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NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing

NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing Example Solution

Ethical and Legal Implications of Prescribing Drugs

As an advanced practice nurse prescribing drugs, you are responsible for the safety of your patients each day. The prescriber is responsible for ensuring that any medical intervention they propose will align with the ethical and legal guidelines. The nurse practitioner must be knowledgeable about the most recent rules governing advanced practice nurses with the power to prescribe.

According to Rosenthal and Burchum (2021), writing prescriptions should prioritize patient safety and minimize medication errors through thorough assessment, clear documentation, electronic prescribing systems, and ongoing monitoring. The prescriber should ensure that any intervention taken has to account for the patient’s wishes and those of the family members and the primary caregivers.

Ethical and Legal Implications

  1. Prescriber:

From the scenario, as an advanced nursing practitioner, prescribing medication makes the nurse face ethical and legal responsibilities. Ethically, the prescriber must prioritize AC’s best interests and respect his autonomy. The prescriber should consider the principle of beneficence by providing appropriate and necessary treatment.

They should also respect AC’s autonomy by ensuring his values and wishes are considered, even without advanced directives (Rosenthal & Burchum, 2021). Legally, the prescriber must follow applicable laws and regulations regarding informed consent, decision-making capacity, and end-of-life care.

  1. Pharmacist:

The pharmacist has ethical and legal obligations as well. Ethically, the pharmacist should prioritize patient welfare and respect the autonomy of AC. They should ensure that the prescribed medications are appropriate, safe, and effective. The pharmacist may also play a role in counseling the patient’s family about the potential benefits, risks, and alternatives to treatment options. Legally, the pharmacist must adhere to laws and regulations related to medication dispensing, patient privacy, and confidentiality (Rosenthal & Burchum, 2021).

  1. Patient (AC):

Although unresponsive and unable to communicate, AC has the ethical right to receive appropriate and compassionate care. The ethical principle of autonomy requires that AC’s values and wishes, as expressed by his family, be considered (American Geriatrics Society, 2019). If AC had previously expressed his wishes regarding end-of-life care, those should be respected. The healthcare team must act in his best interests if his wishes are unknown.

  1. Patient’s Family (wife and daughter):

The wife and daughter have emotional and ethical involvement in AC’s care. Ethically, the wife’s belief that AC would not want to live in his current state should be respected, as it aligns with the principle of autonomy. The daughter’s belief that AC should be kept alive raises questions about the balance between hope and futility. Ethical discussions and family meetings can help address their concerns, consider AC’s values, and reach a consensus regarding his care.

Strategies to Address Disclosure and Non-disclosure

  1. Open communication and shared decision-making: Engage in open dialogue with the wife, daughter, and other relevant stakeholders. Discuss the prognosis, treatment options, and potential outcomes. Please encourage them to express their concerns, values, and beliefs. By involving them in decision-making, you promote shared decision-making and respect for their autonomy (Rosenthal & Burchum, 2021).
  2. Respecting patient confidentiality: Maintain patient confidentiality and privacy throughout the discussions. Ensure that sensitive information is only shared with individuals who have a legitimate need to know. Familiarize yourself with the laws specific to your state regarding patient confidentiality and privacy, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States, and adhere to them.
  3. Exploring legal frameworks: Familiarize yourself with the legal framework in your state regarding disclosure and nondisclosure in healthcare. Laws may vary, but generally, healthcare professionals have a duty to disclose information to patients or their surrogates that is relevant to the patient’s condition and treatment decisions. However, laws also recognize exceptions where disclosure may not be appropriate, such as when it could cause serious harm to the patient or if the patient has explicitly requested nondisclosure (Rosenthal & Burchum, 2021).
  4. Involving an ethics committee or legal counsel: In complex situations with conflicting views, involving an ethics committee or seeking legal counsel can provide guidance and ensure compliance with legal and ethical obligations. These resources can help navigate the specific laws in your state and provide recommendations on how to address disclosure and nondisclosure appropriately.

Strategies to Guide My Decision Making

  1. Ethical reflection and consultation: Engaging in ethical reflection allows for a thoughtful examination of the situation, weighing the principles of autonomy, beneficence, and non-maleficence. Consulting with colleagues, an ethics committee, or a supervisor can provide different perspectives and support in decision-making. Discussing the ethical dilemma of disclosing the error with trusted individuals can help ensure a well-considered decision.
  2. Adherence to professional standards and guidelines: Utilizing professional standards, such as those set forth by nursing organizations, can provide a framework for decision-making. These standards emphasize the importance of patient safety, communication, and accountability. In this scenario, disclosing the error may align with professional standards and guidelines, as it promotes transparency, fosters trust with the patient and family and allows for shared decision-making.

Whether to disclose the error should be carefully considered, considering the potential impact on the patient, their family, and the healthcare team. Justification for disclosing the error may include promoting transparency, maintaining trust, and involving the patient and family in decision-making (Rosenthal & Burchum, 2021). However, it is important to consult legal and institutional policies to ensure compliance with disclosure requirements specific to the jurisdiction.

The Process of Writing Prescriptions

  1. Patient assessment and diagnosis: Conduct a thorough assessment of the patient, including their medical history, current symptoms, and any allergies or contraindications. Accurate diagnosis is crucial for prescribing the appropriate medication (Shojaei & Salari, 2020).
  2. Selecting the medication: Choose the most appropriate medicine based on the patient’s diagnosis, considering efficacy, safety, dosage form, and patient-specific factors (e.g., age, comorbidities).
  3. Determine dosage and frequency: Calculate the correct dosage and frequency of administration based on the patient’s age, weight, renal or hepatic function, and other relevant factors. Double-check calculations and refer to reliable references or prescribing guidelines.
  4. Write clear and legible prescriptions: Use clear and concise language when writing prescriptions, including the medication name, strength, dosage form, instructions for use, and duration of treatment. Avoid abbreviations or ambiguous terminology to minimize confusion.
  5. Electronic prescribing systems: Utilize electronic prescribing systems whenever possible, as they can help reduce errors by providing decision support, alerts for potential interactions or allergies, and automated dose calculations.
  6. Double-check and review: Review the prescription for accuracy and completeness before transmitting or handing it to the patient. Ensure there are no potential drug-drug interactions, duplications, or contraindications (Shojaei & Salari, 2020).
  7. Communication and patient education: Clearly communicate the prescription instructions to the patient or caregiver, ensuring they understand the medication regimen, potential side effects, and any necessary precautions.
  8. Ongoing monitoring: Regularly assess the patient’s response to the medication, monitor for adverse effects, and adjust the prescription as needed.

Conclusion

The case scenario presented ethical and legal implications for all stakeholders involved, including the prescriber, pharmacist, patient, and patient’s family. The conflicting perspectives regarding end-of-life care highlighted the importance of open communication, shared decision-making, and respecting patient autonomy. Strategies such as ethical reflection, adherence to professional standards, and consultation with ethics committees or legal counsel can guide decision-making in complex situations.

Additionally, the process of writing prescriptions should prioritize patient safety and minimize medication errors through thorough assessment, clear documentation, electronic prescribing systems, and ongoing monitoring. By considering the ethical and legal aspects while implementing strategies to minimize errors, healthcare professionals can provide compassionate and appropriate care in challenging situations.

References

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 Download Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767

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

Shojaei, A., & Salari, P. (2020). COVID-19 and off-label use of drugs: an ethical viewpoint. DARU Journal of Pharmaceutical Sciences, 28, 789-793. https://www.mdpi.com/1383694

NURS 6521 WEEK 1: AT A GLANCE BASIC PHARMACOTHERAPEUTIC CONCEPTS/ETHICAL AND LEGAL ASPECTS OF PRESCRIBING

INTRODUCTION

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

  • 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 SocietyDownload 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.

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

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

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

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

Introduction to Advanced Pharmacology

  • Meet Dr. Terry Buttaro, associate professor of practice at Simmons College of Nursing and Health Sciences as she discusses the importance of pharmacology for the advanced practice nurse.

Time Estimate: 8 minutes

Note: This media program is approximately 18 minutes.

Note: This media program is approximately 14 minutes.

NURS 6521 Week 1 Discussion

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.

BY DAY 3 OF WEEK 1

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.

Week 1 Discussion Sample

While working at a medical ward in my 4th year of practice, I encountered a 72-year-old male named Mr. Smith. The patient had been in the ward for over a month and presented with hypertension and chronic kidney disease. His blood pressure was through the roof as he had a history of non-compliance with medication regimens and a significant genetic predisposition to drug metabolism variations. The patient has been on antihypertensives but has no detectable elevated blood pressure changes.

Factors That May Have Influenced Mr. Smith’s Pharmacokinetic and Pharmacodynamic Responses

  1. Genetics and Pharmacogenetics: Mr. Smith may have had changed drug metabolism and clearance rates due to genetic differences in drug-metabolizing enzymes, such as cytochrome P450 enzymes. Higher medication concentrations and a higher likelihood of negative consequences may follow (Rosenthal & Burchum, 2021).
  2. Age: Given Mr. Smith’s age of 65, changes in drug absorption, distribution, metabolism, and excretion due to aging may take place. For instance, decreased renal function in CKD may impact medication clearance, potentially causing drug buildup and protracted effects.
  3. Pathophysiological Changes: Mr. Smith’s chronic kidney disease may have changed his pharmacokinetic characteristics, particularly for medications whose main route of elimination are the kidneys. Medication clearance may be lowered, and medication exposure may rise due to impaired renal function (American Geriatrics Society, 2019).
  4. Non-Compliance: The effectiveness of Mr. Smith’s prescription antihypertensive medicine may have been harmed by his prior history of non-compliance with medication regimens. Drug levels in the body can fluctuate due to inconsistent drug use, which can lessen the intended therapeutic effects.

Individualized Plan of Care:

Mr. Smith could have the individualized plan of care listed below based on the patient’s medical history and contributing factors:

  1. Pharmacogenetic testing should be carried out to find particular genetic variants that could affect medication metabolism. The likelihood of adverse drug reactions can be decreased by using this information to help with dosage modifications and medication selection.
  2. Individualized Dosing: Change the antihypertensive drug dosage based on Mr. Smith’s renal function and pharmacokinetic data. Regular medication level monitoring and renal function testing are essential for appropriate dosing.
  3. Patient Education and Counseling: Stress to Mr. Smith the value of drug compliance. Inform him of the dangers of disobeying instructions and the advantages of constantly following his prescribed drugs (Rosenthal & Burchum, 2021).
  4. Use a multidisciplinary approach to manage Mr. Smith’s chronic kidney illness and monitor his renal function. The effectiveness of the treatment should be checked frequently, and the prescription schedule should be changed as necessary.

References

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 Download Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767

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

NURS 6521 Week 1 Assignment 2 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.

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.

Please use the following scenario for this assignment:

  • AC is a 72-year-old male who is admitted to your ICU after suffering a massive stroke that has left him unresponsive and unable to communicate.  He is currently on a ventilator.  His wife of 48 years is available along with their one adult daughter.  The wife informs you that they don’t have any advanced directives, but she is “pretty sure her husband would not want to live like this.”  However, their daughter is adamant her dad would want to be kept alive in case there is any chance to come out of this.

Talk to you all soon!

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.

BY DAY 7 OF WEEK 1

Write a 2- to 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 errors.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632.). All papers submitted must use this formatting.

Rubric – NURS_6521_Week1_Assignment_Rubric

NURS_6521_Week1_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeExplain the ethical and legal implications of the scenario you selected on all stakeholders involved such as the prescriber, pharmacist, patient, and the patient’s family.

25 to >22.25 pts

Excellent

The response accurately and thoroughly explains in detail the ethical and legal implications of the scenario selected on all stakeholders involved. … The response includes accurate, clear, and detailed explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

22.25 to >19.75 pts

Good

The response explains the ethical and legal implications of the scenario selected on all stakeholders involved. … The response includes accurate explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

19.75 to >17.25 pts

Fair

The response inaccurately or vaguely explains the ethical and legal implications of the scenario selected for all stakeholders involved. … The response includes vague explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

17.25 to >0 pts

Poor

The response vaguely and inaccurately explains the ethical and legal implications of the scenario selected for all stakeholders involved, or the response is missing. … The response vaguely and inaccurately explains how these implications affect the prescriber, pharmacist, patient, and the patient’s family, or is missing.

25 pts

This criterion is linked to a Learning OutcomeDescribe strategies to address disclosure and nondisclosure as identified in the scenario selected. Be sure to reference laws specific to your state.

20 to >17.8 pts

Excellent

An accurate, detailed, and clear description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided. … The response includes specific, detailed, and accurate reference to state laws related to the scenario.

17.8 to >15.8 pts

Good

An accurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided. … The response includes accurate reference to state laws related to the scenario.

15.8 to >13.8 pts

Fair

A vague or inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided. … The response includes inaccurate or vague reference to state laws related to the scenario.

13.8 to >0 pts

Poor

A vague and inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided, or is missing. … The response includes vague and inaccurate reference to state laws related to the scenario, or is missing.

20 pts

This criterion is linked to a Learning OutcomeExplain 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.

20 to >17.8 pts

Excellent

The response accurately and thoroughly explains in detail at least two strategies that an advanced practice nurse would use to guide decision making in the scenario. … The response accurately and completely explains whether they would disclose the error, including an accurate, detailed, and clear justification for the explanation provided.

17.8 to >15.8 pts

Good

The response accurately explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario. … The response accurately explains whether they would disclose the error, including an accurate justification for the explanation provided.

15.8 to >13.8 pts

Fair

The response inaccurately or vaguely explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario, or only explains one strategy. … The response inaccurately or vaguely explains whether they would disclose the error, including a justification that is vague, inaccurate, or misaligned to the explanation provided.

13.8 to >0 pts

Poor

The response inaccurately and vaguely explains only one strategy that an advanced practice nurse would use to guide decision making in the scenario, or is missing. … The response inaccurately and vaguely explains whether they would disclose the error, with no justification provided, or is missing.

20 pts

This criterion is linked to a Learning OutcomeExplain the process of writing prescriptions including strategies to minimize medication errors.

20 to >17.8 pts

Excellent

The response provides an accurate, detailed, and thorough explanation of the process of writing prescriptions, including detailed strategies to minimize medication errors.

17.8 to >15.8 pts

Good

The response provides an accurate explanation of the process of writing prescriptions, including some strategies to minimize medication errors.

15.8 to >13.8 pts

Fair

The response provides an inaccurate or vague explanation of the process of writing prescriptions, including inaccurate or vague strategies to minimize medication errors.

13.8 to >0 pts

Poor

The response provides an inaccurate and vague explanation of the process of writing prescriptions, including inaccurate and vague strategies to minimize medication errors, or is missing.

20 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

5 to >4.45 pts

Excellent

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

4.45 to >3.95 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.95 to >3.45 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

3.45 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.45 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

4.45 to >3.95 pts

Good

Contains a few (1–2) grammar, spelling, and punctuation errors

3.95 to >3.45 pts

Fair

Contains several (3–4) grammar, spelling, and punctuation errors

3.45 to >0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

5 to >4.45 pts

Excellent

Uses correct APA format with no errors

4.45 to >3.95 pts

Good

Contains a few (1–2) APA format errors

3.95 to >3.45 pts

Fair

Contains several (3–4) APA format errors

3.45 to >0 pts

Poor

Contains many (≥ 5) APA format errors

5 pts

Total Points: 100

NURS 6521 Module 2: Cardiovascular and Respiratory Systems

NURS 6521 Week 1 EmmaGarcia Ethical and Legal Aspects of Prescribing

MODULE 2: AT A GLANCE – CARDIOVASCULAR AND RESPIRATORY SYSTEMS

WEEK 2

WEEK 3

WHAT’S HAPPENING THIS MODULE?

Module 2: Cardiovascular and Respiratory Systems is a 2-week module, Weeks 2 and 3 of the course. In this module, you will examine how patient factors may influence pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics used in the treatment of cardiovascular and respiratory disorders. You will also explore and suggest drug therapy plans for asthma and analyze the stepwise approach for asthma treatment and management.

INTRODUCTION

Alterations of the cardiovascular system can cause serious adverse events and may lead to death when not treated in a timely and safe manner. Unfortunately, many patients with cardiovascular disorders are unaware until complications appear. In clinical settings, patients often present with symptoms of several cardiovascular disorders, making it essential for you, as the advanced practice nurse, to be able to recognize these symptoms and recommend appropriate drug treatment options.

This week, you examine the impact of patient factors that may lead to changes in pharmacokinetic and pharmacodynamic processes on patient drug therapy for cardiovascular disorders. You also explore ways to improve drug therapy plans for cardiovascular disorders based on patient factors and overall health needs.

LEARNING OBJECTIVES

Students will:

  • Analyze the influence of patient factors on pharmacokinetic and pharmacodynamic processes
  • Analyze the impact of changes in pharmacokinetic and pharmacodynamic processes on patient drug therapies
  • Evaluate drug therapy plans for cardiovascular disorders

PHARMACOTHERAPY FOR CARDIOVASCULAR DISORDERS

…heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…

—Murphy et al., 2018

Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.

As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.

Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db328.htm

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare

  • Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
  • Review the case study assigned by your Instructor for this Assignment.
  • Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
  • Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
  • Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
  • Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

BY DAY 7 OF WEEK 2

Write a 2- to 3-page paper that addresses the following:

  • Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
  • Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
  • Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632Links to an external site.). All papers submitted must use this formatting.

NURS_6521_Week2_Assignment_Rubric

NURS_6521_Week2_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeExplain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.

25 to >22.5 pts

Excellent

The response accurately and completely explains in detail how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.

22.5 to >19.75 pts

Good

The response provides a basic explanation of how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.

19.75 to >17.25 pts

Fair

The response inaccurately or vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient.

17.25 to >0 pts

Poor

The response inaccurately and vaguely explains how the factor selected might influence the pharmacokinetic and pharmacodynamic processes in the patient, or is missing.

25 pts

This criterion is linked to a Learning OutcomeDescribe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.

30 to >26.7 pts

Excellent

The response accurately and completely describes in detail how changes in the processes might impact the patient’s recommended drug therapy. … Accurate, complete, and aligned examples are provided to support the response.

26.7 to >23.7 pts

Good

The response accurately describes how changes in the processes might impact the patient’s recommended drug therapy. … Accurate examples may be provided to support the response.

23.7 to >20.7 pts

Fair

The response inaccurately or vaguely describes how changes in the processes might impact the patient’s recommended drug therapy. … Inaccurate or vague examples are provided to support the response.

20.7 to >0 pts

Poor

The response inaccurately and vaguely describes how changes in the processes might impact the patient’s recommended drug therapy, or is missing. … Inaccurate and vague examples may be provided to support the response, or is missing.

30 pts

This criterion is linked to a Learning OutcomeExplain how you might improve the patient’s drug therapy plan, and explain why you would make these recommended improvements.

30 to >26.7 pts

Excellent

The response accurately and clearly explains in detail how to improve the patient’s drug therapy plan. … The response includes an accurate and detailed explanation to support the recommended improvements.

26.7 to >23.7 pts

Good

The response accurately explains how to improve the patient’s drug therapy plan. … The response may include an accurate explanation to support the recommended improvements.

23.7 to >20.7 pts

Fair

The response inaccurately or vaguely explains how to improve the patient’s drug therapy plan. … The response may include an inaccurate, vague, or misaligned explanation to support the recommended improvements.

20.7 to >0 pts

Poor

The response inaccurately and vaguely explains how to improve the patient’s drug therapy plan, or is missing. … The response may include an inaccurate and vague explanation to support the recommended improvements, or is missing.

30 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

5 to >4.45 pts

Excellent

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

4.45 to >3.95 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.95 to >3.45 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

3.45 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.45 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

4.45 to >3.95 pts

Good

Contains a few (1–2) grammar, spelling, and punctuation errors

3.95 to >3.45 pts

Fair

Contains several (3–4) grammar, spelling, and punctuation errors

3.45 to >0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

5 to >4.45 pts

Excellent

Uses correct APA format with no errors

4.45 to >3.95 pts

Good

Contains a few (1–2) APA format errors

3.95 to >3.45 pts

Fair

Contains several (3–4) APA format errors

3.45 to >0 pts

Poor

Contains many (≥ 5) APA format errors

5 pts

Total Points: 100

LEARNING RESOURCES

Required Readings

  • Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants(2nd ed.) St. Louis, MO: Elsevier.
    • Chapter 33, “Review of Hemodynamics” (pp. 285–289)
    • Chapter 37, “Diuretics” (pp. 290–296)
    • Chapter 38, “Drugs Acting on the Renin-Angiotensin-Aldosterone System” (pp. 297–307)
    • Chapter 39, “Calcium Channel Blockers” (pp. 308–312)
    • Chapter 40, “Vasodilators” (pp. 313–317)
    • Chapter 41, “Drugs for Hypertension” (pp. 316–324)
    • Chapter 42, “Drugs for Heart Failure” (pp. 325–336)
    • Chapter 43, “Antidysrhythmic Drugs” (pp. 337–348)
    • Chapter 44, “Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels” (pp. 349–363)
    • Chapter 45, “Drugs for Angina Pectoris” (pp. 364–371)
    • Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)

Required Media

Cardiovascular Disorders

[Music] One of the missions

of this course is to straddle the basic sciences

and the clinical sciences. Many years ago,

Sir William Osler said, “One cannot become

a competent clinician “without the full knowledge

of human physiology “and pathology. “Without it,

one flounders along “in an aimless fashion,

never able to gain “an accurate conception

of disease, “practicing a sort

of popgun pharmacy, “hitting now the malady

and again the patient, he himself

not knowing which.” This week,

Dr. Norbert Myslinski examines how categories of drugs

working through different mechanisms can provide

a synergistic effect creating more treatment options. So often in hospitals

and the doctors’ offices and also in medical schools

and nursing schools and dental schools,

there is this dichotomy between the two. I mean, you first learn

the basic sciences, then you forget about those

and you go to the clinics, I think you learn

the real stuff, but we want to do

with this course is to produce a bridge between the two. And make the understanding

of the clinical portions more relevant by knowing

the basic science– knowing the basic science

that we have. Another way in which groups

are important is synergism. In pharmacology,

we have a concept where the effect

of two different drugs is greater than the sum

of the individual drugs and which is very important

when you combine different drugs and especially when you have

groups of drugs or categories that work via

different mechanisms of action. You may have a same end result

of different categories of drugs, but they work

via different mechanisms. And if you do that,

you’re more likely to get a synergistic effect

than if they all worked via the same mechanism. Some drugs work

via same mechanism no matter what

their effects are, okay? For instance, aspirin. Aspirin has many effects,

all right? Aspirin is an analgesic

that alleviates pain. Aspirin is anti-inflammatory,

alleviates inflammation. Aspirin is an anticoagulant

for the blood. Aspirin also is antipyretic. It decreases

body temperature, okay? But how does it do it? It has many effects. By the way, all drugs

have multiple effects. No drug only has one effect. All drugs have

more than one effect. But how does aspirin do

all these different effects? Via the same mechanism. And that’s

through the inhibition of a certain compound

in the body called prostaglandins. So inhibition of the synthesis

of prostaglandins produces all of them. Okay? There are many different types

of prostaglandins and therefore we have

different effects in there, Okay? So if we have

two different drugs, they work via the inhibition

of prostaglandins. Say, aspirin and Tylenol, right? They’re not going to have

a synergistic effect. They’ll have an additive effect,

right? But if you have, for instance,

a narcotic like morphine, okay? And then you also have Tylenol,

you can have a synergistic effect

with those two. Although with Tylenol

and aspirin, there is a ceiling. You can take

two or three tablets and that’s the maximum

pain relief you’re going to get. No matter if you take five

or 10 after that, you may have gastric distress,

but it’s more of an effect, it’s a ceiling. With morphine though

there is no ceiling. You just keep going,

going, going, you get more

and more pain relief, you know, until your respiration

shuts down and you die. So if we look at hypertension,

that silent killer. That’s one disorder

that we have a wealth of groups and categories of drugs working

via many different mechanisms. So we can have

a very nice synergistic effect. We can tailor-make

their pharmacotherapy, you know, so they can control

their blood pressure with the least amount

of side effects and they can function

in society. For example, you have

your ACE inhibitors, you have

your angiotensin inhibitors, you have your beta-blockers,

you have your calcium-channel blockers,

you have your diuretics, all of them can

reduce blood pressure, all of them work

via different mechanisms. There are two types

of blood vessels that go up, which is the carotids

and the vertebrals and then they go into

a little area here and distributed throughout

the brain and one of the most

common causes of disability that we have is stroke. Now, stroke is when you have

a deprivation of oxygen going to a part of the brain. And that’s usually

due to one of three things. Either there is a buildup

of a clot in that blood vessel, a primary site,

so the blood stops going to that area

or you have a clot that breaks off

from a different part of your body, more likely

from the left side of heart because you may have

atherosclerosis, build up of fatty tissues

and clots there and if one breaks off,

it can go into your brain and to clog a blood vessel,

that will be quick or you can have

a weak blood vessel wall so that it blows up

like a balloon, a balloon is aneurysm

and eventually it bursts and when it bursts

then you have a stroke in that part

of the area of brain. Now, the symptoms of a stroke

on many patients that nurses treat

for chronic time periods, the symptoms of a stroke

can be quite varied. You know, as many functions

that are functions of the brain depending upon

where the stroke is, depending upon

where the stroke is, okay? For instance, if it happens here

at the back of the brain, you’ll have a lot

of visual symptoms because this is where

the brain processes visual information,

occipital lobes. If you have one over here

in the temporal lobes, that process is hearing, okay? So you’d have

hearing problems, okay? If you have a stroke

that affects this part over here,

this is somatosensory cortex, you may have a problem

with the feeling, touch, and pressure

in different parts of your body. Over here is the motor cortex

and that has to do with movement. So you may have problems

with movement of your body. Okay, so it all depends upon

where that injury is and it’s very interesting

because when there is a stroke, the main part dies and then

the other parts around it shut down and unless

treatment is given quickly and drugs can be given that can

dissolve a clot real quickly, okay, the part

that sort of are not dead yet, but they are affected

around there if not treated quickly

then that part may also die. And so when you first

have a stroke your symptoms involve

not only the dead part, but also the part back here

sort of shut down, all right? If you’re treated quickly,

if you have the signs of a stroke you have

what we call a brain attack then you get right there

to the emergency center, you can dissolve the clot,

and then you can have reversal of some of the symptoms. Like dysfunction of all

these ones around, the dysfunctional ones can come

back and we can have reversal of the symptoms, but if you

don’t get the treatment, these will eventually die too

and the others– those symptoms will stay around

for a very long time. And so it all depends upon

where the dysfunction is and that determines

what kind of symptoms we have. Captioning performed by

Aegis Communications

NURS 6521 Week 3 Assignment Instructions – Asthma and Stepwise Management

INTRODUCTION

Asthma and chronic obstructive pulmonary disease (COPD) are significant public health burdens. Currently, more than 25 million people in the United States have asthma (HealthyPeople.gov, 2019). As an advanced practice nurse, you will likely encounter patients who will present with respiratory disorders, including asthma or COPD. Understanding specific treatment protocols as well as the types of pharmacotherapeutics used to treat respiratory disorders is important to ensure the effective and safe delivery of advanced nursing practice.

This week, you will evaluate drug therapy plans for patients who present with asthma and analyze the stepwise approach to asthma treatment and management from a patient in your professional practice.

Reference: HealthyPeople.gov. (2019). Respiratory diseases. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/respiratory-diseasesLinks to an external site.

LEARNING OBJECTIVES

Students will:

  • Evaluate drug therapy plans for asthma
  • Assess the impact of asthma treatments on patients
  • Analyze the stepwise approach to asthma treatment and management

ASTHMA AND STEPWISE MANAGEMENT

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.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

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.

BY DAY 7 OF WEEK 3

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.

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK3Assgn_LastName_Firstinitial
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

LEARNING RESOURCES

Required Readings

  • Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants(2nd ed.) St. Louis, MO: Elsevier.
    • Chapter 62, “Drugs for Asthma and Chronic Obstructive Pulmonary Disease” (pp. 557–579)
    • Chapter 63, “Drugs for Allergic Rhinitis, Cough, and Colds” (pp. 580–588)
  • Document:APA Presentation TemplateDownload APA Presentation Template

Required Media

Note: This media program is approximately 14 minutes.

Note: This media program is approximately 10 minutes.

Optional Resources

This web resource presents guidelines for diagnosing and managing asthma and outlines treatment recommendations for specific age groups.

NURS_6521_Week3_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome Describe the 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.

30 to >26.7 pts

Excellent

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.

26.7 to >23.7 pts

Good

The presentation accurately describes the long-term control and quick relief options for the asthma patient from their practice. … The presentation accurately describes the impact these drugs might have on their patient.

23.7 to >20.7 pts

Fair

The presentation inaccurately or vaguely describes the long-term control and quick relief options for the asthma patient from their practice. … The presentation inaccurately or vaguely describes the impact these drugs might have on their patient.

20.7 to >0 pts

Poor

The presentation inaccurately and vaguely describes the long-term and quick relief options for the asthma patient from their practice, or is missing. … The presentation inaccurately and vaguely describes the impact these drugs might have on their patient, or is missing.

30 pts

This criterion is linked to a Learning OutcomeExplain the stepwise approach to asthma treatment and management for your patient.

30 to >26.7 pts

Excellent

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

26.7 to >23.7 pts

Good

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

23.7 to >20.7 pts

Fair

The presentation inaccurately or vaguely explains the stepwise approach to asthma treatment and management for their patient.

20.7 to >0 pts

Poor

The presentation inaccurately and vaguely explains the stepwise approach to asthma treatment and management for their patient.

30 pts

This criterion is linked to a Learning OutcomeExplain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

30 to >26.7 pts

Excellent

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.

26.7 to >23.7 pts

Good

The presentation accurately explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. … The presentation provides accurate examples to support the explanation provided.

23.7 to >20.7 pts

Fair

The presentation inaccurately or vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. … The presentation provides inaccurate or vague examples to support the explanation provided.

20.7 to >0 pts

Poor

The presentation inaccurately and vaguely explains how stepwise management assists health care providers and patients in gaining and maintaining control of the disease, or is missing. … The presentation provides inaccurate and vague examples to support the explanation provided, or is missing.

30 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

5 to >4.45 pts

Excellent

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

4.45 to >3.95 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.95 to >3.45 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

3.45 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.45 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

4.45 to >3.95 pts

Good

Contains a few (1–2) grammar, spelling, and punctuation errors

3.95 to >3.45 pts

Fair

Contains several (3–4) grammar, spelling, and punctuation errors

3.45 to >0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5 pts

Total Points: 100

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