus, it is a tool that helps researchers to analyze collected data into more concrete, meaningful, critically, and organized data.
The Process of Qualitative Coding
Coding qualitative data can be a little bit challenging but worthwhile, especially for researchers. The process entails steps to help researchers improve their analyses and draw a concrete conclusion in their studies. Developing a research question and design is the first thing (Linneberg & Korsgaard, 2019). The question helps in determining the data type that can be used in the completion of the study. Reviewing appropriate research works is crucial in this process (Linneberg & Korsgaard, 2019). This is important because it assists researchers in developing some data tools that are applicable for their studies and avoids duplication of data of previous studies. Finally, gathering some data and documenting it enhances organized analysis (Linneberg & Korsgaard, 2019). Coding can be tiresome because of analyzing word by word, but it is more effective in research because of its authenticity.
Distinguishing Factors
Inductive and deductive approaches are both used in the coding data process. The inductive process focuses on the terms and phrases that participant’s use. Researchers mainly rely on the participants’ words and not theoretical framework. Thus, it can have several codes in the end (Linneberg & Korsgaard, 2019). While deductive focuses on theories and reviews of literature, hence having two or three codes in its analysis (Linneberg & Korsgaard, 2019). Due to the personal ideas of individuals rather than the researchers’ investigation, the inductive can be more unorganized considered to deductive that is well structured and organized.
References
Elliott, V. (2018). Thinking about the coding process in qualitative data analysis. The Qualitative Report, 23(11), 2850-2861.https://www.proquest.com/openview/bd8668bc7af5c395f8c00171f50100a7/1?pq-origsite=gscholar&cbl=55152
Linneberg, M. S., & Korsgaard, S. (2019). Coding qualitative data: A synthesis guiding the novice. Qualitative research journal.https://pure.au.dk/ws/files/190067680/Linneberg_2019_Coding_qualitative_data.pdf

The Merging of Departments for Cost Containment
This assignment will help you explore how the nursing leader can maintain human and ethical decision making while implementing a departmental merger.
As the chief nursing officer, you have been asked to merge three departments—
social work, discharge planning, and utilization review—with overlapping functions and different managers. You have been told at this point that no one will lose his or her position. However, you must justify each person’s role. Also, you must make the new department an economic revenue saver.
Write a 3-page report that addresses the following:
• Describe the process, strategic questions, and issues related to financial resource management that you must consider while merging the three departments.
• Outline and describe your approach to the following questions:
o How will you maintain the human needs of the staff members in this merger?
o How will you ensure that all the staff members engage fully in this merger?
o How will you ensure the staff members feel good about this merger?
o How will you maintain the fiscal focus of the merger?
-USE APA FORMAT
USE HEADINGS FOR EACH POINT
-Use at least four references not more than five years old

e-portfolio
Section 1: Patient Education Poster: “How does my heart work?”
In this activity you are looking at how to teach your patient about their own cardiac anatomy and physiology. Based on what you have explored in Module 1 you are to devise a poster that can be used as an education resource when explaining the function of the heart. Remember that you may be working with patients from various backgrounds, age groups and different educational perspectives – so you need to make it so that they can understand it. Please include your references at the bottom of the poster.
Some suggestions for poster building applications include: PowerPoint, Canva and PicMonkey.
Section 3: Procedural Risks
Many patients are vulnerable and a considered to be at risk populations with complex cardiac problems and multiple comorbidities. These patients bring special ‘risk’ to any procedural intervention. These risk factors are then compounded by the clinical environment, the potential for the use of medications and anaesthetics, their physical condition of the patient and the reason they are undergoing a particular surgical intervention or procedure. Then you add the trauma due to the procedure itself and then you can start to picture why there are some patients who are at higher risks than others.
Patients experiencing AMI require coronary artery reperfusion. Surgically, this can be obtained through cardiac catheterisation (percutaneous coronary interventions) or coronary artery bypass grafting (CABG).
In this section of your assessment, you are to compare both methods of coronary reperfusion and discuss two potential complications of each (Four in total). In your answer, you are to discuss the cause for your chosen complications and a brief description of how these complications would be assessed and managed, with a stronger focus on the nursing aspects of this management.
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Solution

Nursing Topic Response
Topic 1:
Describe quantitative research designs that are used to support changes in nursing practice. Choose one and explain why you chose it. Give an example of how this research design is used to drive change in nursing practices.
Response 1: (jean)
Describe quantitative research designs that are used to support changes in nursing practice.
Quantitative research collects and analyzes numerical data. It evaluates a predetermined research question. It is a way to learn about a particular group of people (sample population) It may be carried in two ways: –
Experimental research is carried out to introduce an intervention or treatment (Brydon-Miller & Coghlan, 2020). This type of research uses statistical analysis to prove or disprove a theory. In nursing practice this may be done to find out for instance to determine if dressing A works better than dressing B on patients with leg ulcers.
In non- experimental research, no intervention or treatment takes place. Data is collected, measured, or observed to measure trends, compare situations, or validate conditions. This type of research could be carried out to support a change in nursing practice for instance an example could be using a survey to find out if nurses felt emotionally supported during the COVID-19 pandemic.
Choose one and explain why you chose it. Give an example of how this research design is used to drive change in nursing practices.
An example of a non-experimental research design that could be used to drive change in nursing practice could be to ask, “Do patients prefer telehealth appointments to speak to their physician rather than in person appointments.” The information could be collected survey and the data counted to reflect the most popular answer.
Since the COVID pandemic took us by storm, the world has changed, especially the medical field. Many patients have used tele-health appointments to see their physicians instead of taking the risk of traveling to the Dr’s office where they are at risk of catching the virus. This has also helped to protect those in the medical field as they are not coming into contact as frequently with patients who may transmit the virus.
This research would help to determine if tele-health is still a preferred method of talking to their physician or not and the outcome would dictate whether it would be used to drive a change in nursing practice. For many patients the convenience of tele-health might influence patient’s answers like not having to drive or take transportation to get the appointment, not having to ask someone to take you or go with you; no waiting in the doctor’s office and not taking up so much time in a busy day.
Response 2 (chislon)
Quantitative research designs use numbers analysis to answer a research hypothesis or question. A research design is a general plan in which the researcher incorporates several study components in an analytical and coherent way to effectively tackle the research problem. “There are six types of true experimental designs commonly reported in the scientific literature. These include: (1) two-group pretest-posttest – Subjects are randomly assigned to the experimental or control group and are measured before and after the intervention; classic or true experiment, (2) two-group posttest-only – Experimental designs when subjects are randomly assigned to an experimental or control group and measured after the intervention, (3) Solomon four-group – An experimental design with four groups—some receive the intervention, others serve as controls; some are measured before and after, others are measured only after the intervention, (4) multiple experimental groups – Experimental designs using two or more experimental groups with one control group, (5) factorial – Experimental designs allowing researchers to manipulate more than one intervention, and (6) crossover designs – Experimental designs that use two or more treatments; subjects receive treatments in a random order (Schmidt, 2017).”
I will explain some more on the Two-Group Pretest-Posttest Designs. This design is known to be the common/classic design used in experiments and this is the main reason why I chose it. Other than the Two-Group Posttest-Only Designs, this design is one of the simplest designs. A two-group pretest-posttest design is an experimental design, which compares the change that occurs within two different groups on some dependent variable (the outcome) by measuring that variable at two time periods, before and after introducing/changing an independent variable (the experimental manipulation or intervention). For example, a researcher wants to test the insulin administration education of diabetic patients. Patients in a diabetic clinic are assigned randomly between two groups, a computerized learning class or an in-person teaching and demonstration class with demonstrated knowledge check. The knowledge and technique used are measured before and after teaching for all subjects. In the end, the pretest and posttest techniques were compared to determine if learning occurred. Another is to compare the posttest knowledge and technique of both groups to see if the teaching method improved the posttest score more than another did.
Topic 2
What is the difference between statistical significance and clinical significance? Explain why statistically significant results in a study do not always mean that the study is clinically significant. Provide an example.
Response 1: (Erika)
The difference between statistical significance and clinical significance, from what I understood in the literature was that there may be a casual link or association in scientific studies, and expressed by a probability value. One of the examples used, that helped me to better understand it was, “a drug lowered cholesterol levels an average of 195 to 178. Analysis indicated that this decrease was statistically significant; however, because any cholesterol value below 200 is considered to be within normal range, there is no clinical significance to this finding.” In-other-words, if the tested subjects had a cholesterol above 200 and the tested drug had lowered their levels either close to the 200 or even at the 200 level, then it would have had clinical significance and would then make sense to apply it as a practice intervention. (Schmidt & Brown, 2019, p.370) Basically, statistically significant results do not always mean the results have a clinical significance because it depends on the data utilized for the study and results. As the example noted above the average was within normal range then it would not be useful in a clinical practice. Again, that’s if I understood this topic correctly and the question.
Response 2: (herman)
In research studies, there can be clinical significance or statistical significance. Clinical significance is regarded as the event where a result or a course of treatment has had genuine and quantifiable effects (Dahlberg et al., 2020). That means that the treatment under trial is relevant clinically due to the fact that it is practical in causing the effect it was intended to. In that case, it means that a research is considered to be clinically significant when its effects are practical in the real world. On the other hand, statistical significance is where an effect is likely or unlikely to happen by chance (Schober et al., 2018). That means that statistical significance depends on probability while clinical significance depends on the size effects.
According to Dahlberg et al. (2020), studies can reach statistical significance but provide evidence that is not clinically meaningful, or results could not be statistically significant but very clinically relevant. That means that the study findings or the null hypothesis being studied is found to be true but in real life, the results cannot be applied. For example, a treatment regimen could be found to be effective from the point of statistical significance, however, the treatment cannot be applied in real life due to the side effects on humans.
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Solution
Reply 1: (Jean)
I agree with you that quantitative research is important in conducting research data and coming up with various evidence-based practices that are required to support changes in nursing practice. I also agree with you that experimental research and non-experimental research are two of the quantitative research approaches that can be adopted to help to support changes in nursing practice (Noyes et al., 2019). However, there are other quantitative approaches that a researcher can rely on to support evidence-based practices and changes in nursing practice. These include survey research, experimental research, and correlational research. Survey research is one of the basic methods of quantitative research. Survey research is therefore used to explain the characteristics of a given population. Descriptive research is also another approach to quantitative research. Descriptive research involves explaining the statuses of various identifiable variables (Noyes et al., 2019).
References
Noyes, J., Booth, A., Moore, G., Flemming, K., Tunçalp, Z., & Shakibazadeh, E. (2019). Synthesizing quantitative and qualitative evidence to inform guidelines on complex interventions: clarifying the purposes, designs, and outlining some methods. BMJ Global Health, 4(Suppl 1), e000893. https://doi.org/10.1136/bmjgh-2018-000893
Reply 2 (Chislon)
I agree with you that there are different types of quantitative research methods that can be adapted to support changes in nursing practice. These include survey research, descriptive research, experimental research, correlational research, and causal-comparative research (Quick & Hall, 2015). However, one of the most widely-adopted quantitative research methods in nursing research is the cause of comparative research method. The causal-comparative research method is therefore utilized to drive changes in nursing by evaluating whether certain interventions or practice changes will have a positive effect on patient populations (Quick & Hall, 2015). For instance, the causal of comparative research method can be utilized to determine whether physical activity can help improve the outcomes of patients with cardiovascular diseases. In such a research study, the intervention would therefore be physical activities, while the expected outcomes would be an improvement in the condition of patients with cardiovascular diseases.
References
Quick, J., & Hall, S. (2015). Part Three: The Quantitative Approach. Journal of Perioperative Practice, 25(10), 192–196. https://doi.org/10.1177/175045891502501002
Reply 1: (Erika)
I agree with you that statistical significance differs from clinical significance in that statistical significance will simply mean that a certain event is likely to happen, while clinical significance will verify the extent to which a certain event will happen. Statistical significance is mainly focused on disapproving a certain negative and proving that a given event did not occur by chance. On the other hand, clinical significance normally seeks to prove a certain positive event and that a particular event might have occurred in a certain measured manner. Although the statistical significance of study results was far more considered in the past, in modern times, the clinical significance of studying is considered because some studies placed more importance on statistical significance, which has been found not to be so significant after all(Ranganathan et al., 2015). In medical terms, clinical significance can therefore be described as results that indicate that a given course of treatment will have quantifiable and genuine effects. On the other hand, the statistical significance will be assigned to a result where an event will be found to be more unlikely to occur (Ranganathan et al., 2015).
References
Ranganathan, P., Pramesh, C., & Buyse, M. (2015). Common pitfalls in statistical analysis: Clinical versus statistical significance. Perspectives in Clinical Research, 6(3), 169. https://doi.org/10.4103/2229-3485.159943
Reply 2: (Herman)
I agree with you that in research studies, both clinical and statistical significance will be considered. Clinical significance will therefore determine how many applications, for example, in pharmaceutical testing works in testing and various forms of medical research where specific implications and the magnitude of such implications can be quantified and measured (Schober et al., 2018). On the other hand, the statistical significance will have numerous broad applications, including determining the causes of an occurrence or whether an occurrence happened by chance. Statistical significance can also be useful in the early stages of pharmaceutical research to determine whether more research will be needed (Schober et al., 2018).
References
Schober, P., Bossers, S. M., & Schwarte, L. A. (2018). Statistical Significance Versus Clinical Importance of Observed Effect Sizes. Anesthesia & Analgesia, 126(3), 1068–1072. https://doi.org/10.1213/ane.0000000000002798

Discussion: Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.
Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.
When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.
To Prepare
Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history in your case study.
By Day 3 of Week 1
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 rubric Detail
Name: 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.). 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 of nurse practitioners, 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 a pharmacist as a collaborator.
Required Media (click to expand/reduce)
Discussion: Pharmacokinetics and Pharmacodynamics
As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.
Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.
When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.
To Prepare
Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
Think about a personalized plan of care based on these influencing factors and patient history in your case study.
By Day 3 of Week 1
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.
By Day 6 of Week 1
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.
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 “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Assignment 2: Ethical and Legal Implications of Prescribing Drugs
What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that coul_6521_Week1_Discussion?
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Solution
Discussion: Pharmacokinetics and Pharmacodynamics
Advanced practice nurses (APNs) encounter a wide range of patients presented with different clinical manifestations. Thus, APNs should understand pharmacokinetics and pharmacodynamics associated with various medications they will prescribe to their patient during their nursing profession. Pharmacokinetics on the movement of a particular medicine throughout the body (Rosenthal & Burchum, 2018). On the other hand, pharmacodynamics refers to drugs’ physiologic and biochemical impacts on a patient’s body and the molecular mechanisms involved in producing those effects.
The selected case scenario is about a 68-year old female presented to the clinic. Her chief complaint involves “Feeling flushed.” Physical examination findings reveal that she is slightly tachycardic and hypertensive. She has a history of various conditions, including anxiety, COPD, depression, chronic kidney disease, and hypertension. She was admitted for hypertensive complications. The client’s current medications include an ace inhibitor and a serotonin reuptake inhibitor for depression and hypertension.
Her chronic kidney disease is the primary factor to be considered while treating her. This condition is responsible for her uncontrolled hypertension; hence should be considered when administering new medication to this patient. Secondly, the client’s compliance with the home medication regimen should be considered. Finally, her environmental exposure should be considered during the treatment process. The alterations of drug responses are associated with pharmacokinetics in this client due to her acute kidney failure. According to Keller and Hann (2018), kidney dysfunction impacts approximately 50% of all medications. Additionally, an APN should consider environmental exposure when determining the pharmacokinetics and pharmacodynamics of a particular medication. According to Banerjee (2020), environmental pollutants, including pesticides, changes drug-metabolizing enzymes, thus impacting drug metabolism. Finally, the patient’s full health-related information is vital in developing an effective treatment plan based on the presented health history. Therefore, the home dose would be recommended for this client once the hypertensive crisis was controlled. The home dosage would prevent hypertensive incidents in the future.
References
Banerjee et al. (2020). Effect of environmental exposure and pharmacogenomics of drug metabolism. https://doi.org/10.2174/1389200221666200110153304
Keller, F., & Hann, A. (2018). Principles of drug response and alterations in kidney disease. CJASN, 13 (9) 1413-1420; DOI: https://doi.org/10.2215/CJN.10960917
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.