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Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders

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

Walden University Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders-Step-By-Step Guide

 

This guide will demonstrate how to complete the Walden University  Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

 

How to Research and Prepare for Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders

 

Whether one passes or fails an academic assignment such as the Walden University  Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

 

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

 

How to Write the Introduction for Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders

 

The introduction for the Walden University  Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

 

How to Write the Body for Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders 

 

After the introduction, move into the main part of the Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

 

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

 

How to Write the Conclusion for Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders

 

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

 

How to Format the References List for Discussion: Women’s And Men’s Health, Infectious Disease, And Hematologic Disorders

 

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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In this case study, a 60-year-old male is admitted to the hospital with community-acquired pneumonia. The patient’s medical history includes COPD, hypertension, hyperlipidemia, and diabetes. In this case study, the patient was given 500 mg of azithromycin. This is a type of macrolide medication. This antibiotic has a broad spectrum and can combat many gram-positive bacteria. This medication has also been linked to liver toxicity. Some of this medication’s side effects include nausea and vomiting. The patient was also given 1 g of ceftriaxone. This is a subclass of beta-lactams. These antibiotics inhibit bacteria by covalently binding to PB P in the cytoplasmic membrane. This medication’s side effects can include diarrhea, nausea, rashes, and super infections. By combining both antibiotics, the patient will receive a broad spectrum of coverage to prevent further bacterial growth. We have no idea what type of bacteria is causing the pneumonia. Until the laboratory results for bacterial cultures and sensitivities come back, it is worth waiting to see what type of bacteria and antibiotics will work for this specific patient. The patient is allergic to penicillin, but the antibiotic is working well for him. He has not been hypersensitive. If the patient develops hypersensitivity, he or she can be given doxycycline or cephalosporins, which can also provide excellent broad-spectrum coverage for pneumonia.

Osteoporosis is a condition in which an individual’s bone is brittle. This is due to the bon

Discussion Women and Men Health Infectious Disease and Hematologic Disorders NURS 6521
Discussion Women and Men Health Infectious Disease and Hematologic Disorders NURS 6521

e unable to keep up with the process of new bone formation in balance with bone mineral removal. There are many risks involved with having this disease process such as easy fractures, and severe back issues like compression of vertebras. Risk factors for osteoporosis include family history, female, excessive alcohol, diet deficient in calcium and vitamin D, and many more. The nurse may educate patient on the disease process as well as screen the patient for complications. The nurse can educate the patient on a diet low in caffeine, alcohol, provide resources for exercises for bone strength as well as a diet that supports healthy bone.

Patients  has a history of COPD, patient’s oxygen saturations must be monitored on a continuous basis. And if needed, patient must be given supplemental oxygen. Patient also has high blood pressure so  blood pressure must be monitored .The type of medication that I would prescribe would be angiotensin receptor blocker for example Losartan, and irbesartan. ARB are the first line of anti-hypertension medication to be prescribed to treat hypertension. This medication works by blocking receptors that act on hormone especially a T-1 receptors by blocking the action of angiotensin two and helps lower blood pressure. Some side effects may be vomiting, diarrhea, and dizziness. Patient also has hyperlipidemia.I would prescribe a statin medication to help lower cholesterol levels. Patient has diabetes. Patient requires monitoring of  blood glucose levels even with pneumonia. I would prescribe Metformin and insulin since patient is not able to tolerate PO, I would prescribe insulin.

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Also, since patient is not able to tolerate regular diet or anything PO. I would start  IV fluids administer dextrose and an oral parenteral nutrition as needed for patient’s nutritional needs.

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

Week 9 Discussion Post

I would conclude that the patient is entering menopause based on her symptoms. According to Rosenthal and Burchum, menopause affects 95 percent of women between the ages of 45 and 55. Under normal circumstances, hormone therapy would be used to treat hot flashes, nocturnal sweating, and genitourinary complaints (HT). The patient’s family history of breast cancer, on the other hand, makes treating menopausal symptoms significantly riskier.
Before discussing treatment options with the patient, I would ask if the symptoms are manageable or intolerable. First, I’d find out if she wants treatment for the symptoms. If this is the case, we must weigh the risks and benefits of using HT or an SNRI like Effexor. According to Roberts and Hickey (2021), SNRIs reduce vasomotor function.References
The website Breastcancer.org (2021). Using HRT (Hormonal Replacement Therapy).
https://www.breastcancer.org/risk/factors/hrt
Roberts, H., and M. Hickey (2016). An update on menopausal management. Maturitas, 86, 5-58.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for nurse practitioners and physician assistants (2 nd ed). Elsevier, Inc. .

This week I chose ADHD Attention-Deficit/Hyperactivity Disorder since both of my children suffer from it, and I do not fully comprehend it. I do not believe they have ever received proper therapy for it, and I have witnessed them struggle throughout infancy and adolescence due to this poorly known sickness.

5 to 11 percent of school-aged children have ADHD, making it the most prevalent neuropsychiatric disorder in childhood (Rosenthal & Burchum, 2021, p. 251). This condition affects boys by two-thirds more than girls (Rosenthal & Burchum, 2021). This disease is poorly understood, although it is believed that a mutation of the dopamine D4 receptor gene (DRD4) or a variant of the catechol-O-methyltransferase gene (COMT) contribute to it (Block et al., 2021). Manifestations clinically include inattention, hyperactivity, and impulsivity (Rosenthal & Burchum, 2021). These people are regularly late, forgetful in their everyday activities, easily distracted, hyperactive, and forgetful (Block et al., 2021). Not everyone in this group will be hyperactive. To be diagnosed, symptoms must be present before the age of twelve (Block et al., 2021). These children are unable to distinguish between significant and unimportant stimuli, resulting in trouble staying on task and maintaining concentration (Block et al., 2021). This condition may be associated with brain development, including anomalies in the “dopaminergic and noradrenergic neurotransmission system” (Block et al., 2021). Several additional factors have been mentioned as probable associations with this disease, but I will not list them here.

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

Pharmaceutical therapies I elected to initiate this patient’s pathophysiology with 10 mg of chewable Ritalin (methylphenidate) in the morning. Eight-year-old female with a new diagnosis of ADHD who had never taken medication before. At her first follow-up session four weeks after starting medication, her parents noted that her symptoms had improved in the morning, but that the medication appeared to be losing its effectiveness by the afternoon. In the clinic, the patient’s heart rate was measured to be 130 beats per minute, which alarmed the patient’s parents. The patient remarked that her heart felt “weird,” and her parents noted that her heart rate was 130 beats per During this visit, the medication was altered to 20 mg of Ritalin LA to be taken orally each morning. This modification will allow medication to be administered over a period of four to seven hours with a maximum length of twelve hours (Davis’s Drug Guide, 2018). After four weeks, the patient returns for a follow-up appointment, and the parents report that their child’s schooling has improved and the medication is lasting throughout the day. The patient reports that the chest discomfort has subsided. This dosage would be continued for an additional four weeks, accompanied by a clinic checkup.

Ritalin is the medicine of choice for the initial treatment of ADHD, and its efficacy has been demonstrated (Rosenthal & Burchum, 2021). No studies recommend one treatment above another; consequently, if the initial drug is unsuccessful, the practitioner should examine second-line drugs (Rosenthal & Burchum, 2021). Possible stimulant adverse effects include sleeplessness and growth suppression (Rosenthal & Burchum, 2021). As extended-release drugs can last up to twelve hours, they should be administered as near to the child’s waking time as possible to minimize insomnia. If the child has a diminished appetite, administer medicine after or during meals (Rosenthal & Burchum, 2021). Some providers advocate “drug holidays” in which the child does not take medication on the weekends; however, this is not advised for all children (Rosenthal & Burchum, 2021).

References

Block, R., Macdonald, N. P., & Piotrowski, N. A. (2021). Attention deficit hyperactivity disorder (ADHD). Magill’s Medical Guide (Online Edition).

Davis’s Drug Guide. (2018). Davis’s drug guide for nurses (16th ed. ed.). F.A. Davis Company. Retrieved from Www.drugguide.com.: https://www.drugguide.com/ddo/mobile

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd Edition ed.). St. Louis, MO: Elsevier. Retrieved from vbk://9780323554954

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

As an advanced practice nurse, you will most certainly encounter patients with complex comorbidities. Consider a female patient who is pregnant and also has hypertension, diabetes, and a recent tuberculosis infection. What effect might the underlying pathophysiology of these illnesses have on the pharmacotherapeutics you might propose to aid your patient’s health needs? What educational strategies would you suggest to ensure positive patient health outcomes?

You will be allocated a patient case study for this Discussion and will consider how to address the patient’s current pharmacological therapy regimens. You will next make recommendations on how to amend these medication therapy plans in order to provide effective, safe, and high-quality patient care and achieve excellent patient health outcomes.

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

Photographer: Getty Images

To Get Ready
Examine the Resources for this topic and consider the many health demands and body systems given.
For this Discussion, your Instructor will provide you a complex case study to focus on.
Consider how you will use critical thinking to prescribe appropriate medications and treatments to address the complex patient health needs in the patient case study you choose.
Week 9’s third day
Post a brief explanation of your patient’s health needs from the given patient case study. Make your point. Then, explain the type of treatment plan you would prescribe for your patient, including the pharmacotherapeutics you would suggest and why. Make certain to substantiate your response. Explain a patient education method you may offer to help your patient manage their health requirements. Provide specifics and instances.

In Week 10, you will respond to the posts of your coworkers.

Please keep in mind that you must complete your initial post before you may access and comment to your colleagues’ postings in this Discussion. Begin by clicking on the “Post to Discussion Question” option, then “Create Thread” to finish your first post. Remember that once you press the Submit button, you cannot delete or change your own posts, and you cannot publish anonymously. Please double-check your post before clicking the Submit button!

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

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Main Discussion Post by Adam Naig (Hormonal Therapy)

Main Discussion Post by Adam Naig

Firstly, it is vital to obtain a thorough medical history with proper tests to differentiate possible diagnoses and to select the appropriate therapy. Our case scenario is a 46-year-old lady with a family history of breast cancer. The patient also had Atypical Squamous Cells of Undetermined Significance (ASCUS) five years ago, which can be caused by an infection, inflammation, low hormone levels, or benign growth such as cyst or polyp (National Cancer Institute, 2021). The patient is currently on a calcium channel blocker, Norvasc (Amlodipine) 10 mg orally daily and Aquazide (Hydrochlorothiazide) 25 mg orally daily for her hypertension and possible edema. The patient is mainly bothered by symptoms of hot flushing, night sweats, and genitourinary symptoms. Although these symptoms may indicate an estrogen deficiency commonly found in menopause, we cannot completely exclude the possibility of cervical cancer or infection. It is beneficial to check for labs such as complete blood counts and urine culture and sensitivity to rule out infection. Furthermore, a pap smear with human papillomavirus test (HPV) can be made to assess for the risk of cervical cancer. Given the patient’s medical history, there is a high possibility that she is experiencing the initial phase of menopause.

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

Since the patient is symptomatic and her symptoms are troublesome, a hormonal replacement therapy (HRP) can be suggested. Hormonal therapy such as the estrogen, Estrace (Estradiol), and progesterone Megace (megestrol acetate) may be started as it is the most common non-contraceptive therapy for post-menopause (Rosenthal & Burchum, 2021). The purpose of estrogen is to control menstrual symptoms by replacing the estrogen lost from menopause while taking progestin works by counterbalancing estrogen-mediated stimulation, which increases the risk of cancer and endometrial hyperplasia (Rosenthal & Burchum, 2021). We may start at the lowest dose possible and adjust the dose as per the patient’s response to treatment or severe side effects. Also, selective estrogen receptor modulators (SERMs) such as Nolvadex (Tamoxifen) may be prescribed in conjunction with hormonal therapy to reduce the incidence of breast cancer, uterine cancer, thromboembolism, and osteoporosis (Rosenthal & Burchum, 2021).

Before prescribing hormonal therapy, it is essential to screen the patient for contraindications such as a history of deep vein thrombosis, pulmonary embolus, stroke, or breast cancer since taking hormonal therapy might increase their risk. Educate the patient that nausea is the most frequent side effect of estrogen and usually subside with continued use. Also, educate the patient to report fluid retention or edema as it is a common finding in hormonal therapy. Therefore, it is vital to keep a close monitoring of patient weight and blood pressure. If edema or blood pressure worsens, increasing the patient’s diuretic or blood pressure doses may be explored.

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

Educate the patient that hot flushes and night sweats are common symptoms affecting 85% of menopause as they transition to the initial phase of menstrual irregularity (Bansal & Aggarwal, 2019). Additionally, various factors such as obesity, sedentary lifestyle, and smoking are related to hot flushes. Therefore, it is essential to include lifestyle changes and advise the patient on proper diet, physical activity, and smoking cessation as needed. It may also be beneficial to educate the patient more about other signs and symptoms of menopause, such as vaginal dryness, dyspareunia, mood changes, fatigue, sleep disturbances, and sexual dysfunction. Furthermore, in most women in their menopause, hot flushes may subside within several months to a few years or more (Rosenthal & Burchum, 2021). Moreover, it is also helpful to explain to the patient that urethral and vaginal atrophy happens in menopause, explaining the genitourinary symptoms such as incontinence or urinary frequency. Hence, it is essential to educate the patient on proper genitourinary hygiene and adequate oral hydration to prevent urinary infections and combat constipation (a side effect of progesterone).

Instruct the patient to adhere to proper medication administration and maintain regular communication with the health care team. It is also beneficial to schedule the patient for a yearly pelvic exam with frequent follow up clinic visits for safety and evaluation of treatment and as needed.

References

Bansal, R., & Aggarwal, N. (2019). Menopausal Hot Flashes: A Concise Review. Journal of mid-life health, 10(1), 6–13. https://doi.org/10.4103/jmh.JMH_7_19

National Cancer Institute (NCI). ASCUS. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ascus

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

Week 10: Women’s and Men’s Health/Infections and Hematologic Systems, Part II
Bacterial and viral infections may spread through the direct contact of bodily fluids such as blood or through vectors, who help to spread infections via the blood. When you think of infections and the hematologic system, what comes to mind?

Infectious diseases, such as malaria, dengue, or other hemorrhagic fevers are some examples of infections that impact the hematologic system. However, disorders of the hematologic system, such as anemia or blood clotting factor disorders, can also have a deleterious effect on a patient’s health and well-being. As an advanced practice nurse, you will need to understand the different types of pharmacotherapeutics used to treat infections and disorders of the hematologic system as you work to enhance patient-centered approaches for safe, quality, and effective care.

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

This week, you will examine infections and hematologic disorders, as well as the types of drugs used to treat aspects of these disorders or 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 (2nd ed.) St. Louis, MO: Elsevier.

Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)
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

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

Document: Final Exam Study Guide (PDF)

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

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.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6521_Week9_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting
45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3
First Response
17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed. .

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days
Total Points: 100
Name: NURS_6521_Week9_Discussion_Rubric

Wk9 Main Discussion – Case Study #2

Wk9 Main Discussion Post

Case Study #2

A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS (atypical squamous cells of undetermined significance) about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg daily and HCTZ 25mg daily. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.

Perimenopause

The patient is presenting with marked symptoms for perimenopause. Perimenopause is the transitional period between productive and nonproductive years, a transition lasting 2 to 8 years. Perimenopause to each woman age of onset and time span is different.  Some women start experiencing these symptoms a little early, while others start in their 40’s. Perimenopause is that period in a phase of a woman’s life during which she starts experiencing some estrogen imbalance, leading up to the final cessation of her menstrual cycle.  Change in the hormonal occur during this time including erratically higher estradiol levels, decreased progesterone levels, and a disturbed ovarian-pituitary-hypothalamic feedback relationship with higher LH levels (McCance & Huether, 2019, p747).

The patient is experiencing the genitourinary symptoms that can include urethral tone decline along with muscle tone throughout the pelvic area leading to urinary frequency/urgency, urinary tract infections, and incontinence may occur (Huether & McCance, 2019, p750).  Because of the decrease of  estrogen levels, vasomotor systems present as hot flashes, sweating (night sweats) due to peripheral blood vessels dilating, other symptoms that can ensue are palpitations, dizziness, headaches, and increase the risk for cancers of the breast, uterus, and ovaries (Huether & McCance, 2019).

The transition time in the perimenopause phase also varies from one woman to another.  Some women go through this period briefly, while some last several years before they finally achieve menopause.  Women are still having menstrual cycles during this time and can get pregnant.  The menopause-like symptoms start manifesting during the perimenopause phase because the ovaries are slowly regressive in the amount of estrogen it produces. This patient needs to be made aware that perimenopause to menopause modification is a midlife neuroendocrine switch ceremony unique to each woman that occurs on the background of aging biology.

Treatment Regimen

Based on the symptoms the patient is exhibiting, it may be beneficial to start her on hormone replacement therapy (HRT).  According to Akter and Shirin (2018), HRT is considered the most effective treatment for women who are suffering from perimenopausal and menopausal symptoms.  HRT should be discussed thoroughly with patient and is individualized to each woman based on history and symptoms.  The recommended HRT for the patient would be to start her on an estrogen and progestin combination daily.  The estrogen would be prescribed for the treatment of her symptoms of hot flashes and night sweats.  According to Rosenthal and Burchum (2018), low dose estrogen is given to replace the loss of estrogen from perimenopause and reduce the symptoms of hot flashes and night sweats.  Progestin is giving in combination with estrogen because the patient still has her uterus.  Progestin is needed to prevent endometrial cancer during menopause because it offsets the estrogen-mediated stimulation of the endometrium (Rosenthal & Burchum, 2018).  The patient should be aware of the risk related to HRT and whether the risk outweighs the benefit of the relief of symptoms associated with menopause.

Education Strategy

The patient has a history of hypertension which needs to be considered when educating the patient about HRT.  According to Rosenthal and Burchum (2018), HRT can help with reducing cardiovascular disease (CD), but it is important that HRT is not used for that purpose and the patient continues to take prescribed medications related to CD.  The patient takes medications for her hypertension and her current blood pressure is elevated.  The education of continuing to take her antihypertensive medications and maintaining a healthy diet is important in maintaining her cardiovascular health.  According to Ozcan (2019), healthy lifestyle behaviors such as physical activity, healthy diet, and stress management can reduce the menopausal symptoms.  The patient also has a family history of breast cancer and the risk of harm could increase with HRT (Rosenthal & Burchum, 2019).  The patient should always be informed of the risks and educated about the importance of breast screenings.  Overall, at the end of the day the risk versus benefits need to be evaluated with the patient thoroughly. The patient needs to be part of the treatment decisions with proper educational material provided.

References

Akter, M. J., & Shirin, E. (2018). Latest evidence on using hormone replacement therapy in the   menopause. Journal of Bangladesh College of Physicians & Surgeons, 36(1), 26-32. https://doi-

org.ezp.waldenulibrary.org/10.3329/jbcps.v36i1.35508.

McCance, K. L., & Huether, S.E. (2019). Understanding Pathophysiology (8th ed.). Mosby.

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s Pharmacotherapeutics for Advanced Practice Providers. Elsevier.

Ozcan, H. (2019). Healthy lifestyle behaviors and quality of life at menopause. International  Journal of Caring Sciences, 12(1), 492-500. https://search-ebscohost-

com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=136698218&site=eds- live&scope=site.

This is a detailed and outstanding post about the case study.

Indeed, community-acquired pneumonia remains the single most common cause of death from infectious diseases in the elderly population. Regarding the treatment, it is essential to determine the appropriate treatment option after conducting respiratory cultures and blood work to establish the agent that causes the current infections (Rothberg, 2022). This information will help in determining the precise antibiotic that should be given to the patient. When using IV antibiotics, it is important to administer them for five to seven days and reassess the patient to determine their efficacy before discontinuing them to avoid the development of resistance to certain antibiotics. The patient is not tolerating diet appropriately. As such, he needs nutrition therapy and IV hydration until vomiting and nausea are eliminated to avert electrolyte imbalance and dehydration during the existence of the reported symptoms. As you have correctly mentioned, it is important to ensure patient education is conducted by an interprofessional team to achieve optimum patient health outcomes (Munro et al., 2021).

References

Munro, S. C., Baker, D., Giuliano, K. K., Sullivan, S. C., Haber, J., Jones, B. E., … & Klompas, M. (2021). Nonventilator hospital-acquired pneumonia: a call to action: recommendations from the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) among nonventilated patients. Infection Control & Hospital Epidemiology42(8), 991-996. https://doi.org/10.1017/ice.2021.239

Rothberg, M. B. (2022). Community-Acquired Pneumonia. Annals of Internal Medicine175(4), ITC49-ITC64. https://doi.org/10.7326/AITC202204190

A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and presented to her gynecologist for her annual GYN examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap; other than that, Pap smears have been normal. Home medications are Norvasc 10mg QD and HCTZ 25mg QD. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was one month ago.

From a personal standpoint, being age 60, overweight and having a family history of breast cancer, and being hypertensive, I can relate to this case study. I take HRT daily.

I recommend Compounded hormone therapy. According to Thompson, Ritenbaugh&Nichter (2017), this medication is a form of bioidentical hormone therapy that is individually formulated for patients by pharmacists. Popularly, the term “bioidentical” refers to prescription hormones that have “the same molecular structure as a hormone that is endogenously produced and circulates in the human bloodstream.” Bioidentical hormone therapy may be manufactured in standard doses by drug companies and sold under brand names such as Vivelle (estradiol) and Prometrium (micronized progesterone). Alternatively, it may be individually formulated for patients by compounding pharmacists as CBHT. CBHT is available in an array of delivery methods (e.g., capsules, patches, creams, sublingual lozenges or “troches,” and vaginal suppositories) and dose strengths, although common compounded formulations include estriol alone, “bi-estrogen” or “bi-est” combinations (estradiol and estriol), or “tri-estrogen” or “tri-est” combinations (estrone, estradiol, and estriol)—as well as progesterone, testosterone, and dehydroepiandrosterone (DHEA).

According to Dalal&Aganwal (2015), Systemic estrogen therapy is the most effective treatment available for vasomotor symptoms and the associated sleep disturbance. Healthy women in the perimenopausal transition who are experiencing bothersome hot flashes but still menstruating may benefit from oral contraceptives.

I would recommend for the patient have yearly mammograms and pap tests, a weight program, and monitor blood pressure and heart rate at home. Follow up in 3 months for repeat blood work to see the efficacy of therapy.

 

References:

Dalal, P. K., & Agarwal, M. (2015). Postmenopausal syndrome. Indian journal of psychiatry57(Suppl 2), S222–S232. https://doi.org/10.4103/0019-5545.161483 Links to an external site.

Thompson, J. J., Ritenbaugh, C., &Nichter, M. (2017). Why women choose compounded bioidentical hormone therapy: lessons from a qualitative study of menopausal decision-making. BMC women’s health17(1), 97. https://doi.org/10.1186/s12905-017-0449-0

A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.

I feel this 46-year-old, 230lb woman is experiencing perimenopause. During perimenopause, you experience symptoms such as hot flashes, night sweats, and vaginal dryness.  This occurs prior to menopause with menstrual irregularities, hot flashes, and night sweats and continues until menopause starts or 12 months of amenorrhea occurs (Delamater, & Santoro, 2018).  It appears that up to 80% of women experience VMS during perimenopause, increasing over the transition from early to late menopausal transition (Delamater, & Santoro, 2018) Treatment for her symptoms would be hormone therapy, but she is not a candidate for this since she has a history of breast cancer in her family. “Estrogen and progesterone also promote the growth of some breast cancers, which are called hormone-sensitive (or hormone-dependent) breast cancers. Hormone-sensitive breast cancer cells contain proteins called hormone receptors

Links to an external site. (estrogen receptors Links to an external site., or ERs, and progesterone receptors

Links to an external site., or PRs) that become activated when hormones bind to them. The activated receptors cause changes in the expression of specific genes, which can stimulate cell growth” (Delamater, & Santoro, 2018) Other treatment alternatives are hypnoses, cognitive behavioral therapy, yoga, meditation, and others to help reduce symptoms.  There are also herbal products supplements, and vitamins (Johnson, Roberts, & Elkins, (2019). Anti-depressant medications such as SSRIs and SNRIs have been shown to reduce symptoms of perimenopause. Brisdelle (paroxetine mesylate) is an SSRI antidepressant. It’s the only antidepressant that’s FDA-approved for treating hot flashes (Johnson, Roberts, & Elkins, 2019). I would like her to start this medication and follow up in several weeks to see if this is helping with her symptoms.

I would also recommend some dietary changes and have a dietician work with her since she is overweight and has hypertension. I would recommend increasing her Norvasc to 20 mg QD and her Hydrochlorothiazide to 50mg QD and have her monitor her blood pressure daily to see if it starts to trend down. I would educate her on the need to exercise daily and eat a healthier diet with protein at each meal with more fruits and vegetables than carbohydrates. I would also order blood work for hormone levels and a plasma glucose (FPG) test, a hemoglobin A1c (A1c) test, and an oral glucose tolerance test (OGTT). She has a lot of risk factors for diabetes and some of her symptoms could be from unstable blood sugar (Niddk.Nih.gov, 2022).

NURS_6521_Week9_Discussion_Rubric

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Main Posting
Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3
First Response
Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response
Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed. .

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days
Total Points: 100