Nursing

NURS 6521 Advanced Pharmacology, medule 2, week 3, Assignment: Asthma and Stepwise Management
Assignment: Asthma and Stepwise Management
Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.
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One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.
To Prepare
Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.
By Day 7 of Week 3
Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:
Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
Explain the stepwise approach to asthma treatment and management for your patient.
Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.
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Solution

You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be
sure to consider co-morbid physical, as well as mental factors that might impact the client’s
diagnosis and treatment.
At each Decision Point stop to complete the following:
Brief introduction and the purpose of the paper
Decision #1: Differential Diagnosis is Cyclothymic Disorder
Which Decision did you select?
Why did you select this Decision? Support your response with evidence and
references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response
with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and
the results of the Decision. Why were they different?
Decision #2: Treatment Plan for Psychotherapy-Begin Abilify 10 mg orally daily
Why did you select this Decision? Support your response with evidence and
references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response
with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and
the results of the Decision. Why were they different?
Decision #3: Treatment Plan for Psychopharmacology-Maintain current dose of Abilify 10 mg Orally daily
Why did you select this Decision? Support your response with evidence and
references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response
with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and
the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and
communication with clients and their family
Conclusion
References (most recent)

asthma drug treatment among patients
Welcome to Week 3
I have officially finished looking through your assignments and discussion posts. Fantastic class participation. Grading is in progress. We now enter WEEK 3!
One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.
To Prepare
Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.
By Day 7 of Week 3
Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:
Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
Explain the stepwise approach to asthma treatment and management for your patient.
Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.
For this week’s PowerPoint slides, remember content over aesthetics.
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Solution

Scenario
As a nurse practitioner, you prescribe medications for your patients. You make an error when prescribing medication to a 5-year-old patient. Rather than dosing him appropriately, you prescribe a dose suitable for an adult.
To Prepare
Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
Review the scenario assigned by your Instructor for this Assignment.
Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.
By Day 7 of Week 1
Write a 2- to 3-page paper that addresses the following:
Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
Explain two strategies that you, as an advanced practice nurse, would use to guide your decision-making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
Explain the process of writing prescriptions, including strategies to minimize medication errors.
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Solution
Ethical and Legal Implications of Prescribing Drugs
Legal and ethical measures guide nurse practitioners during care delivery. Legal and ethical guidelines prevent medication errors, thus preventing adverse drug reactions to promote patient safety. This discussion presents an incident of a prescription error, including all stakeholders involved in ethical and legal implications, measures for addressing disclosure and nondisclosure based on Maryland law, strategies that guide an advanced practice nurse in making decisions, and the process for writing a prescription.
Ethical and Legal Implications associated with the Presented Case and involved Stakeholders
The provided case study involves medication errors that occurred during drug prescription. A dose suitable for an adult was prescribed to a 5-year-old patient. Thus, the presented scenario is attributed to some ethical and legal implications. The first ethical and legal implication applies to the nurse practitioner who, in this case, prescribed an adult dosage to a five years old boy, thus exposing him to an adverse drug reaction. Consequently, legal action should be taken against the prescriber. Secondly, ethical and legal implications apply to the pharmacist who provided the adult dosage to the five years old client. The pharmacist should have rectified the prescription error made by the prescriber rather than compounding it. For this reason, legal action should be taken against the pharmacist. Additionally, the pharmacist and the prescriber acted against the ethical principle of beneficence and nonmaleficence. Beneficence advocates for doing good to the patient while nonmaleficence prevents healthcare providers from exposing patients to any form of harm knowingly. Nonetheless, no ethical or legal implication applies to the patient and his family members. They only trusted the nurse practitioner for quality and safe care, but they did not reduce prescription errors.
Measures for Addressing Disclosure and Nondisclosure Based on Maryland Law
Every state in the United States has a set of regulations and policies that guide nurse practitioners during drug prescription to prevent prescription errors. Additionally, states have laws regulating the medication error disclosure process. Healthcare regulations aim at promoting the quality and safety of patient care (El-Jardali, & Fadlallah, 2017). Similarly, the state of Maryland has enacted laws and regulatory measures to guide nurse practitioners in the event of a medication error. In Maryland, medical professionals should adhere to health care standards approved in the health care system (ARFAA Law Group, 2017). Thus, the failure of the medical practitioners to comply with the set guidelines results in medical malpractice. Additionally, the health care provider is liable for patient harm caused by deviation from the established care standard. Maryland law also permits medication error victims to hold the healthcare practitioner accountable for the adverse drug reaction and should compensate for the caused harm (Lebowitz & Mzhen, 2021). Finally, the prescriber should report the error the relevant authorities as a requirement by Maryland law.
Strategies that Guide an Advanced Practice Nurse in Making Decision
The most effective strategy in this case is disclosure. The nurse should inform the patient about the harm and potential harm. Professional standards guide advanced nurse practitioners in making all clinical decisions. Nursing professional standards prioritize quality care for all patients (WHO, 2021). Thus, a nurse practitioner should make decisions to promote patient care quality to achieve a positive patient experience and health outcomes. Additionally, practitioners should be guided by morals, thus making morally right decisions. Moral decisions consider the outcomes of a particular action. Hence, nurses will consider actions that lead to better health outcomes (Bryant-Lukosius et al., 2017).
The process of writing a Prescription
Nurse practitioners should consider various factors when writing a prescription. First, they should consider patients’ demographics, particularly age, to ensure they are prescribed the right dosage based on their age. A practitioner should also consider a patient’s drug-related allergies to avoid prescribing drugs that cause allergic drug reactions. Additionally, the prescriber should consider other aspects, including medication name, medication indication, strength, medication frequency, dose, number of pills to dispense, refills number, prescriber name, contact information, license number, and the DEA number during prescription.
Medication errors are associated with legal and ethical implications that apply to the parties involved in the error. In this case, the prescriber and the pharmacist are responsible for the medication error. According to the state of Maryland law, the prescriber is liable for the error, and legal action should be taken against him or her by the patient’s family.
References
ARFAA Law Group. (2017). Medication Errors on the Rise in Maryland and Elsewhere. Baltimore Medical Malpractice Lawyer. https://www.baltimoremedicalmalpracticelawyer.net/medication-errors-rise-maryland-elsewhere/
Bryant-Lukosius, D., Valaitis, R., Martin-Misener, R., Donald, F., Peña, L. M., & Brousseau, L. (2017). Advanced practice nursing: a strategy for achieving universal health coverage and universal access to health. Revista latino-americana de enfermagem, 25.
El-Jardali, F., & Fadlallah, R. (2017). A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan. BMC health services research, 17(1), 1-13.
Lebowitz, M & Mzhen, A. (2021). Maryland Medication Error Lawsuits. https://www.pharmacyerrorinjurylawyer.com/maryland-medication-error-lawsuits/
World Health Organization (WHO). (2021). Delivering quality health services: A global imperative for universal health coverage. WHO. http://apps.who.int/iris/bitstream/handle/10665/272465/9789241513906-eng.pdf

Assignment 2: Practicum Experience Plan (PEP)
As you establish your goals and objectives for this course, you are committing to an organized plan that will frame your practicum experience in a clinical setting, including planned activities, assessment, and achievement of defined outcomes. In particular, your plan must address the categories of clinical reasoning, quality in your clinical specialty, and interpersonal collaborative practice.
For this Assignment, you will consider the areas you aim to focus on to gain practical experience as an advanced practice nurse. Then, you will develop a Practicum Experience Plan (PEP) containing the objectives you will fulfill in order to achieve your aims. In this practicum experience, when developing your goals and objectives, be sure to keep PMHNP clinical skills in mind.
To Prepare
Review your Clinical Skills Self-Assessment Form you submitted last week, and think about areas for which you would like to gain application-level experience and/or continued growth as an advanced practice nurse. How can your experiences in the practicum help you achieve these aims??There may be overlap between your skills goals and your PEP goals.
Review the information related to developing objectives provided in this week’s Learning Resources.?Your practicum?learning objectives that you want to achieve during your practicum experience must be:
Specific
Measurable
Attainable
Results-focused
Time-bound
Reflective of the higher-order domains of Bloom’s taxonomy (i.e., application level and above)
Discuss your professional aims and your proposed practicum objectives with your Preceptor to ascertain if the necessary resources are available at your practicum site.
Select one nursing theory and one counseling theory to best guide your clinical practice. Explain why you selected these theories. Support your approach with evidence-based literature.
Create a timeline of practicum activities that demonstrates how you plan to meet these goals and objectives based on your practicum requirements.
The Assignment
Record the required information in each area of the Practicum Experience Plan template, including three to four (3–4) measurable practicum Learning Objectives you will use to facilitate your learning during the practicum experience.
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Solution
Practicum Learning Objectives
Objective 1: develop at least 10 treatment plans based on screening results for psychiatric patients during the practicum experience.
Planned activities: screening patients collaboratively with the preceptor and other health care providers engaging at least one patient at a personal level weekly, active engagement in care management.
Mode of assessment: number of patients handled/screened weekly, number of new conditions per week, and number and length of collaborative sessions per week.
PRAC Course Outcome(s) Addressed: (3) – Apply advanced practice nursing assessment, diagnosis, and treatment skills in mental health settings.
Objective 2: To implement the use of different psychotherapeutic modalities in treating patients of various age groups during the practicum experience.
Planned activities: collaborating with the preceptor and other health care providers in implementing different psychotherapeutic modalities based on patients’ age groups.
Assess and record the variation of psychotherapeutic modalities according to patient needs and ages.
Mode of assessment: differentiated assessments including the type and numbers of psychotherapeutic modalities applied weekly, clinical work hours (weekly), number of patients attended to weekly.
PRAC Course Outcome(s) Addressed: (4) – Analyze cases involving advanced care of patients across the lifespan in mental health settings.
Objective 3: evaluate at least five treatment plans for patients weekly during the practicum experience.
Activities: collaborating with the preceptor and other health professionals in evaluating psychiatric treatments and weekly records of patients’ reaction to psychiatric treatments.
Mode of assessment: number of patients attended to weekly, number of conditions experienced weekly, number of hours spent with patients.
PRAC Course Outcome(s) Addressed: (4) – Analyze cases involving advanced care of patients across the lifespan in mental health settings.
Theories to Guide Clinical Practice
Nursing goals are vital in clinical practice to guide best practices and policies and ensure that patients receive the best care possible. Imogene King’s theory of goal attainment is a suitable nursing theory to best guide my clinical practice. Its central tenet is that the nurse and patient should communicate, set goals collaboratively, and take the necessary initiatives to achieve the set goals (Smith & Gullett, 2020). Nurses must also realize that many factors affect goal attainment, including space, time, and roles. Accordingly, initiatives applied to achieve the goals must consider possible barriers. I selected this theory since it recommends a collaborative approach to solving patient problems. Collaboration is pivotal in clinical practice as the basis for informed decision-making and quality care (Nibbelink & Brewer, 2018). It will be a critical component in facilitating achieving practicum and individual goals.
On counseling theories, the most suitable theory is behavioral theory. According to Garrett (2019), the behavioral theory is found on the premise that behavior is learned. As a result, the occurrence and outcomes of a behavior can be decreased. The same concept applies to psychiatric care. Mental health professionals should work collaboratively to change patients’ unwanted and destructive behaviors (Chauhan et al., 2017). For instance, which I look forward to learning more about during the practicum experience, positive behavior modification techniques can reinforce desired behaviors. Such an approach underlines the critical role of cognitive-behavioral therapy (CBT) and similar behavioral approaches in clinical settings.
Timeline of Practicum Activities
Objective Main Activities Timeline
1 i. Collaborative patient screening
ii. Patient engagement
Continuous activity
To develop at least 10 treatment plans by the last week.
2 i. Implementing psychotherapeutic modalities Complete by the end of the practicum experience.
3 ii. evaluating psychiatric treatments 5 treatments weekly
Conclusion
Nurses need an organized plan to frame their practicum experience in a clinical setting. This practicum experience plan describes my objectives, theories to guide the clinical practice, and the timeline of practicum activities. Under objectives, the primary urge is to gain more experience on treatment plans and psychotherapeutic modalities. Imogene King’s theory of goal attainment and behavioral theory will guide my clinical practice. The timeline is a projection of when specific activities should be completed.
References
Chauhan, B. F., Jeyaraman, M., Mann, A. S., Lys, J., Skidmore, B., Sibley, K. M., … & Zarychanksi, R. (2017). Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews. Implementation Science, 12(1), 1-16. doi: 10.1186/s13012-016-0538-8
Garrett, M. T. (2019). Psychotherapy for psychosis: Integrating cognitive-behavioral and psychodynamic treatment. The Guilford Press.
Nibbelink, C. W., & Brewer, B. B. (2018). Decision?making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5-6), 917-928. doi:10.1111/jocn.14151
Smith, M. C., & Gullett, D. L. (2020). Nursing theories and nursing practice. F.A. Davis Company.

Please use these points. self-leading, 2. leading an organization, 3.Leading others 4. leading as a vocation, Professional Development Plan Complexity of leadership has different definitions and different characteristics that describe leadership.
This paper will describe my development plan, which includes my self-reflection, vision, leadership goals and objectives, and a leadership plan
SELFL-EADERSHIP Continued professional development also involves keeping in check my social and emotional intelligence.
1. Self-reflection is a necessary tool to improve the way you function as a leader. How do you plan to practice methods of self-reflection that contribute to the development of how you lead?
2. Which characteristics of professional excellence do you currently have or want to have?
3. Emotional and social intelligence can be an area of significant personal growth.
4. How can you demonstrate flexibility and adaptability in response to changing or unknown circumstances?
Leading others
1. How do you plan to inspire followership through the utilization of leadership and motivation theories?
2.How will you analyze people’s strengths in order to leverage diversity to improve performance outcomes?
3. What strategies for effectively leading teams and fostering collaboration among various stakeholders will you apply?
4 What are some methods of coaching and providing guidance that help develop leadership qualities in others?
Leading organization
1. What are some guidelines to ensure you lead with moral obligation for the good of followers and the community? How do you intend to lead with kindness, compassion, and justice?
2. How do you intend to implement leadership as a service to others that promotes the common good and contributes to the benefits of communities and society at large?
Leadership as a vocation requires a commitment to professional excellence and integrity, which can be achieved through establishing habits of self-reflection, life-long learning, and professional development. The purpose of this assignment is for you to reflect on where you currently are in your leadership capabilities; define where you want to go; and specify goals, plans, and a timeframe for achieving your professional objectives. Your professional development plan will be composed of three parts: Vision, Goals/Objectives, and Plans.
Vision:
The ability to create, communicate, and compel vision is critical to inspiring and effective leadership. While ultimately many leaders are responsible for developing visions to guide complex organizations, effective leadership begins on a much more personal level—a vision of yourself as a leader. Who are you and who do you want to become in your field or sphere of influence? Once you are clear about that, you can then confidently establish how you will help others and your organization achieve their visions.
Your leadership vision is based on a number of factors including your attitude, values, personal beliefs, guiding principles, and how you behave. It may also be influenced by theoretical, philosophical, or religious frameworks and the leadership traits, values, and behaviors of others. A leadership vision is also dynamic. No great leader ever ”arrived.” Those who have adopted leadership as their vocation can spend a lifetime in self-reflection in order to continue to learn and more effectively motivate and inspire others.
Spend some time reflecting below on where you currently are in your leadership capabilities, what you have learned about leadership in the course, and how you want to develop and improve as you continue your leadership studies and move forward in your field. Review the document “Essential Leadership Competencies” for an overview of the scope of effective leadership capabilities.
Reflection
Vision:
Then, in 300-500 words, briefly articulate your vision for yourself as a leader 3-5 years from now. Where do you want to be? What kind of leader do you want to become?
Goals/Objectives:
After you have stated your vision, create five to eight leadership goals/objectives you will strive to meet in the next 3-5 years. Try to formulate at least one goal/objective related to the four major leadership competencies included in ”Essential Leadership Competencies”: self-leadership, leading others, leading an organization, and leadership as a vocation. Include a brief justification for each goal/objective to explain how it will help you achieve the qualities of professional excellence and integrity required of excellent leaders
Plan:
Specify activities you will engage in to achieve your goals/objectives. You may find it helpful to research professional development activities in your field or organization to determine what resources are available to you. Be specific about projects you will engage in either as student or as a professional and identify people in your life who can help you achieve your goals. Be sure to include a timeline of events.
Finally, include a method for evaluating your professional development plan at regular intervals. What milestones will you include in your plan to help ensure its success? How will you use methods of self-reflection to assess your progress as you move towards your goals?

PHN 652 Topic 7 DQ 2-Principles And Sources For Financial Management
DISCUSSION QUESTION INSTRUCTIONS
FOR THIS QUESTION-(The chosen population for this order is adolescents between the ages of 12 to 18) ( I have uploaded my edited version of order number 133867 for reference on the chosen population)
-Please DO NOT include anything about mental health.
-The question will be uploaded
– Sources must be published within the last 5 years. It must be from 2016 and after and appropriate for the paper criteria and public health content.
– Please do not use blogs as references
-References should be in APA 7th ed.
-Add references to reference page
-Add the hyperlink/DOI for each reference in APA 7th edition format.
Thank you
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Solution
Grants
For the chosen population, which mainly includes adolescents between 12 to 18 years who mainly suffer from substance and alcohol abuse, they are different grants that are available and would help support research for different programs. The three agencies that offer grants that fund substance abuse prevention treatment and recovery services include the office of national drug control policy, the department of human and health services, and the Department of Justice (Neema & Chandrashekar, 2021). The different grants provided by various government departments focus on different services, including targeted substance abuse prevention and also targeted treatment and recovery services. Through the department of health and human services, the National Institute on drug abuse provides grant funding for research on different issues related to illegal substance abuse. The federal government, through various departments, plays a significant role in providing grants to fund alcohol and substance abuse-deterrent among adolescents (Heyard & Hottenrott, 2021). The grant that would be most appropriate for use in adolescents between 12 to 18 years would be a grant provided by NIDA, which would help to enhance research on illicit substance abuse among adolescents. It is therefore important for all stakeholders to understand the trends related to illicit substance abuse among adolescents. It is therefore important for stakeholders to understand the trends related to illicit substance abuse among adolescents so as to effectively provide interventions for such challenges. (Heyard & Hottenrott, 2021).
The NIDA grant will help to support efforts to understand the causes of substance abuse behavior among adolescents and develop various strategies that can help to prevent the onset of substance abuse and illicit substance abuse among adolescents.
To secure NIDA funding for my program, I would need to apply through writing to NIDA and clearly highlight the objectives of my program and the expected results.
References
Heyard, R., & Hottenrott, H. (2021). The value of research funding for knowledge creation and dissemination: A study of SNSF Research Grants. Humanities and Social Sciences Communications, 8(1). https://doi.org/10.1057/s41599-021-00891-x
Neema, S., & Chandrashekar, L. (2021). Research funding—Why, when, and how? Indian Dermatology Online Journal, 12(1), 134. https://doi.org/10.4103/idoj.idoj_684_20

Chi-Square and Correlation- TOPIC 4 DQ 1
QUESTION- TOPIC 4 DQ 1-
Correlation is a common statistic to measure a general linear relationship between two variables. Explain why correlation does not equal causation.
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Solution
Explain Why Correlation Does Not Equal Causation
Causation and correlation are some of the most misunderstood and misused terms. In some instances, correlation and causation are used interchangeably. Understanding both terms is therefore important not only in making conclusions but also in making the correct conclusions. Correlation will therefore not equal causation. Correlation can therefore be defined as a statistical technique that indicates the linear relationship between a pair of variables and how a change in one will cause a change in the other (Rohrer, 2018). Correlation, therefore, does not indicate the reasons between relationships between a pair of variables but only indicates that the relationship exists (Joly, 2017). An example of correlation that is observed during summer is the sale of sunglasses being correlated with the sale of ice creams.
On the other hand, causation explains the relationship of variables. In causation, a change in one variable will therefore cause a change in another variable. In causation, a change in one variable is, therefore, the cause of the change in the associated variable (Rohrer, 2018). Causation is therefore referred to as cause and effect (Joly, 2017). An example of a causal relationship is when a person exercises to burn calories. The number of calories burnt increases every time a person exercises. Exercise is therefore causing the burning of calories.
The correlation of two variables will not mean that one causes the other. In this regard, correlation will not mean causality. In most instances, correlation will result from coincidences. When making observations, individuals are therefore more likely to observe correlations as they do not have detailed information. On the other hand, when detailed information is available, transparency will arise, enabling one to see actual causal relationships (Rohrer, 2018).
References
Joly, E. (2017). Baseball and jet lag: Correlation does not imply causation. Proceedings of the National Academy of Sciences, 114(16), E3168. https://doi.org/10.1073/pnas.1702637114
Rohrer, J. M. (2018). Thinking Clearly About Correlations and Causation: Graphical Causal Models for Observational Data. Advances in Methods and Practices in Psychological Science, 1(1), 27–42. https://doi.org/10.1177/2515245917745629

Frequency Distribution- Topic 2 DQ 1
QUESTION-Frequency distributions can be graphed with bar charts, histograms or polygons. Choose one variable from the “Health Behavior Data Set” and discuss which type of graph is appropriate and why. Refer to section 2.3 in the Using and Interpreting Statistics: A Practical Text for the Behavioral, Social, and Health Sciences textbook as needed for assistance.
Topic 2 DQ 1 – Classmate (Samantha) There are different types of graphs that shows frequency. It would depend on. The numbers that would indicate what graph needs to be used. Choosing which graph to use depends on whether the numbers are discrete or continuous. If the numbers are discrete, use a bar graph. If the data are continuous, use a histogram or a frequency polygon (Corty 2016). A variable from the Health Behavior Data set from our textbook is Sex. It’s labeled as a discrete variable because it’s more straight to the point than the other variables that would be considered continuous. An appropriate graph for the Sex variable would be a bar graph. Bar graphs are used to demonstrate the frequency with which the different values of discrete variables occur (Corty 2016). Another variable example with the perfect use of a bar graph could be the comparison of countries. It only takes certain values. An example for this variable and a bar graph could be comparing the number of people in teenage population (age 13-17) in each country. Its very specific and straight to the point. Bar graphs are important to help organize data. Its simple and important of seeing the comparison and variables (Ian 2010).
Resources
Corty, E. (2016). Using and interpreting statistics: A practical text for the behavioral, social, and health sciences. Worth Publishers/Macmillan Learning.
Ian. (2010, February 8). Difference between bar graph and histogram. Difference Between Similar Terms and Objects. Retrieved September 19, 2021, from http://www.differencebetween.net/science/difference-between-bar-graph-and-histogram/.
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Solution
Response
Thank you for this remarkable opportunity to participate in this discussion. I highly appreciate you taking your time to contribute as well. I will only add a few points to your post. Frequency distributions are represented using different forms of graphs. The data set most likely influences the suitable graph to represent a given sample in a study. That is, data patterns and variables are essential in determining the appropriate graph to visualize the study.
In addition to why the bar graph is the most suitable in this case, I would like to emphasize that it is easier to show and relate values in a discrete category and the frequency with bar graphs. The bar graphs are more flexible and can interpret variables in two or more data set in a class. Summarizing data as either descriptive or inferential statistics can help decide how to graph the information.
Variables explain a lot when it comes to using graphs (Ssekitoleko, 2018). The type of a variable determines the flow of the bar graph, which can be observed once the frequency data is recorded. Therefore, it is crucial to check the data set and variables before deciding on which graph to use. Understanding the foundation of each concept’s layout helps to plot the information of the sample in a correct and precise manner that is observable and interpretable.
In comparing the teenage population in various countries, a bar graph is an efficient communication tool that presents and transfers data and information (In & Lee, 2017). The values representing the teenagers against different countries are visual enough to help readers understand the content, engage their interest, internalize and feel confident to present bulky quantities of complex data (In & Lee,2017).
References
In, J., & Lee, S. (2017). Statistical data presentation. Korean journal of anesthesiology, 70(3), 267. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453888/
Ssekitoleko, R. (2018). Variables and Data presentation. https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1005&context=liberia_peer

WEEK 11, NURS 6521N, WALDEN, ASSIGNMENT, OFF-Label drug use in Pediatrics HV
Week 11: Pediatrics
Children, like adults, deal with variety of health issues, but they also have issues that are more prevalent within their population. One issue that significantly impacts children is the prescription of drugs for off-label use. As an advanced practice nurse, how do you determine the appropriate use of off-label drugs in pediatrics? Are there certain drugs that should be avoided with pediatric patients?
This week, you examine the practice of prescribing off-label drugs to children. You also explore strategies for making off-label drug use safer for children from infancy to adolescence, as it is essential that you are prepared to make drug-related decisions for pediatric patients in clinical settings.
Learning Objectives
Students will:
• Evaluate the practice of prescribing off-label drugs to children
• Analyze strategies to make the off-label use of drugs safer for children
• Identify key terms, concepts, and principles related to prescribing drugs to treat patient disorders
________________________________________
Learning Resources
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
• Chapter 8, “Drug Therapy in Pediatric Patients” (pp. 65—67)
Corny, J., Lebel, D., Bailey, B., & Bussieres, J. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives. The Journal of Pediatric Pharmacology and Therapeutics, 20(4), 316–328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557722/
This article highlights pediatric governmental initiatives to prevent unlicensed and off-label drug use in children. Review these initiatives and guidelines and how they might impact your practice as an advanced practice nurse.
Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423
Note: You will access this article from the Walden Library databases.
This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing. This study also examines off-label prescribing to children with ADHD.
Required Media (click to expand/reduce)
Laureate Education (Producer). (2019i). Therapy for pediatric clients with mood disorders [Interactive media file]. Baltimore, MD: Author.
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Assignment: Off-Label Drug Use in Pediatrics
The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.
When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.
Photo Credit: Getty Images
Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.
To Prepare
• Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
• Reflect on situations in which children should be prescribed drugs for off-label use.
• Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.
By Day 5 of Week 11
Write a 1-page narrative in APA format that addresses the following:
• Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
• Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.
Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Zoloft 25 mg orally daily
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• No change in depressive symptoms at all
Decision Point Two
Increase dose to 37.5 mg orally daily
RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Depressive symptoms decrease by 20%. Client reports feeling a little bit better
Decision Point Three
Maintain current dose
Guidance to Student
At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Paxil 10 mg orally daily
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea
Decision Point Two
Decrease dose for 7 days then return to previous 10 mg day dose
RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Nausea, vomiting, diarrhea subsides with dose reduction, but returns with reinitiation of 10 mg dose
Decision Point Three
Attempt to decrease dose for another 7 days then return to 10 mg dose
Guidance to Student
Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, you will need to select a different agent as these side effects are unfavorable to the client and may result in refusal to take treatment. Also, continuing to drop medication dose to subtherapeutic level will do minimal to treat depressive symptoms. Changing to a different SSRI would be the ideal choice as not all SSRIs have the same side effect profile in all clients. It would not be appropriate to increase the dose at this time as it would most likely result in increased intensity of side effects.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
BACKGROUND INFORMATION
The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.
• Client complained of feeling “sad”
• Mother reports that teacher said child is withdrawn from peers in class
• Mother notes decreased appetite and occasional periods of irritation
• Client reached all developmental landmarks at appropriate ages
• Physical exam unremarkable
• Laboratory studies WNL
• Child referred to psychiatry for evaluation
MENTAL STATUS EXAM
Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.
You administer the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression)
RESOURCES
§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services.
Decision Point One
Select what you should do:
Begin Zoloft 25 mg orally daily
Begin Paxil 10 mg orally daily
Begin Wellbutrin 75 mg orally BID
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Paxil 10 mg orally daily
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Reduction in The Children’s Depression Rating Scale by 5 points overall, but with complaints of nausea, vomiting, and diarrhea
Decision Point Two
Increase dose to 20 mg orally daily
RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Nausea, vomiting, and diarrhea has increased and client is refusing to take medication
Decision Point Three
Discontinue Paxil and begin Prozac 10 mg orally daily
Guidance to Student
Temporarily decreasing the drug for 7 days and then increasing is an acceptable option- however, if the side effects return with the reinitiation of the dose, you will need to select a different agent as these side effects are unfavorable to the client and may result in continued refusal to take treatment. Changing to a different SSRI may be appropriate if the trial decrease of dose is unsuccessful and if the nausea, vomiting, and diarrhea return with reinitiation of 20 mg orally daily. Changing the medication may be appropriate as not all SSRIs have the same side effect profile in all clients.
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
Decision Point One
Begin Wellbutrin 75 mg orally BID
RESULTS OF DECISION POINT ONE
• Client returns to clinic in four weeks
• Child is unable to fall asleep at night
Decision Point Two
Change from immediate release to extended release 150 mg orally daily in the morning
RESULTS OF DECISION POINT TWO
• Client returns to clinic in four weeks
• Child’s sleep patterns return to baseline. No change in depressive symptoms
Decision Point Three
Change to SSRI
Guidance to Student
You can continue drug therapy for another 4 weeks, however, it is discouraging that there have been no changes in depressive symptomatology. Increasing the dose to 300 mg orally daily may be appropriate if the child is tolerating the medication well. Changing to an SSRI may also be appropriate, but it may be more prudent to give the Wellbutrin at an appropriate dose for an adequate duration of therapy before switching therapeutic classes.
REFERENCE GIVEN IN THE SYUDENT PORTAL
Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423
-REFERENCE GIVEN IN THE STUDENT PORTAL
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• J Pediatr Pharmacol Ther
• v.20(4); Jul-Aug 2015
• PMC4557722
J Pediatr Pharmacol Ther. 2015 Jul-Aug; 20(4): 316–328.
doi: 10.5863/1551-6776-20.4.316
PMCID: PMC4557722
PMID: 26380572
Unlicensed and Off-Label Drug Use in Children Before and After Pediatric Governmental Initiatives
Jennifer Corny, PharmD, Candidate,1 Denis Lebel, BPharm, MSc,1 Benoit Bailey, MD, MSc,2 and Jean-François Bussières, BPharm, MSc, MBA 1,3
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This article has been cited by other articles in PMC.
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Abstract
OBJECTIVES: Governmental agencies (US Food and Drug Administration and European Medicines Agency) implemented initiatives to improve pediatric clinical research, starting in 1997 and 2007, respectively. The aim of this review was to quantify the unlicensed and off-label drug uses in children before and after these implementations.
METHODS: Literature review of unlicensed and off-label drug uses was performed on PubMed and Google-Scholar from 1985 to 2014. Relevant titles/abstracts were reviewed, and articles were included if evaluating unlicensed/off-label drug uses, with a clear description of health care setting and studied population. Included articles were divided into 3 groups: studies conducted in United States (before/after 2007), in Europe (before/after 2007), and in other countries.
RESULTS: Of the 48 articles reviewed, 27 were included. Before implementation of pediatric initiatives, global unlicensed drug use rate in Europe was found to be 0.2% to 36% for inpatients and 0.3% to 16.6% for outpatients. After implementation, it marginally decreased to 11.4% and 1.26% to 6.7%, respectively. Concerning off-label drug use rates, it was found to be 18% to 66% for inpatients and 10.5% to 37.5% for outpatients before the implementation. After implementation, it decreased marginally to 33.2% to 46.5% and to 3.3% to 13.5%, respectively. In other countries, unlicensed and off-label drug use rates were found to be, respectively, 8% to 27.3% and 11% to 47%.
CONCLUSIONS: Governmental initiatives to improve clinical research conducted in children seem to have had a marginal effect to decrease the unlicensed and off-label drug uses prevalence in Europe.
INDEX TERMS: off-label use, pediatrics, review
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INTRODUCTION
Before a drug can be approved for sale in a given market, governmental authorities in each country have to assess its safety, efficacy, and quality. At the end of this process, pharmaceutical companies are granted market authorization, and the drug gets a license for marketing in the country (e.g., Notice of Compliance in Canada). The drug also has a label (i.e. drug monograph), specifying the details for drug use (e.g., target population, dose, indication, specific use).
Virtually all drugs that get an approval for use in adults should also get an approval for use in children; this is often not the case considering the paucity of clinical research for that population. Therefore, drug monographs are frequently silent about the use of the drug in children. However, in most legislation, clinicians can prescribe to children a drug approved for adult (i.e., an off-label use). In some case, clinicians must also import from another country a drug that has not obtained a license for marketing (i.e., an unlicensed use). Both situations expose clinicians and patients to delays, costs, and risks. In response to these challenges, governmental authorities have established various strategies and regulations to oversee and promote clinical research in children and hopefully to decrease both unlicensed and off-label drug uses.
In 1997, the US Food and Drug Administration (FDA) adopted the FDA Modernization Act (FDAMA),1 followed in 2002 by the Best Pharmaceuticals for Children Act (BPCA),2 which provided an incentive for drug companies to conduct FDA-requested pediatric studies. In 2003, the FDA also created the Pediatric Research Equity Act (PREA), which requires drug companies to study their products in children under certain circumstances.3 In Europe, the European Medicines Agency (EMA) created the European (EU) Pediatric Regulation, in 2007.4 Its objective was to improve the health of children in Europe by facilitating the development and availability of medicines for that population. In other countries, such as in Canada, the Pediatric Expert Advisory Committee was created in 2009 to provide advice to Health-Canada in the development, licensing, and post-approval monitoring of drugs.5
Our hypothesis was that even though these initiatives were not implemented to decrease unlicensed or off-label drug use rates, they probably would have a favorable consequence on those uses. Ten years after the first regulations, we could expect that the prevalence of unlicensed and off-label prescriptions in children would have decreased. Thus, we reviewed the literature to explore the effect of the regulatory changes.
The primary objective of this literature review was to determine the effect of governmental initiatives to improve clinical research in children on unlicensed and off-label drug uses in inpatient and outpatient settings in the world. The secondary objective was to determine the unlicensed and off-label drug use rates in countries where no governmental initiatives to improve clinical research in children have been implemented.
Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423
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