WOMEN’S AND MEN’S HEALTH, INFECTIOUS DISEASE, AND HEMATOLOGIC DISORDERS

As an advanced practice nurse, you will likely experience patient encounters with complex
comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying
pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you
recommend for ensuring positive patient health outcomes?

For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.

RESOURCES

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

WEEK 9 RESOURCES (httpsiwaldenu.instructure.com/courses/79007/modules/items/2443890)

WEEK 10 RESOURCES (httpsiwaldenuinstructure.com/courses/79007/modules/items/2443931)

 

To Prepare:

 

• Review the Resources for this module and reflect on the different health needs and body systems presented.
• Your Instructor will assign you a complex case study to focus on for this Discussion.
• Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient
  health needs in the patient case study you selected.

BY DAY 3 OF WEEK 9

 

Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of

treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

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

 

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

 

BY DAY 6 OF WEEK 10

Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s

 

CASE STUDY 1

 

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

Ht: 5’8″ Wt: 89 kg

 

Allergies: Penicillin {rash)

 

BE SURE TO REVIEW & DISCUSS THE C&S

 

On admission Dav 3 Vitals Temp (F) l02.7 100.9 BP 138n2 I 36n0 HR 124 88 RR 34 20 02 Saturation 90% (4L 02) 92% (room air) Na (mEq/L) 144 140 K (mEq/L) 4.6 4.3 CI (mEq/L) 103 105 HC03 (mEa/L) 34 30 BUN (mg/dL) 30 18 Cr (m!!/dL) 1.2 1.1 Glucose (mg/dL) 180 143 WBC (x 103 cells/mm 3) 18.2 14.6 Neu t 86% 83% Bands 10% 8% Lymph 4% 6% Mono 0% 1% Eos 0% 1% Baso 0% 1%

Results

Urine Legionella  antigen: Non-reactive

Urine Pneurnococc al antigen: Non-reactive

CXR: Right lower lobe infiltrate

Blood cultures (2 sets): No growth to date x days

Bronchial alveolar lavage (BAL) culture:

Gram-positive cocci in pairs, 34 WBCs, 3 epithelial cell

Heavy growth Strept ococcus pneumoniae

Antibiotic       MIC        Interpretation

Penicillin           I            Susceptible

Ceftriaxone           0.25         Susceptible

Yancomycin        0.125   Susceptible

Erythromycin       >16              Resistant

Levofloxacin       s 0.5     Susceptible

Tetracycline          > 16         Resistant

 

CASE STUDY 2

A 46-year-old, 2301b 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. She has regular monthly menstrual cycles. Her LMP was 1 month ago.

Ht: 5’4″

 

BP 150/90