Discussion: Pharmacotherapy for Cardiovascular Disorders

As the leading cause of death in the United States for both men and women, cardiovascular disorders account for 7 million hospitalizations per year (NCSL, 2012). This is the result of the extensive treatment and care that is often required for patients with these disorders. While the incidences of hospitalizations and death are still high, the mortality rate of cardiovascular disorders has been declining since the 1960s (CDC, 2011). Improved treatment options have contributed to this decline, as well as more knowledge on patient risk factors. As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Consider the following case studies:

Case Study 1:

Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

· Atenolol 12.5 mg daily

· Doxazosin 8 mg daily

· Hydralazine 10 mg qid

· Sertraline 25 mg daily

· Simvastatin 80 mg daily

Case Study 2:

Patient HM has a history of atrial fibrillation and a transient ischemic attack (TIA). The patient has been diagnosed with type 2 diabetes, hypertension, hyperlipidemia and ischemic heart disease. Drugs currently prescribed include the following:

· Warfarin 5 mg daily MWF and 2.5 mg daily T, TH, Sat, Sun

· Aspirin 81 mg daily

· Metformin 1000 mg po bid

· Glyburide 10 mg bid

· Atenolol 100 mg po daily

· Motrin 200 mg 1–3 tablets every 6 hours as needed for pain

Case Study 3:

Patient CB has a history of strokes. The patient has been diagnosed with type 2 diabetes, hypertension, and hyperlipidemia. Drugs currently prescribed include the following: 

· Glipizide 10 mg po daily

· HCTZ 25 mg daily

· Atenolol 25 mg po daily

· Hydralazine 25 mg qid

· Simvastatin 80 mg daily

· Verapamil 180 mg CD daily

To prepare:

· Review this week’s media presentation on hypertension and hyperlipidemia, as well as Chapters 19 and 20 of the Arcangelo and Peterson text.

· Select one of the three case studies, as well as one the following factors: genetics, gender, ethnicity, age, or behavior factors.

· Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.

· Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.

· Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

With these thoughts in mind:

Post an explanation of how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you selected. Then, describe how changes in the processes might impact the patient’s recommended drug therapy. Finally, explain how you might improve the patient’s drug therapy plan.

Link to Media:

https://class.waldenu.edu/bbcswebdav/institution/USW1/201930_27/MS_NURS/NURS_6521/adobePresenter/Week03/media2/index.htm

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Urinary Tract Infection

1. Urinalysis is necessary to verify the infection and presence of positive urine culture (Choe et al., 2017). It is particularly important to keep track of leukocytes and nitrites when utilizing a urine test strip (Ebell, Butler, & Hay, 2018). It may also be necessary to utilize ultrasound (RBUS) to detect genitourinary anomalies if it is established that the patient suffers from febrile UTI.

2. An UTI is most likely to be caused by bacteria and available evidence indicates that conditions like acute pyelonephritis are primarily caused by E. coli in close to eighty percent of the cases (Choe et al., 2017).

3. It could be appropriate to prescribe Cephalexin 10 mg/kg/d or Cefaclor 10 mg/kg/d (Choe et al., 2017). On the other hand, such factors as the expected pathogen should be taken into account when selecting an appropriate antibiotic agent. Additionally, the duration of the therapy should be between seven and fourteen days depending on the situation. Therefore, additional information is necessary to determine appropriate pharmacological treatment for the patient.

4. It is imperative to ensure that the patient and her mother have an understanding of safe dosing and follow the recommendations. Additionally, a healthcare professional should explain the need to follow the regimen and explain the risks that could be faced by the patient if recommendations are ignored. It is also necessary to explain the benefits of preventing UTI and the risks associated with possible antimicrobial resistance in the future. Available evidence indicates that cranberry and associated products have the potential to prevent UTI in children, and it would be appropriate to advise the patient to consume such products to avoid infections in the future (Choe et al., 2017). The patient should also be advised to drink plenty of water to dilute urine and reduce the risks related to UTI in the long-term.

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References

Choe, H., Lee, S., Yang, S. S., Hamasuna, R., Yamamoto, S., Cho, Y., & Matsumoto, T. (2017). Summary of the UAA-AAUS guidelines for urinary tract infections. International Journal of Urology, 25(3), 175–185. doi:10.1111/iju.13493

Ebell, M. H., Butler, C. C., & Hay, A. D. (2018). Diagnosis of urinary tract infections in children. American Family Physician, 97(4), 273-274. 

Case

Sometimes It Works, Sometimes It Doesn’t

Jim Beaufort was appointed as the administrator of Marshall Nursing Center, a 230-bed skilled nursing facility located in a large metropolitan area. The facility’s occupancy rate had gradually declined from 82% (188 residents) a year ago to 74% (170 residents). Three months ago when Jim was hired for the job, the company’s vice president of operations, Ronald Ortner, was upfront about the declining census. Ortner was particularly impressed with Jim’s business degree in marketing, and how Jim had enthusiastically talked about using a “mystery shopper”* to get information on the competitors of a nursing home he had previously managed. Jim knew that his work was cut out for him. When offering the job, Ortner had said, “I am giving you a 20% raise over what you were making at your old job; I want this facility turned around in a year’s time.” To that Jim had confidently responded, “Oh, you will see a trend change much before that.”

Jim spent the first 3 months on the job getting to know the staff, residents, and some of the family members. He made written notes on some of his observations:

• The certification survey 6 months ago was satisfactory. There were no serious deficiencies.
• Some issues with building cleanliness have been addressed with the housekeeping supervisor.
• Department head meetings had been sparse and irregular.
• Food was the most common complaint from residents and family members, but so it is at every other facility.
• The licensed nursing staff is stable, but high turnover of certified nursing assistants creates some staffing shortages. Overtime is high, and the director of nursing says that there is some burnout among both nurses and CNAs.
• The facility’s expenses are below budget; the previous administrator must have been a “penny pincher.”
• Patients are scattered throughout the building. Many of them are occupying private rooms, whereas Medicaid pays only for semiprivate accommodations.

Jim thinks that he has just 9 months left to increase the census and keep his job. So, he embarks on formulating a marketing plan:

• Free up as many patient rooms as possible in one section of the building by moving patients to other occupied parts of the facility. Start an adult day care center by using some of the empty rooms.
• Hire one additional RN and one LPN to alleviate the feelings of burnout among the staff. Start a CNA training program at the facility.
• Send a mystery shopper to the three main competitors to evaluate how they handle the inquiry process. Have the mystery shopper evaluate Marshall’s inquiry process as well. Improve the admission coordinator’s personal selling skills.
• Purchase advertising at the local newspaper, radio station, and TV station that would say:

Marshall Nursing Center has excelled in providing high-quality nursing and rehabilitation care in this community for more than 20 years. Our staff’s caring is like a healing touch. We are accepting new patients. Bring your loved one here and see the results for yourself.

“That will get people’s attention,” Jim thought to himself.

• Discard the black and white brochures and replace them with a four-color brochure with some pictures and the same message used in advertising. Place these brochures in hospital waiting rooms and doctors’ clinics.
• Invite the hospital’s discharge planners to dinner at a fine restaurant. Explain to them the facility’s new marketing plan and ask for their help in referring patients.
• While the marketing plan is being implemented, Jim will personally handle all preadmission inquiries, using the admission’s coordinator for backup.

Jim was confident that in another 6 months the facility’s census would start turning around, but it only deteriorated further. Frustrated, he starts looking for another job. Sitting in his office, he moans, “Marketing is just a theory: sometimes it works, sometimes it doesn’t.”

* A mystery shopper, also referred to as a “secret shopper,” is a marketing professional who specializes in visiting and evaluating business practices, posing as a potential client.

Questions

1.  How should Jim have handled his job interview with regard to the declining census?

2.  Do you agree with Jim’s statement: Marketing is just a theory: sometimes it works, sometimes it doesn’t? Explain why marketing may not work.

3.  Evaluate Jim’s marketing plan. What main improvements would you make?

4.  Critically evaluate the promotional message.

 

Assignment: Both parts below into one APA paper

Part 1: Continuing Education (Part 1 should be at least 750 words and include 2 outside references plus the textbook.)

Continuing education units are required for renewal of license (in some states) and for recertification. Continuing education opens doors to job opportunities. Answer the questions:

• Why is advancing your degree and knowledge important for nursing as a profession? Explain and give several reasons.
• How would you respond to a nurse that states: “I only want to live and work in a state that does not require continue education credits and I never want to advance my degree?” Explain in detail what you would say and why.

Part 2: Future of Nursing (Part 2 should be at least 1000 words and include 2 outside references and the textbook.)

Review the author’s vision in the textbook (Chapter 25), of the future of nursing and complete your own research to include the Institute of Medicine’s (IOM) report. 

• Do you agree with the authors or do you have a different vision of nursing? Explain and provide examples as to why you do agree or do not agree.

PLEASE PAY ATTENTION TO THE CASE STUDY and CHAPTERS ATTACHED

PLEASE FOLLOW THE PROMPTS OF THE WAY THE QUESTIONS WERE ASKED.

ZERO PLAGIARISM

FIVE REFERENCES

 

The Assignment

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

• Decision #1
  • 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
  • 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
  • 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.