Sentinel N521 Advanced Pharmacology Assignment 2
Sentinel N521 Advanced Pharmacology Assignment 2
Assignment 2
R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to his CNP in his family practice clinic. He presents with progressive difficulty getting his breath while doing simple tasks. He is having difficulty doing any manual work, but he has no symptoms when working behind his desk.
He also reports a cough, fatigue, and weight loss. He has been treated for three respiratory infections a year for the past 3 years and feels like another one is developing now. On physical examination, you notice clubbing of his fingers, use of accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs. Pulmonary function studies show an FEV1 of 58%.
In a paper not to exceed six pages, excluding title and reference pages, please answer the following:
- What is R. W.’s likely diagnosis?
- What stage of disease does RW have?
- List specific pharmacotherapeutic treatment goals for R. W.
- What drug therapy would the CNP likely prescribe? Why?
- What are the parameters for monitoring the success of the therapy?
- Describe specific patient education based on the prescribed therapy.
- List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.
- What would be the choice for second-line therapy?
- What health promotion activities should be recommended for this patient?
- If RW was currently taking metoprolol for “headaches” would a change be recommended?
Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work.
|
Competency |
40 |
36 |
33 |
0 |
Points Earned |
| Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales | Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources. | Accurate discussion of nine case study questions presented with use of current evidence-based resources. |
Accurate discussion of 8 questions using current evidence-based resources |
Missing response to questions or inappropriate answers to questions. No use of evidence-based resources. |
/40
|
|
40 |
36 |
33 |
0 |
|
|
Evidence of
|
Well-defined evidence of
|
Evidence of critical thinking in prescriptive therapy, monitoring and adverse events. May have lacked a teaching plan or pathophysiologic discussion. |
Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology. |
Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking. |
/40
|
|
|
10 |
9 |
8 |
0 |
Points Earned |
| Grammar, spelling, and punctuation | There are no errors in grammar, spelling, and punctuation | There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors) | There are major errors in grammar, spelling, and punctuation .(4-5 errors) |
No content or more than 5 errors |
/10
|
|
10 |
9 |
8 |
0 |
|
|
| APA Compliance | The paper meets APA formatting guidelines | There are a few minor errors (1-3 errors) | There are significant errors in the format of the paper (4-5 errors) |
No content or more than 5 errors |
/10 |
| Total Points |
|
|
|
|
/100 |
- Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales
- Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources.
- Accurate discussion of nine case study questions presented with use of current evidence-based resources.
- Accurate discussion of 8 questions using current evidence-based resources
- Missing response to questions or inappropriate answers to questions. No use of evidence-based resources.
Evidence of critical thinking therapeutic decision-making in drug selection and evaluation of patient care pathophysiology and current pharmacological research assessment of the effectiveness of drug therapy formulation of clinical care and teaching plans for persons from diverse populations
Well-defined evidence of critical thinking therapeutic decision-making in drug selection and evaluation of patient care pathophysiology and current pharmacological research assessment of the effectiveness of drug therapy formulation of clinical care and teaching plans for persons from diverse populations
Evidence of critical thinking in prescriptive therapy, monitoring and adverse events. May have lacked a teaching plan or pathophysiologic discussion.
Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology.
Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking.
Points Earned
Grammar, spelling, and punctuation
- There are no errors in grammar, spelling, and punctuation
- There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors)
- There are major errors in grammar, spelling, and punctuation .(4-5 errors)
- No content or more than 5 errors
APA Compliance
- The paper meets APA formatting guidelines
- There are a few minor errors (1-3 errors)
- There are significant errors in the format of the paper (4-5 errors)
- No content or more than 5 errors
Total Points /100
Sentinel N521 Advanced Pharmacology Assignment 2 Discussion 4
R. S., a 65-year-old African-American man, was referred to the CNP in the hypertension clinic for evaluation of high BP noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year. Past medical history: Appendectomy 30 years ago, Peptic ulcer disease 10 years ago, Type 2 diabetes mellitus for 10 years; Family history: Father had hypertension; died of myocardial infarction at age 55,
Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60; Physical examination: Height 69 in, weight 108 kg; BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm); Pulse: 84 beats/min, regular; Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages;
Laboratory findings: Blood urea nitrogen: 24 mg/dL, Serum creatinine: 1.5 mg/dL, Glucose: 95 mg/dL, Potassium: 4.0 mEq/L, Total cholesterol: 201 mg/dL, High-density lipoprotein cholesterol: 30 mg/dL, Triglycerides: 167 mg/dL, Urinalysis: 1+ proteinuria; Electrocardiogram and chest radiograph: mild left ventricular hypertrophy; Social history: Tobacco: 35 pack years, Alcohol: pint of vodka/week, Coffee: 2 cups/day
Diagnosis: Stage 1 Hypertension
In this discussion forum:
- Discuss specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol
- Discuss what you would consider to be first-line pharmacotherapy for R. S., and why.
- Discuss the parameters for monitoring the success of the therapy.
- Discuss health promotion recommendations you would consider for R. S.
- Does the presence of Diabetes Mellitus impact your treatment selection?
Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria.
Sentinel N521 Advanced Pharmacology Assignment 2 Example Discussion 4 Approach
Specific therapy goals on the patient, in this case, R.S, include decreased blood pressure, decreased cholesterol, and lower cardiovascular disease risk (Arcangelo & Peterson, 2017). First-line therapy is influenced by age, ethnicity/race, and other medical conditions (Arcangelo & Peterson, 2017). To treat the diagnosed hypertension, R.S should be prescribed a diuretic, specifically a thiazide diuretic.
Being that R.S is of African American descent, he should be more responsive to monotherapy with the diuretic (Arcangelo & Peterson, 2017). The hypertension treatment needs to be considered in the presence of kidney issues. Arcangelo & Peterson (2017) state that the first line of treatment for dyslipidemia includes HMG-CoA reductase inhibitors or statins.
Monitoring a patient’s fasting lip levels for one to three months after therapy initiation is vital. If the LDL levels decrease, this is considered a success. A reduction of fifty percent is what is expected in a high-dose statin. A reduction of thirty percent should be seen with a moderate dose statin treatment Arcangelo & Peterson.
This patient has a diagnosis of diabetes. The goal in treating a patient in the presence of this condition and hypertension includes a blood pressure reading of less than 140/90 (Arcangelo & Peterson, 2017). Blood pressure needs to be measured at every visit. How a patient has been modifying their lifestyle should be readdressed. If a patient is not responding, a hypertension specialist’s referral may be needed (Arcangelo & Peterson 2017).
According to Arcangelo & Peterson (2017), African Americans are more prone to hypertension. R.S has a genetic predisposition to hypertension, diabetes, and hyperlipidemia. The patient should be educated at each visit on healthy lifestyle choices. R.S needs to change his diet and eating habits, maintain average body weight through exercise of at least one hundred and fifty minutes a week R.S should be educated on smoking and alcohol cessation, and a low sodium diet with a therapeutic plan should always be encouraged.
Arcangelo, V. P., Peterson, A. M., Wilbur, V. F., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: a practical approach. Wolters Kluwer.