Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.  

One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.

To Prepare

• Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
• Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
• Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.
• Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:
• Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
• Explain the stepwise approach to asthma treatment and management for your patient.
• Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.the disease.
• Please review the rubric for this assignment.

Rubric:

The presentation clearly and accurately describes in detail the long-term control and quick relief treatment options for the asthma patient from their practice.

The presentation clearly and accurately describes in detail the impact these drugs might have on their patient.

The presentation clearly and accurately explains in detail the stepwise approach to asthma treatment and management for their patient.

The presentation clearly and accurately explains in detail how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

The presentation provides accurate and detailed examples to support the explanation provided.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

Uses correct grammar, spelling, and punctuation with no errors

References:

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

• Chapter 60, “Drugs for Asthma and Chronic Obstructive Pulmonary Disease” (pp. 673–693)
• Chapter 61, “Drugs for Allergic Rhinitis, Cough, and Colds” (pp. 695–702)

Many people in the US, particularly the elderly, take more than one prescribed medication. CDC (2014) reported that between 2009 and 2012 nearly 48% of persons asked used at least one prescription drug, 22% used three or more prescription drugs, and nearly 11% used five or more.

In a recent study published by the Mayo Clinic, seven out of 10 Americans take at least one prescription drug. The most commonly prescribed drug is antibiotics — taken by 17 percent of Americans — followed by antidepressants and opioids — each taken by 13 percent of Americans. In addition, findings showed that:

• Even more staggering than the CDC findings, currently more than half of Americans take two prescription medications, and 20 percent of Americans are on at least five prescription medications.
• More women than men receive prescription medications.
• Antidepressant prescriptions are more common among women than men, and are most common among women ages 50 to 64.

When people take multiple medications, there is a greater risk for confusion about which medications are taken, when they are taken, and what they are being taken for. There is also a higher risk for drug interactions and increased side effects and adverse reactions.

Sometimes because of the sheer number of medications being prescribed, they may be forgotten, become too much of a bother, or a financial burden which can significantly impact client compliance and lead to poor health outcomes.

In this written assignment, you will be conducting an interview of a client who is taking multiple prescribed medications (three or more) and submitting a written paper describing the findings from the interview. You will then develop a Client Teaching Plan. Your instructor will assist you in the selection of the client. You must achieve a “pass” in this assignment to satisfactorily fulfill the requirements for the Pharmacology course.

The three parts of this assignment are:

Conduct an interview of a client who is taking multiple medications (polypharmacy). You must prepare the client before the interview by explaining why you are conducting the interview. You can say “my assignment is to find out about the medications you are taking so I can determine if you need more information about what you are taking”. You must always get permission from the client to conduct the interview and you must tell the client how the information will be used. You can say, “I will not be using your name in the information I share and I will be submitting it to my instructor only for this student assignment”. If there is important information that needs to be communicated to you, your doctor, family, or nurse, my instructor will assist me in following up on this”. Tell the client you will take no more than 30-45 minutes for the interview.

There may be a family member or significant other present during the interview. That is fine. Be sure to identify who answered a question and if possible always have the client answer first. Always thank the client (and others) when you complete the interview.

Do not use recording equipment for this interview. Have a notepad and pencil or pen and explain that you will be taking notes. When the interview is over, go to a quiet place and take some time to fill in any information you did not jot down. If you wait, you will not remember.

When setting the environment for the interview, make sure the client (and others) is comfortable and you are comfortably seated facing the client. If possible, do the interview in a quiet place.

Ask questions slowly giving the client time to answer. Pay attention to the client’s hearing and ability to respond to the questions. Be sure your non-verbal communication demonstrates you are calm and relaxed.

Use the following interview question guidelines when conducting the interview. Be aware that the client may not be able to answer each of the questions with detailed information. Collect as much information as the client is able and willing to give you. Remember you are the interviewer so you will be collecting information and not making any comments about the information shared by the client except to ask for further clarification if you are not sure what was said or need more detail if it is available.

1. What medications are you taking?
   (Before the interview research each of the medications. In your paper include the reason for each medication, the drug classification, the route of administration, the dose, and possible side effects/adverse reactions).

   For the following questions, paraphrase the client’s answers for your written paper.

2. How long have you taken each these medications?
3. Do you know why you are taking these medications?
4. Who told you about the medications and why you need to take them? Were you able to ask any questions about the medications and if so were they answered so you understood what was said?
5. How do you feel about taking these medications?
6. Are you taking other medication purchased “over the counter” such as in a drug store? If so, what is it and why are you taking it.
7. How and when do you take your medications?
8. Do you have any difficulty taking the medications? If so, what happens and how do you deal with any difficulties.
9. Have you ever felt any uncomfortable feelings and/or body reactions to taking these medications? If so, what were they and how were they handled?
10. If you had the above reaction, did they take you off the medication and/or replace it with another medication? Were you told why this happened?
11. Do you have any reason not to take the medications?
12. Have you ever not taken the medication? If so, what was the reason?

Ask a final question about whether the client would like to tell you anything further about their medications.

Write a paper describing your research and findings about the medications being taken and the results of the interview. Report your findings in a 3-5 page written paper. In your paper include the reason for each medication, the drug classification, the route of administration, the dose, and possible side effects/adverse reactions.

Use accurate and appropriate spelling and grammar and APA Editorial Format for sources used in your written paper.

Develop a teaching plan for this client based on your findings. Based on the findings from the interview, develop a 2-3 page teaching plan to include the following:

1. List one goal for this teaching plan
2. Describe two to three teaching resources that might be used
3. Identify two teaching strategies that can be used based on the client interviewed
4. List specific client instructions regarding the medications and what adverse reactions they should be aware of/and what to do
5. Identify at least one factor that may negatively influence adherence to the medications and how it can be overcome
6. If, appropriate, describe how the family might be involved in ensuring the client is on a proper and safe medication regime

 Chapter: 20 Anus,Rectum,Prostate 

While you are examining a 1-year-old girl, the mother mentions how eager she is to begin toilet training her child. How should you respond? When is it best to begin toilet training? 

What do the rectum and anus form?

Control of the external anal sphincter is gradually achieved at what age?

Differentiate between internal and external hemorrhoids.

You are observing an examiner take the history of a 70-year-old man as part of the musculoskeletal examination. You notice that the examiner asks the patient about exercise habits in his early years. Is this a relevant question to ask this patient? Why or why not?

A young woman is concerned about a 1-cm difference in the length of her legs. What is the best response to give this patient?  

A 3-year-old boy has had anal itching that becomes worse at night. What do these symptoms indicate?

You are assessing a pregnant woman who has had a fourth-degree perineal laceration. Why is it necessary to assess this patient’s anal sphincter function? 

You are about to perform a rectal examination of an older adult. What is the suggested position for this patient? 

What is a clue to the diagnosis of Hirschsprung disease?

What do persistent, pencil-like stools suggest?

Distinguish between the stool of a formula-fed baby and a breastfed baby.

Create a chart or two-column list that compares the risk factors for colorectal cancer with those for prostatic cancer.

What are the risk factors for colorectal cancer?

What are the risk factors for prostate cancer?

What symptoms are associated with BPH?

JF is a 42-year-old patient who presents for an annual examination, but he complains that he has had a fever for the past few days and recently some “urinary symptoms.”

1- Describe the best method for a rectal examination during the physical assessment

2- What additional past medical history questions would you ask of JF since you suspect prostatitis?

3- During the rectal examination of JF with acute prostatitis, what findings would expect on physical examination? .

A, Correct procedure for introducing finger into rectum. Press pad of finger against the anal opening. B, As external sphincter relaxes, slip the fingertip into the anal canal. Note that patient is in the hips-flexed position.

Discussion: Treating Childhood Abuse

In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse.

In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse.

Learning Objectives

To Prepare for this Discussion:

• Read the Learning Resources concerning treating childhood abuse.
• Read the Child Abuse Case Study in the Learning Resources.

Post:

• What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.
• How might exposure to the media and/or social media affect the patient?
• What type of mandatory reporting (if any) is required in this case? Why?

Select ONLY ONE question listed below to write an essay for this week’s discussion forum.

1.  From Chapter 7, p 182-191, Darr (2011, p. 150) writes, “Managers must achieve the difficult balance between loyalty to the organization and fidelity to their personal ethic and professional integrity. How far should a manager go in following the crowd or in standing alone?”.  Address this question with details and supporting/opposing opinions.

2.  From Chapter 7, whistle-blowing is discussed.  Define the term whistle-blowing.  Identify positive and negative outcomes of whistle-blowing for the party who exposed the issue(s).

No formal format required, 200-250 words required. This is a very short forum post, simple and to-the-point answer needed only.