Peer reply pharmacy DB5

1 -triana

DERMATOLOGY CASE STUDY

 Chief complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief.  She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin  AF cream and it did not help relief her symptoms. She has not tried other remedies.

Denies associated symptoms of fever and chills. 

 1.According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? Write her complete prescriptions using the prescription writing format in your textbook.

 Onychomycosis is a fungal infection of the nail, either fingernail or toenail. The common dermatophyte that is found in onychomycosis is tinea unguium , with candida infections also a cause . Effective treatment usually involves months of systemic antifungal medication, commonly griseofulvin, ketoconazole ,itraconazole or terbinafine. Topical treatment is usually not effective except for ciclopirox nail lacquer (Woo & Robinson, 2016).

 

Terbinafine 250mg 1 tab PO daily x 12 weeks 

 Terbinafine 250mg take one tablet by mouth daily for 12 weeks 

 2.  What labs for baseline and follow up of therapy would you order for this patient?

Liver enzymes and complete blood count should be monitor every 6 weeks if treatment last longer than 6 weeks. 

 Terbinafine is an orally and topically active allylamine fungicidal agent which is used to treat superficial fungal infections of the skin and nails.  Terbinafine has been clearly linked to rare instances of acute liver injury that can be severe and sometimes fatal.

Drug induced liver injury due to terbinafine was identified shortly after its introduction into medical use.  Oral therapy with terbinafine is associated with elevations in serum aminotransferases in less than 1% of patients and the elevations are generally asymptomatic and resolve without stopping therapy.  The estimated probability of developing elevated serum aminotransferase levels requiring stopping treatment is about 0.31% for 2 to 6 weeks’ treatment and 0.44% for treatment longer than 8 weeks (“Terbinafine”, 2019).

 

Reference 

Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advance practice nurse prescribers. Philadelphia: F.A. Davis Company.

 Terbinafine. (2019, July 1). Retrieved September 30, 2019, from https://livertox.nlm.nih.gov/terbinafine.htm.

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2- Rivera

 

 

 

Part 2: Labs 

            Because Terbinafine is metabolized by the liver, will be important to perform hepatic function testing for the patient due to the risk of liver enzyme elevation, and establish a baseline. Liver enzymes and complete blood count should be done every 6 weeks, during treatment (Woo and Robinson, 2016).  

 

References

Woo, T. & Robinson, M., V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers. Philadelphia, PA: F. A. Davis company.

 

Follow up 

Specify when to refer the patient after therapy and why? Provide rationale.

According to the recommended guidelines, what are the non-pharmacological approaches to Onychomycosis? Provide patient education. Keep in mind the past medical history of this patient.

Patient should be referring to Podiatrist for follow up. Foot care is essential for the diabetic patient, and should definitely follow up with podiatrist for further treatment.  

Patient will also be referred to endocrinologist for follow up due to her history of diabetes mellitus type 2. There is no documentation that diabetes is being treated. Patient is obese which may indicate she is not following an appropriate diet.  A referral will also be given to a dietician due to obesity (BMI: 31). 

According to Woo and Robinson Vicks VapoRub is commonly used for onychomycosis. A pilot study was conducted by Derby, Rohal, Jackson, Beutler, and Olsen (2011), to test Vicks VapoRub as a non-pharmacological approach to treat onychomycosis. The study included 18 participants and 83% had a positive response to this treatment after a course of 48 weeks. This study was done with a small sample; however Vicks VapoRub still showed to be a safe and cost-effective non-pharmacological treatment of onychomycosis (Derby, Rohal, Jackson, Beutler, and Olsen, 2011). 

Patient was educated on importance of an adequate diet that includes appropriate daily servings of fruits and vegetables, food low in saturated fat and low cholesterol. Patient was encouraged to continue being active, getting at least 30 minutes of regular physical activity.  Also encouraged to start taking Omega 3 fatty acids to help increase her HDL which is low (38mg/dl) and this is considered a risk factor for heart disease. 

References

Derby, R., Rohal, P., Jackson, C., Beutler, A. & Olsen, C. (2011). Novel treatment of 

onychomycosis using over the counter mentholated ointment: A clinical case series. 

Journal of the american board of family medicine (24)1 69-74. 

doi: 10.3122/jabfm.2011.01.100124

Woo, T. & Robinson, M., V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers. Philadelphia, PA: F. A. Davis company.

 

1. Professional socialization relates to the manner in which we learn the roles and functions of being a nurse once we enter the healthcare system. What are some of the ways this socialization occurs in your place of employment, and do you believe it leads to effective assumption of the nursing role? This socialization occurs in a patriarchal healthcare system that still remains predominantly male physician-based. Discuss the impact, you believe, this has on socialization to the nursing role.
2. Identify an area of practice where change theory may find applicability. Provide examples to support your answer. Comment on the inherent weaknesses in change theory that may impact real life situations or give rise to difficulties in the process of applying this theory.

• View article, Developing Program Goals and Measurable Objectives. 
• https://ctb.ku.edu/en/table-of-contents/structure/strategic-planning/vmosa/main

1. List my mission and vision statement. Which is;

• Vision Statement Our vision is to improve the health of every child in the community for a better future.
• Mission Statement Our mission is to enhance the health conditions of special needs children through providing the best medical care, safe, affordable high-quality child care to where children are encouraged to grow at their own pace and which will benefit the child, the parent, the staff and the community.
• 2. Create at least two project objectives that have a measurable component. Example of a program objective: “Successfully launch 3 new products in the next 2 years.”
• 3. Create a timeline for each project objective. Include the month and year of completion for each item. Example, “By December…” or “In the 2018 Fiscal year…
• 4. Create at least one program strategy statement to accompany each project objective that you create. Think: How will the project reach its objective?
• 5. In each statement, include specific details about who will complete each objective and how. Example of a program strategy statement: “Marketing and research will launch one new product each six month for trial”. You may choose to even get more in depth with specific names of your personnel if you know those details.
• Include References 

Module 1 – SLP

INTRODUCTION TO THE U.S. HEALTH CARE DELIVERY SYSTEM 

The overall goal of the Session Long Project is to examine health care delivery in the United States from a strategic perspective.

The Patient Protection and Affordable Care Act, or in short Affordable Care Act, changed the landscape of the health care industry. For this assignment, read the article “Information asymmetries and risk management in healthcare markets: The U.S. Affordable Care Act (ACA) in retrospect” by Mendoza, and write a paper to respond to the following questions:

1. Discuss the “moral theory” contained in this article.
2. Explain whether you agree or disagree with the author that the ACA was an answer to health care accessibility.
3. Explain whether you believe or do not believe that ACA will improve patient care.
4. Discuss what you think President Trump should do with the ACA.
5. Discuss what strategies you would recommend to deal with economic realities of health care based on your own research.

Length: Submit a 3-page paper, not including the cover page and the reference list.

SLP Assignment Expectations

Assessment and Grading: Your paper will be assessed based on the performance assessment rubric. You can view it under Assessments at the top of the page. Review it before you begin working on the assignment. Your work should also follow these Assignment Expectations.

Please complete ALL THREE of the Professional Development exercises.

1. Some institutions that require students to develop e-portfolios as a part of their program of study also may use this evidence of student learning to evaluate the program quality or generate evidence for accreditation reports. What do you think should be the driving purpose behind requiring electronic portfolios – professional development planning or institutional evaluation? What are the merits of each approach?
    
2. Conduct a literature search for a scholarly article about e-Portfolios and how they are used in nursing. Summarize the findings, and discuss how this may be applicable within your nursing practice.
    
3. Investigate a healthcare informatics technology trend
    
   • Use both Internet sites and library resources to describe the trend.
   • Cover both hardware and software requirements.
   • Discuss considerations for implementing the trend.
   • Discuss how the technology trend will impact nursing knowledge and/or practice.  

Please submit one APA formatted paper 1000 words, not including the title and reference page. Each assignment should have a minimum of two scholarly sources, in addition to the textbook.

McGonigle, D. & Mastrian, K. (2017) Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett