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.

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Week 1: Basic Pharmacotherapeutic Concepts/Ethical and Legal Aspects of Prescribing

How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?

Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.

This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.

Learning Objectives

Students will:

• Analyze factors that influence pharmacokinetic and pharmacodynamic      processes in patients
• Assess patient factors and history to develop personalized plans of      care
• Evaluate ethical and legal implications related to prescribing      drugs
• Analyze ethical and legal practices of prescribing drugs
• Analyze strategies to address disclosure and nondisclosure
• Justify advanced practice nurse strategies to guide prescription      drug decision-making
• Analyze the process of writing prescriptions to avoid medication      errors

  

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

· Chapter 1, “Prescriptive Authority” (pp. 1–3)

· Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 4–7)

· Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 8–12)

· Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 13–33)

· Chapter 5, “Adverse Drug Reactions and Medication Errors” (pp. 34–42)

· Chapter 6, “Individual Variation in Drug Response” (pp. 43–45)

American Geriatrics Society 2019 Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. doi:10.1111/jgs.15767

American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults by American Geriatrics Society, in Journal of the American Geriatrics Society, Vol. 67/Issue 4. Copyright 2019 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright Clearance Center.

This article is an update to the Beers Criteria, which includes lists of potentially inappropriate medications to be avoided in older adults as well as newly added criteria that lists select drugs that should be avoided or have their dose adjusted based on the individual’s kidney function and select drug-drug interactions documented to be associated with harms in older adults.

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

This website outlines the code of federal regulations for prescription drugs.

Drug Enforcement Administration. (n.d.-b). Mid-level practitioners authorization by state. Retrieved May 13, 2019 from http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

Drug Enforcement Administration. (2006). Practitioner’s manual. Retrieved from http://www.legalsideofpain.com/uploads/pract_manual090506.pdf
This manual is a resource for practitioners who prescribe, dispense, and administer controlled substances. It provides information on general requirements, security issues, recordkeeping, prescription requirements, and addiction treatment programs.

Drug Enforcement Administration. (n.d.-c). Registration. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/drugreg/index.html

This website details key aspects of drug registration.

Fowler, M. D. M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application (2nd ed.). Silver Spring, Maryland: American Nurses Association.

This resource introduces the code of ethics for nurses and highlights critical aspects for ethical guideline development, interpretation, and application in practice.

Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. Retrieved from https://www.ismp.org/recommendations/error-prone-abbreviations-list

This website provides a list of prescription-writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

This article provides NPs with information regarding state-based laws for NP prescribing.

Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist‐led educational intervention for nurse practitioner students. Journal of the American Association ofNursePractitioners, 29(5), 248–254. doi:10.1002/2327-6924.12446

The authors of this article assess the impact of a pharmacist‐led educational intervention on family nurse practitioner (FNP) students’ prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator.

Required Media (click to expand/reduce)

  

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

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When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

• Review the Resources for this module and consider the principles of      pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical      practices from the last 5 years and think about how pharmacokinetic and      pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s      pharmacokinetic and pharmacodynamic processes, such as genetics (including      pharmacogenetics), gender, ethnicity, age, behavior, and/or possible      pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing      factors and patient history in your case study.

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

At Least 3 citations with 7th edition APA Format

  

Assignment: Ethical and Legal Implications of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient.  

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As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

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

Write a 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 

At Least 3 citations using 7th edition APA format

  

3.1 Case Study—Several Different Styles Vanessa Mills was recently hired to work at a branch of Lakeshore Bank as a personal banker. The branch is very busy and has a large staff, including three on-site managers. As a new employee, Vanessa is trying to figure out how to succeed as a personal banker while meeting the expectations of her three very different managers. Vanessa is paid a salary, but also receives a commission for activities including opening new accounts and selling new services to customers such as credit cards, lines of credit, loans, and stock accounts. Personal bankers are expected to open a certain number of accounts each month and build relationships with customers by exploring their various banking needs and offering services to meet those needs. Marion Woods is one of the managers at Vanessa’s branch. She has worked for Lakeshore Bank for 10 years and prides herself on the success of the branch. Marion openly talks about employees’ progress in terms of the number of accounts opened or relationships established, and then commends or scolds people depending on their productivity. Marion stresses to Vanessa the importance of following procedures and using the scripts that Marion provides to successfully convince customers to open new accounts or accept new services with the bank. As a new banker, Vanessa has not opened many accounts and feels very uncertain about her competence. She is intimidated by Marion, believing that this manager is continually watching and evaluating her. Several times Marion has publically criticized Vanessa, commenting on her shortcomings as a personal banker. Vanessa tries hard to get her sales numbers up so she can keep Marion off her back. Bruce Dexter, another manager at Vanessa’s branch, has been with Lakeshore Bank for 14 years. Bruce started out as a teller and worked his way up to branch manager. As a manager, Bruce is responsible for holding the bank staff’s Monday morning meetings. At these staff meetings, Bruce relays the current numbers for new accounts as well as the target number for new accounts. He also lists the number of new relationships the personal bankers have established. After the meetings, Bruce retreats back into his office where he sits hidden behind his computer monitor. He rarely interacts with others. Vanessa likes when Bruce retreats into his office because she does not have to worry about having her performance scrutinized. However, sometimes when Vanessa is trying to help customers with a problem that falls outside of her banking knowledge, she is stressed because Bruce does not provide her with any managerial support. The third manager at the branch is Heather Atwood. Heather just started at Lakeshore Bank within the last year, but worked for nine years at another bank. Vanessa finds Heather to be very helpful. She often pops in when Vanessa is with a customer to introduce herself and make sure everything is going well. Heather also allows Vanessa to listen in when she calls disgruntled customers or customers with complicated requests, so Vanessa can learn how to manage these types of interactions. Heather trusts her staff and enjoys seeing them grow, encouraging them by organizing games to see who can open the most accounts and offering helpful feedback when customer interactions do not go as planned. Vanessa is grateful for the advice and support she receives from Heather, and looks up to her because she is competent and kind. Vanessa is coming up on her three-month review and is very nervous that she might get fired based on her low sales record and the negative feedback she has received from Bruce and Marion regarding her performance. Vanessa decides to talk to Heather about her upcoming review and what to expect. Heather assures Vanessa that she is doing fine and shows promise even if her numbers have not reached that of a seasoned banker. Still, Vanessa is concerned about Bruce and Marion. She has hardly had more than two conversations with Bruce and feels intimidated by Marion who, she perceives, manages by running around barking numbers at people. 

Questions 

Based on the assumptions of Theory X and Theory Y, how would you describe each manager’s philosophy and style of leadership? In what way do the managers’ attitudes about Vanessa affect their leadership? 

In this type of customer service setting, which leadership style would be most effective for the bank to meet its goals? 

From the bank’s perspective, which (if any) manager exhibits the most appropriate leadership? 

Discuss. What advice would you give to each of the managers to enhance his or her leadership skills within the bank? 

What do you think Vanessa can do to prepare herself for her three-month review?

3.2 Case Study—Leading the Robotics Team Anders Dahlgren is the mentor for a high school robotics team that has spent the past three months designing, building, and programming a robot for competition. The team is composed of 14 boys and one girl, and the students range from freshmen to seniors. With the first competition in three weeks, Anders needs to designate a team captain so the team can get used to working under a new leader. During the competition, the team captain is often called on to make crucial team decisions. The robotics team is divided into groups: Mechanical, whose members design and build the robot, and Programming, whose members develop the computer code that tells the robot how to complete its tasks. During competition, the team captain will have to work with both groups to tweak the robot’s design and programming on the fly to improve the robot’s performance. It can be a high-pressure job for any teenager, and with emotions and stress levels of other team members running on high, the captain will not only need an understanding of both the mechanical and programming aspects, but must also be able to keep 14 other personalities and egos working toward a common goal. There are three members of the robotics team that Anders is considering for captain: • Pria is a junior and the only girl on the team. This is her second year on the team, and she is in the Programming group. Anders describes her as being very serious and a whiz at coding, and she has offered some great design ideas. Pria is very organized—after the team’s first meeting of the year, she developed a schedule with tasks and deadlines and wrote it on the large whiteboard in the workshop so team members could follow it. Pria doesn’t have a lot of patience with teenage boy shenanigans and will admonish her group members to “focus, please” whenever she thinks they’ve gotten off task, such as when they start talking about YouTube videos or music. Pria is very rule-bound and will point out when team members try to cut corners or haven’t adequately followed instructions or the schedule. Anders has noticed that when the other programming group members have a problem or obstacle, they defer to Pria for a solution. He suspects it’s partly because they respect her opinion and partly because they know she’ll tell them how to fix it regardless. Once, though, when Pria was home sick, Anders overheard several of the boys from both groups call Pria “bossy” and say she “stressed them out” with her deadlines and rigidity. • Justin, a senior, is also in his second year on the team. An upbeat, congenial kid, Justin is a member of the Mechanical group. He isn’t much for planning, however; he has a tendency to pick up a power tool and use it before he has actually thought out what he is going to do with it. The other Mechanical group members call him “MacGyver” because he is great working with his hands and often comes up with fixes to mechanical problems by just fiddling around with different pieces and parts for an hour or so. The group members are also pretty forgiving when Justin makes a mistake because his sense of humor keeps them all laughing and he always finds a way to fix it. Anders notices that the Mechanical group is the most creative when Justin is at the helm, but that work sessions can devolve into chaos pretty quickly if Anders doesn’t step in and set parameters and establish goals. • Jerome, also a member of the Mechanical group, is quiet, respectful, and polite. He is a senior and has been on the robotics team since his freshman year. He is a veteran of robotics competitions, and what he has learned over the years has informed a lot of the team’s efforts this year. He is most happy working on the computer-aided designs for the robot and helping those building it to understand and follow the plans and schematics. When group members question elements of his design, however, he will ask, “How do you think we should do it?” He listens to their ideas, and if the other group members agree, they will implement an idea even when Jerome personally doesn’t think it’ll work. Jerome’s method of allowing for trial and error often slows down progress; when the group realizes an idea won’t work, the team members will have to take apart what was built and start over. Anders asked Jerome why he isn’t more assertive in defending his plans, and Jerome answered, “That’s just not my style. How do I know I have all the right answers? We are all supposed to be learning, right? And if I insist they do it my way all the time, how will we learn anything?” 

Questions 

How would you describe the individual leadership styles of Pria, Justin, and Jerome? 

Based on the assumptions of Theory X and Theory Y, how would you describe Pria, Justin, and Jerome’s individual philosophies of leadership? 

The robotics team will be asked to compete in a situation that sounds like it will be intense and stressful. Do you think a democratic leader would be as effective as an authoritarian leader in this situation?

 Select a research article, other than the articles from your assignments, from the GCU library. Provide an overview of the study and describe the strategy that was used to select the sample from the population. Evaluate the effectiveness of the sampling method selected. Provide support for your answer. Include the article title and permalink in your post. 

 

Module 08 Content

1. Competency
   Prioritize nursing care strategies for clients with cardiovascular disorders.
   Scenario
   Cardiac disease a one of the leading causes of death in the United States. Since it is so prevalent, you want to ensure your co-workers are fully prepared to care for patients. You are hosting a lunch to provide a refresher on heart disease and how to care for patients. During the lunch, you will present a PowerPoint Presentation to your co-workers.
   Instructions
   Choose one of the cardiac diseases that we covered in the last two modules. Within your presentation include:
   • Provide a detailed overview of the disease process
   • Diagnosis
   • Treatment
   • Multidimensional care including risk reduction, health promotion, and nursing interventions specific to the disease process