NURS 6521 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

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As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?

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For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.

Photo Credit: Getty Images

To Prepare

Review the Resources for this module and reflect on the different health needs and body systems presented.
Your Instructor will assign you a complex case study to focus on for this Discussion.
Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

By Day 3 of Week 9

Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples. NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Case 1 Study – week 9 discussion

COLLAPSE

Case Study

This is a case of a 68-year old gentleman who was admitted and diagnosed with community – acquired pneumonia. Patient is currently receiving ceftriaxone (Rocephin) 1 g IV daily and azithromycin (Zithromax) 500 mg IV for the past 3 days. Patient’s past medical history includes COPD, HTN, hyperlipidemia, and diabetes. Patient’s condition has improved since admission, with decreased oxygen requirements. Current complaint is that patient is unable to tolerate his diet accompanied by nausea and vomiting.

Disease Background

Community-acquired pneumonia (CAP) is considered as a leading cause of hospitalization, death and incurs significant health care cost. CAP can be managed either as an outpatient or as in-patient depending on the severity of illness. The causative agents, S. pneumoniae and H. influenzae are the leading causes of bacterial pneumonia worldwide. In the United States, the most common pathogens identified were human rhinovirus, influenza virus and Streptococcus pneumoniae (Regunath & Oba, 2020). CAP is a common and potentially serious illness that is associated with morbidity and mortality, in which bacterimic Streptococcus pnuemoniae pneumonia is the number one case of mortality, representing 70% of all CAP deaths. While advent of new medical technologies and discovery of new drugs and treatments promises new hope, bacterimic pneumococcal pneumonia is still lethal and treatment continues to be a challenge in 21^st century. Immunocompromised status, aging population, presence of comorbid conditions are but the explanations for this situation (Caballero and Rello, 2011).

In the case of Mr. HH, considering his current comorbidities, and age, he responded well with the combination of therapy of ceftriazone (Rocephin) – a cephalosporin and azithromycin (Zithromax) – a macrolide. Combination antibiotic therapy achieves a better outcome compared to monotherapy for the treatment of patient with severe CAP. Combination therapy achieves a better outcome compared with monotherapy. It has been suggested, that initial empirical combination therapy of a cephalosporin plus a macrolide for patients with CAP who require hospitalization is associated with decreased mortality and or shorter hospital stay than treatment with cephalosporin alone (Caballero and Rello, 2011). IN the past three days that he is on these combination therapy patient’s condition improved as evidenced by decreased oxygen requirements and improvement of clinical status.

Treatment Regimen

Since the patient is responding very well with ceftriaxone (Rocephin) and azithromycin (Zithromax), I will still continue to keep the patient in these treatments. Patients diagnosed with community acquired pneumonia are managed depending on the severity of disease. Many patients hospitalized with pneumonia are treated with both a macrolide and cephalosporin antibiotic (Metersky, et al, 2017). For patients with comorbidities ( CHF excluding hypertension, chronic lung disease – COPD and asthma; chronic liver disease; chronic alcohol use disorder; diabetes mellitus; smoking; splenectomy; HIV or other immunosuppression) a respiratory fluoroquinolone or a combination of oral beta-lactam and macrolide is recommended. For outpatients, monotherapy with a macrolide (erythromycin, azithromycin, or clarithromycin) or doxycycline is recommended. (Caballero and Rello, 2011). The patient’s age, as well as his presence of comorbidities makes him a good candidate for the combination therapy.

Ceftriaxone (Rocephin) is a 3^rd generation cephalosporins. Cephalosporins are B-lactam antibiotics similar in structure and actions to the penicillins. These drugs are bactericidal, often resistant to B-lactamases, and active against a broad spectrum of pathogens. Their toxicity is low. Cephalosporins inhibit the cell wall synthesis, that causes cell wall disruption. This in turn, will lead to bacterial lysis and death. Cephalosporins are generally well tolerated and constitute one of the safest groups of antimicrobial drugs (Rosenthal & Burchum, 2020). On the other hand, azithromycin (Zithromax), a macrolide-type antibiotic, are broad-spectrum that inhibit protein synthesis. They are termed as macrolides because they are big. The oldest member of the family of macrolides is erythromycin where the newer macrolides -azithromycin and clarithromycin were derived. Gastrointestinal disturbances such as epigastric pain, nausea and vomiting and diarrhea are the most common side effects which can be minimized by administering the medication with meals (Rosenthal & Burchum, 2020). In one study conducted by Hansen, et al. (2019), disturbances in tastes were also reported more often by participants taking macrolide antibiotics.

Addressing Gastrointestinal Side Effects

Mr. HH’s inability to tolerate diet may be due to the nausea and vomiting he is experiencing as an adverse effect of taking macrolides. We can correct the nausea and vomiting by adding an anti-emetic as a PRN medication . In addition, we will put a high regard on him being diabetic so we will ensure that he is getting the right caloric intake – a referral to a dietitian is necessary. With the dietitian on board, we can work collaboratively in order to improve patients appetite, for instance asking the patient what are the foods that he likes to eat and from there, perform selective choices. Encourage meticulous oral care, a refreshed and clean buccal cavity can enhance one’s appetite.

Patient Education Strategy

It is a must for the primary care provider to provide patient education to their patients in order to achieve the desired outcome of treatment. Explaining the reason for tests, desired effect and adverse of effects of medication is important to ensure patient adherence and completing of therapy. Provide education pamphlets or materials for patient reference for them to understand their disease and how it may impact their current medical problems. If patient is internet savvy, we can suggest websites that particular to their current illness to enlighten them more with information. Educate about their pharmacotherapy regiment. Medication side effects are most of the time the cause of patient non – compliance in continuing their medications. This can frustrate the patient and may lead to stopping of the medication they are taking which can create avenue of problems. Educating the patients about their medications, the way it works, duration of therapy and their the side effects will help them a full understanding why its included in their therapy. Encourage the patient that they are in charge in their health as well.

References:

Caballero, J., & Rello, J. (2011). Combination antibiotic therapy for community-acquired pneumonia. Annals of intensive care, 1, 48. https://doi.org/10.1186/2110-5820-1-48

Hansen MP, Scott AM, McCullough A, Thorning S, Aronson JK, Beller EM, Glasziou PP, Hoffmann TC, Clark J, Del Mar CB. Adverse events in people taking macrolide antibiotics versus placebo for any indication. Cochrane Database Syst Rev. 2019 Jan 18;1(1):CD011825. doi: 10.1002/14651858.CD011825.pub2. PMID: 30656650; PMCID: PMC6353052.

Metersky, M. L., Priya, A., Mortensen, E. M., & Lindenauer, P. K. (2017). Association Between the Order of Macrolide and Cephalosporin Treatment and Outcomes of Pneumonia. Open forum infectious diseases, 4(3), ofx141. https://doi.org/10.1093/ofid/ofx141

Rosenthal, Laura D., and Jacqueline Rosenjack Burchum. Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier, 2021.

Regunath H, Oba Y. Community-Acquired Pneumonia. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430749/

Weiss, K., & Tillotson, G. S. (2005). The controversy of combination vs monotherapy in the treatment of hospitalized community-acquired pneumonia*. Chest, 128(2), 940-6. Retrieved from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fcontroversy-combination-vs-monotherapy-treatment%2Fdocview%2F200452640%2Fse-2%3Faccountid%3D14872

You will respond to your colleagues’ posts in Week 10.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 9 Discussion Rubric

Post by Day 3 of Week 9 and Respond by Day 6 of Week 10

To Participate in this Discussion:

Week 9 Discussion

What’s Coming Up in Week 10?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will continue working on your Discussion assigned in Week 9, as you examine the types of drugs used to treat infections and disorders of the hematologic system.

Next Week

To go to the next week:

Week 10

Week 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part I

As an advanced practice nurse, you will likely encounter many disorders associated with women’s and men’s health, such as hormone deficiencies, cancers, and other functional and structural abnormalities. Disorders such as these not only result in physiological consequences but also psychological consequences, such as embarrassment, guilt, or profound disappointment for patients. For these reasons, the provider-patient relationship must be carefully managed. During evaluations, patients must feel comfortable answering questions so that you, as a key health-care provider, will be able to diagnose and recommend appropriate treatment options. Advanced practice nurses must be able to educate patients on these disorders and help relieve associated stigmas and concerns.NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

This week, you examine women’s and men’s health concerns as well as the types of drugs used to treat disorders that affect women’s and men’s health. You also explore how to treat aspects of these disorders on other health systems.

Learning Objectives

Students will:

Evaluate patients for treatment of complex health issues
Evaluate patients for treatment of infections
Evaluate patients for treatment of hematologic disorders
Analyze patient education strategies for the management and treatment of complex comorbidities

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 (2^nd ed.) St. Louis, MO: Elsevier.

Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 364–371)

Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396)

Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436)

Chapter 51, “Birth Control” (pp. 437–446)

Chapter 52, “Androgens” (pp. 447–453)

Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)

Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661)

Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662–668)

Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694)

Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699)

Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714)

Chapter 79, “Antifungal Agents” (pp. 715–722)

Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)

Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770)

Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5–15. doi:10.3109/13685538.2015.1004049

This article presents recommendations on the diagnosis, treatment, and monitoring of hypogonadism in men. Reflect on the concepts presented and consider how this might impact your role as an advanced practice nurse in treating men’s health disorders.

Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting. PLoS ONE, 9(2), e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872

This study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality, and HIV transmission.

Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. .https://doi.org/10.1016/j.maturitas.2016.01.007

This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition.

Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, and counseling.

Required Media (click to expand/reduce)

Laureate Education (Producer). (2019h). Pathopharmacology: Pharmacology and immunological disorders: Improvements in medications and drug administration [Video file]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 8 minutes.
Nurse Manager, Bette Nunn discusses how technology has improved the practice of administering drugs and created new and improved drug therapies. The importance of using technology as well as a patient’s knowledge of their own drug history is also discussed.

Pharmacology and the Immunological Disorders:Improvements in Medication and Drug AdministrationsProgram Transcript[MUSIC PLAYING] NARRATOR: With so many medications available today, nurses need to take advantage of every resource available to ensure patient safety. BETTE NUNN: Administering medications is more than just simply handing a medication to a patient. NARRATOR: This week, Bette Nunn shares some of the progress technology and pharmacologic interventions have had on administering drug therapies as well as drug advancements used in treating immune system disorders. BETTE NUNN: We are lifelong learners. And as research begins to understand disease processes more and more, then new drugs are developed. And so it is our charge, because we are the advocate for our patients, that we are going to know about what these drugs are. So with that said, that is probably our biggest challenge. But there’s good news there, because we’ve moved past the days where in my pocket, I would have a manual for all the IV medications and drugs, and I’d be looking them up before I gave them to my patients. What’s really terrific for today’s nurse is that technology is really our partner. So when you’re standing in front of your perhaps electronic medical record, you can really click on that particular drug, and you can access an entire micro medics. So you can right then and there know everything that you need to know about a particular drug. The one thing that a nurse should never do is give a medication that they have no clue as to what it is. And it can be challenging, because often, medications have many different names. So it’s important if you’re not recognizing that name to always look at the generic name for a drug. The other thing that technology really provides is that there are other resources even on medications there are simple notations. Don’t crush this drug. And I think an important message is to learn what’s there for you, no matter what organization you’re working in, because there’s a lot of information. And again, your other colleagues, your nurse colleagues that you’re working side by side with, are your resource. Nurses ask questions. That’s the biggest thing that you can do to be successful. NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Pharmacology and the Immunological Disorders:Improvements in Medication and Drug Administrations©2019 Laureate Education, Inc.2And each time you are in an experience with a particular patient and see, maybe, some untoward effects of a medication, then you’re able to help add to your knowledge base, and it makes you a better critical thinker. Many units have clinical pharmacists, and they are partners in care. You can certainly pick up the phone if one is not there and ask questions. And I think that’s really the key for us as nurses at the bedside as we tackle all these new drugs is to remember where our resources are, and the physician is certainly another partner in our care. And sometimes, we don’t think about it as nurses, but our patient is. MALE SPEAKER: I’m taking this [INAUDIBLE], and I’m just wondering if it drops my blood pressure down. FEMALE SPEAKER: And that’s why we take your blood pressure before we give you the medication every morning. BETTE NUNN: One of my experience would be that if you’re getting ready to give a medication to a patient, and they have a question, and they’re saying that, gee, I don’t take this kind of medicine, what this is, you really should stop and regroup. Because sometimes, they may be right. You may not be giving them this medication at the time that they’re taking, or it’s a new drug, and it’s an opportunity to do some teaching for that patient, because it is a new drug. And patients are becoming smarter, and they are being held accountable, too, to know what medications they are taking. So I think we have to be a little humble, and listen to our patients, and not get nervous when they’re questioning a medicine that we’re giving. FEMALE SPEAKER: Mr. Weinstein, we have your medication. BETTE NUNN: From a practical standpoint, I think that using the processes that are in place to help us deliver these medications safely is critical. So it is important that you are looking at that order when you’re giving a medication to make sure that it is— we’re following these five hours, which from the beginning of time, have not gone away. You need to make sure that you have the right drug, and you’re giving it to the right patient, in the right dose, at the right time, and the right route. And that will always serve you well when you’re giving medications. Drug therapy has certainly expanded life expectancy. And as a nurse for 35 years, I can truly say that I’ve been able to see new drugs come on board for certain disease processes, and that can be something as simple and maybe understated as antibiotics, and seeing generations of antibiotics, and clearly making the difference of sometimes life and death in a patient.

Pharmacology and the Immunological Disorders:Improvements in Medication and Drug Administrations©2019 Laureate Education, Inc.3But there are many drugs that have led to expanded life expectancy. And certainly, there are many drugs out there that have helped with managing chronic illnesses of patients, such as diabetes, asthma. I think mental illness is something that’s a little under-reported, but clearly makes a difference in the quality of life that patients have. One of the examples that I think for me in my practice is in the ’80s, where I, in critical care, was able to see HIV in its earliest states. And when a patient was diagnosed with HIV at that point in time, it truly was a death sentence. And it was many patients that we cared for, that it was just— there were not drugs there. But that illness is a fine example of where research has certainly been able to look at that process. And we never thought that we’d be able to ever make any advances. It just seemed to be that mountain that just couldn’t be hurdled. But as research took place, and we began to understand more and more of how this virus worked, then drugs were discovered, and it led to more drugs and more drugs. And I can say today that you don’t see patients admitted with HIV any longer as a primary diagnosis. It is a comorbidity, such as someone coming in with diabetes. And that is remarkable, and that is where pharmacology and the understanding that the nurse has of how pathway pharmacology works in this patient population. It can be very confusing for the nurse when she’s giving those meds, because it’s really become such a recipe, and there are so many drugs. But boy, are we happy that those drugs are there.Pharmacology and the Immunological Disorders:Improvements in Medication and Drug AdministrationsContent Attribution Sinai Hospital photograph courtesy of Sinai Hospital of Baltimore. NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders