Discussion Prompt

Post your answers to the 6 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations)

A 70-year-old woman is in your office complaining of recently having trouble maintaining her balance after taking diazepam (valium). She occasionally takes diazepam when she feels anxious and has trouble sleeping. She has a 15-year history of taking diazepam.

Q1. Explain the cause of this patient’s difficulty in maintaining her balance?

Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?

A 75-year-old woman develops symptoms of a cold and buys an over-the-counter cold medication at the grocery store. The medication contains diphenhydramine, acetaminophen, and phenylephrine. She takes the recommended adult dose but soon after taking the medication she becomes very confused and disoriented.

Q3. What is likely causing the signs of confusion?

A 26-year-old woman who has never been pregnant is seeking preconception care as she is planning to pursue pregnancy in a couple of months. Currently, she has no symptoms to report and on review of body systems, there were no concerns. Her past medical history is significant for a history of rheumatic fever as a child. She subsequently underwent valve replacement with a mechanical heart valve. She is followed by a cardiologist who has already evaluated her cardiac function and she has received clearance from her cardiologist to pursue pregnancy. Records from her cardiologist include a recent cardiac echocardiography report that reveals a normal ejection fraction indicating normal cardiac function.

She has no alterations in her daily activities related to her heart. She has no other significant medical or surgical history. She is a non-smoker, drinks occasionally but has stopped as she is attempting to conceive, and does not use any non-prescription drugs.

Current Medications: Her current medications include only prenatal vitamins, which she has begun in anticipation of pregnancy, and warfarin. She has no known drug allergies.

Vital Signs: On examination, her pulse is 80 beats per minute, blood pressure is 115/70 mm Hg, respiratory rate is 18 breaths per minute, and she is afebrile.

Measurements: Weight = 152 pounds, Height = 5′5 ″, BMI= 25.29

Q4. How is warfarin metabolized? Does warfarin cross the placental barrier?

Q5. Explain the hepatic drug metabolism of children 1 year and older. How do they compare with the hepatic drug metabolism of infants and adults?

Q6. Explain protein binding in the neonate.

PLEASE PROVIDE A HIGH LEVEL OF EXPLANATION FOR EACH QUESTION

 

Course Scenario

Chaparral Regional Hospital is a small, urban hospital of approximately 60 beds, and offers the following:

• Emergency room services
• Intensive care
• Surgical care
• Obstetrics
• Diagnostic services
• Some rehabilitation therapies
• Inpatient pharmacy services
• Geriatric services
• Consumer physician referral services

 

Recently, the CEO has been hearing complaints from both patients and staff, varying from long wait times to rude physicians. You have been hired to design and implement a Quality Improvement Plan to help uncover quality problems and to satisfactorily resolve them.

Instructions

The CEO has received some resistance from the Board on undertaking a QI program. She has asked you to develop a set of talking points on the pros and cons of common measurement techniques used in healthcare that she can use the next time she runs into a Board member. 

Talking points are used to quickly explain something by condensing it into a compelling, but easily digestible, list. If the goal is to increase support for a QI program, the talking points must provide the ideas she needs to convey in order to achieve the goal.

Your talking points should be submitted in a Word document. Your talking points should include the pros and cons of implementing a QI program.

Upon completion of your talking points, please prepare a PowerPoint presentation (or other shareable Webware/software you prefer) with narration where you will explain each talking point to the CEO so they clearly understand and can answer questions from the Board.

APA formatting for the talking points, and proper grammar, punctuation, and form are required.  

1. Length of PowerPoint is secondary to the quality of the presentation as a whole.
2. Highlight specific pros and cons of QI programs.
3. Use the Notes area on each slide as needed to expand on the key points.

 Your audio presentation should include an introduction, a concise discussion of each slide, and a conclusion. Make sure to use audience-specific language and tone in your PowerPoint. Remember, you would be presenting this to the CEO of your facility. The presentation will be assessed on your overall knowledge of the content, clarity of your voice, pronunciation of words, organization of your presentation, proper recording of your presentation, overall aesthetics and professionalism, and general clarity of your presentation. 

 SOAP note format

Clinical Case Presentations

Students must post one interesting case that he/she has seen in the clinical setting via Discussion Board in the online part of this course. The case should be an unusual diagnosis, or a complex case that required in-depth evaluation on the student’s part. The case should be posted in the SOAP format, with references for the patient diagnosis, differential diagnoses (there should be at least 3), and the treatment plan. Notes will be graded as “pass/fail”. In order to receive grade points for SOAP notes, the notes must be approved by the deadlines specified on the course assignments page. The student will lose the opportunity for points on any SOAP notes not approved by the specified deadlines. The posting does not have to be written in APA format, but should be written with correct spelling and grammar. References should be in APA format. The selected references should reflect current evidence – dated within the past 5 years. See rubric in the syllabus section  

Follow the Soap Note Rubric as a guide:

Use APA format and must include minimum of 2 Scholarly Citations.

Soap Note Rubric:

  

(Student Name)

Miami Regional University

Date of Encounter:

Preceptor/Clinical Site:

Clinical Instructor: 

Soap Note # 1     Main Diagnosis: Acute Myocardial Infarction

PATIENT INFORMATION

Name:

Age: 

Gender at Birth: 

Gender Identity: 

Source: 

Allergies: 

Current Medications: 

 

PMH: 

Immunizations: 

Preventive Care: 

Surgical History: 

Family History:

Social History: 

Sexual Orientation: 

Nutrition History: 

Subjective Data:

Chief Complaint: 

Symptom analysis/HPI:

The patient is … 

Review of Systems (ROS)

CONSTITUTIONAL: 

NEUROLOGIC: 

HEENT: 

RESPIRATORY: 

CARDIOVASCULAR: 

GASTROINTESTINAL: 

GENITOURINARY: 

MUSCULOSKELETAL: 

SKIN: 

Objective Data:

VITAL SIGNS: 

GENERAL APPEARANCE: 

NEUROLOGIC:

HEENT: 

CARDIOVASCULAR: 

RESPIRATORY: 

GASTROINTESTINAL: 

MUSKULOSKELETAL:

INTEGUMENTARY: 

ASSESSMENT:

Main Diagnosis

(Include the name of your Main Diagnosis along with its ICD10 I10. (Look at PDF example provided) Include the in-text reference/s as per APA style 6th or 7th Edition. 

Differential diagnosis (minimum 3)

–

–

–

PLAN:

Labs and Diagnostic Test to be ordered (if applicable)

· – 

· – 

Pharmacological treatment: 

–

Non-Pharmacologic treatment: 

Education (provide the most relevant ones tailored to your patient)

Follow-ups/Referrals

References (in APA Style)

Examples 

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). 

ISBN 978-0-8261-3424-0

Domino, F., Baldor, R., Golding, J., Stephens, M. (2010). The 5-Minute Clinical Consult 2010

(25th ed.). Print (The 5-Minute Consult Series).

I attached one example:

Please no plagiarism!!!

 I am going to ask the class to share various articles on research (topics include: quantitative research, qualitative research, literature review, experimental research design). Please upload it to the discussion board (There are no formal discussions noted for this week – Just upload an article on the topics mention to share with your class). Just let us know what the article is about. This will help your colleagues gain an understanding of our process as we go into Phase One of our research course.