case study

Case Study: Prescribed Drugs with CAMs

Mr. X, a 42-year-old male presents to your primary care practice today complaining of low back pain.

History – Mr. X states that he has had chronic low back pain since he had a skiing accident about 10 years ago. Three days ago, he felt a pulling sensation in his lower back after moving some boxes. The pain intensity increased over the subsequent 24 hours and is now steady, aching in nature, at 3-4 out of 10. Mr. X also has Type2 diabetes, which is well controlled on metformin with a HGA1c of 5.6. He has a history of DVT 4 months ago for which he takes Coumadin, INR is WNL. He is followed by a specialist for this problem. He recently started taking two OTC products; kava kava for what he describes as “anxiety” and CoEnzyme Q10 on the advice of a friend.

Social – Mr. X is a smoker, 1 pack per week for 15 years. No alcohol or drug use. He is employed as an accountant and has medical insurance. He is divorced.
PE/ROS – Complains of low back stiffness and pain on movement with occasional spasms related to moving in certain directions. You note he has mild difficulty getting onto the exam table but gait is normal. He denies weakness/numbness/tingling of legs, no radiation, no change in bowel or bladder habits. BMI 27. All range of motion of the back is decreased by 25%. Straight leg lift is negative bilaterally, DTR intact. All other systems WNL.

Medications:

Metformin 1000mg ER one tab daily – Type II Diabetes controlled

Coumadin 5 mg. daily – Hx of DVT – Controlled

Kava Kava 50 mg. tid – Self-medication for anxiety

CoQ10 – 200 mg. daily. – Self-medication for unknown reason

1. Provide a diagnosis for the patient and your rationale for the diagnosis

2. Provide a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.

3. Comment on the use of OTC products in relation to Mr. X’s current chronic and acute disease diagnoses and medications. Include drug-drug interactions and side effect profiles.

4. Provide an education plan for Mr. X

5. Present this Assignment as a PowerPoint presentation with between 12 and 16 slides (not including opening slide and resource slide).

6. You will use the Narrative notes section of the presentation to include the majority of your evidentiary support of your treatment choices and education of family complete with in-text citations using APA formatting,

Due by the last day of Unit 9 at 11:59 p.m.

Assignment Requirements:

Before finalizing your work, you should:

· be sure to read the Assignment description carefully (as displayed above);

· consult the Grading Rubric (under Course Resources) to make sure you have included everything necessary; and

· utilize spelling and grammar check to minimize errors.

· Submit to and review results of Turnitin. Purdue University Global Student Conduct policy as it relates to plagiarism will be adhered to in this course.

Your writing Assignment should:

· follow the conventions of Standard English (correct grammar, punctuation, etc.);

· be well ordered, logical, and unified, as well as original and insightful;

· display superior content, organization, style, and mechanics; and

· utilize APA 7th edition formatting.

Rubric Title: MN553 Unit 9 Assignment Rubric

Assignment Criteria

Level III

Level II

Level I

Not Present

Criteria 1

Level III Max Points

Points: 8

Level II Max Points

Points: 6.4

Level I Max Points

Points: 4.8

Not Present

0 Points

Correctly diagnosing the patient

· A correct diagnosis is provided with supportive rationale from literature

· A correct diagnosis is provided without rationale

· Does not meet the Criteria

· Does not meet the criteria

Criteria 2

Level III Max Points

Points: 12

Level II Max Points

Points: 9.6

Level I Max Points

Points: 7.2

Not Present

0 Points

Prescribing a treatment plan

· An appropriate and specific treatment plan for the case study patient is provided with rationale from literature for treatment choices.

· A specific treatment plan is provided for the case study patient but is missing less than 50% of pharmacologic and non-pharmacologic treatment with rationale from literature for treatment choices

· A specific treatment plan is provided for the case study patient but is missing more than 50% of pharmacologic and non-pharmacologic treatment with rationale from literature for treatment choices; Or

· Rationale for treatment choices from literature are not provided

· Does not meet the criteria

Criteria 3

Level III Max Points

Points: 11

Level II Max Points

Points: 8.8

Level I Max Points

Points: 6.6

Not Present

0 Points

Over-the-counter medication use discussion

A thorough discussion of the kinetics and dynamics of OTC products is provided and a rationale for including or excluding them from the treatment plan is provided.

· Kinetics and dynamics of OTC products are discussed and are related to the patient's current meds/conditions but specific direction regarding continued use is not included

· Kinetics and dynamics of OTC products are discussed but not related to the patient's current meds/conditions.

· Does not meet the criteria

Criteria 4

Level III Max Points

Points: 8

Level II Max Points

Points: 6.4

Level I Max Points

Points: 4.8

Not Present

0 Points

Education plan

· A thorough education plan for the treatment plan is provided which includes principles of therapeutic communication.

· An education plan is provided which provides more than 50% of necessary information for the treatment plan and includes principles of therapeutic communication

· An education plan is provided but contains less than 50% of necessary information and includes principles or therapeutic communication OR

· Principles of therapeutic communication are not included

· Does not meet the criteria

Criteria 5

Level III Max Points

Points: 8

Level II Max Points

Points: 6.4

Level I Max Points

Points: 4.8

Not Present

0 Points

College-level academic writing

· Professional, peer-reviewed, advanced practice references are used

· Grammar and mechanics of writing demonstrate graduate level work

· Adheres to page number requirements

· The majority of references used are professional, peer-reviewed and advanced practice

· Errors in grammar or mechanics of writing are present but do not interfere with readability

· Adheres to page number requirements

· The minority of references used are professional, peer-reviewed and advanced practice

· Errors in grammar or mechanics of writing are present Which interferes with readability

· Does not adhere to page number

· Does not meet the criteria

Criteria 6

Level III Max Points

Points: 8

Level II Max Points

Points: 6.4

Level I Max Points

Points: 4.8

Not Present

0 Points

Citations and Formatting

· There is a strong attempt to cite all sources using APA style.

· Minor paper formatting errors may occur.

· Minor in-text citation errors may occur.

· All authorship is clear and retrievable.

· There is an overall attempt at APA formatting and citation style.

· Errors in formatting of citation or sources are present.

· All sources have some form of citation and all citations have a matching source.

· Citations generally make authorship clear.

· Major errors in citations or source formatting are present.

· Citation or source information may be missing or incorrect.

· Authorship may be unclear.

· Does not meet the criteria

Maximum Total Points

55

44

33

0

Minimum Total Points

45 points minimum

34 points minimum

1 point minimum

0

Power Point

Assignment

Create a Power Point

Purpose

This assignment will focus on developing a health policy analysis presentation that includes a problem statement, background, landscape, options, and recommendations from the week’s readings. The health policy analysis presentation is based on an identified healthcare issue in one’s local community. 

As Family Nurse Practitioner:

1. Research healthcare issues that have been identified in your local community. Develop a PowerPoint presentation with speaker notes. You will then use the PowerPoint during your Kaltura recording. Structure a health policy analysis presentation that addresses the following topics particular to your health problem:

· Problem Statement 

· Background 

· Landscape 

· Options 

· Recommendations 

Please provide FootNotes

2. Next, record your Kaltura presentation showing your PowerPoint and yourself speaking. Upload your Kaltura presentation into the week 4 assignment. How to use Kaltura resources are in Home/Resources/Technology Resources.

3. Posting your recording:

· Go to the week four assignment tab and hit Submit Assignment

· Use the Text Entry Tab. You will have the option of selecting the Kaltura icon.

· It will take you to your My Media Gallery and upload it from there.

Project Literature

 Using at least 1 current (within the past 5 years), relevant, peer-reviewed resources, create a literature review that does the following:

  • Describes the project’s topic, resources reviewed, and conclusions of each article.
  • Summarizes the principal findings of the research and their relevance to the project’s proposed outcomes.

Attached is a copy of Part 1 of this project thaty has been submitted related to medication errors. Please review to follow the related topic for literature review. 

NURSING

Introduction

Interprofessional collaboration is a critical aspect of a nurse’s work. Through interprofessional collaboration, practitioners and patients share information and consider each other’s perspectives to better understand and address the many factors that contribute to health and well-being (Sullivan et al., 2015). Essentially, by collaborating, health care practitioners and patients can have better health outcomes. Nurses, who are often at the frontlines of interacting with various groups and records, are full partners in this approach to health care.Reflection is a key part of building interprofessional competence, as it allows you to look critically at experiences and actions through specific lenses. From the standpoint of interprofessional collaboration, reflection can help you consider potential reasons for and causes of people’s actions and behaviors (Saunders et al., 2016). It also can provide opportunities to examine the roles team members adopted in a given situation as well as how the team could have worked more effectively.As you begin to prepare this assessment you are encouraged to complete the What is Reflective Practice? activity. The activity consists of five questions that will allow you the opportunity to practice self-reflection. The information gained from completing this formative will help with your success on the Collaboration and Leadership Reflection Video assessment. Completing formatives is also a way to demonstrate course engagement Note: The Example Kaltura Reflection demonstrates how to cite sources appropriately in an oral presentation/video. Your assessment will reflect on either a professional collaboration you experienced or a collaboration case study scenario that you imagine you experienced

References

Saunders, R., Singer, R., Dugmore, H., Seaman, K., & Lake, F. (2016). Nursing students’ reflections on an interprofessional placement in ambulatory care. Reflective Practice, 17(4), 393–402.Sullivan, M., Kiovsky, R., Mason, D., Hill, C., Duke, C. (2015). Interprofessional collaboration and education. American Journal of Nursing, 115(3), 47–54.

Demonstration of Proficiency

  • Competency 1: Explain strategies for managing human and financial resources to promote organizational health.
    • Identify how poor collaboration can result in inefficient management of human and financial resources supported by evidence from the literature.
  • Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
    • Reflect on an interdisciplinary collaboration experience noting ways in which it was successful and unsuccessful in achieving desired outcomes.
    • Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work more effectively together.
  • Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
    • Identify best-practice leadership strategies from the literature, which would improve an interdisciplinary team’s ability to achieve its goals.
  • Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
    • Communicate via video with clear sound and light.
    • The full reference list is from relevant and evidence-based (published within 5 years) sources, exhibiting nearly flawless adherence to APA format.

Professional Context

This assessment will help you to become a reflective practitioner. By considering your own successes and shortcomings in interprofessional collaboration, you will increase awareness of your problem-solving abilities. You will create a Kaltura video of your reflections, including a discussion of best practices for interprofessional collaboration and leadership strategies, supported by references to the literature.You may choose to reflect on a collaborative interprofessional project you worked on in your current or former place of practice, or you may choose to imagine that you worked on the collaborative interprofessional scenario presented in the Assessment 01 Supplement: Collaboration and Leadership Reflection Video [PDF] resource.

Scenario

As part of an initiative to build effective collaboration at a site where you work as a nurse, you have been asked to:

  • Reflect on an interprofessional collaborative project.
  • Examine what happened during the collaboration.
  • Identify positive aspects and areas for improvement.
  • Research best practice for interprofessional collaboration.
  • Use lessons learned from your research and experience to create a video reflection (5-10 minutes) that share suggestions for improving interprofessional collaboration that can be shared with leadership and colleagues.

Instructions

Using Kaltura, record a video (5–10 minutes) where you reflect on an interprofessional collaboration experience, proposing recommendations for how to improve interprofessional collaboration that can be shared with leadership and colleagues. Support these recommendations with references to the literature.The interprofessional project that you reflect on may be one that you collaborated on at your current or former place of practice, or you may choose to imagine you collaborated on the interprofessional project presented in the Assessment 01 Supplement: Collaboration and Leadership Reflection Video [PDF] Download Assessment 01 Supplement: Collaboration and Leadership Reflection Video [PDF]resource and reflect on that.Be sure that your assessment addresses the following criteria. Please study the scoring guide carefully so you will know what is needed for a distinguished score:

  • Reflect on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes.
    • Explain aspects of the collaboration that helped the team make progress toward relevant goals or outcomes.
    • Explain aspects of the collaboration that could have been improved.
  • Identify how poor collaboration can result in inefficient management of human and financial resources, citing supporting evidence from the literature.
    • Discuss the ways in which the interdisciplinary team did not collaborate effectively.
    • Discuss the negative implications for the human and financial resources of the interdisciplinary team and the organization as a whole.
    • Cite the literature for support.
  • Identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals, citing at least one author from the literature.
    • Identify at least one leadership best practice or strategy that you believe would improve the team’s ability to achieve their goals.
    • Identify the strategy and its source or author and provide a brief rationale for your choice of strategy.
    • Cite the literature for support.
  • Identify best-practice interdisciplinary collaboration strategies to help a team achieve its goals and work together, citing the work of at least one author.
    • Identify at least one best practice or strategy for interdisciplinary collaboration to help the team achieve its goals and work more effectively together.
    • Identify the strategy, its source, and reasons why you think it will be effective.
  • Communicate in a professional manner, is easily audible, and uses proper grammar. Format reference list in current APA style.
    • Submit an APA-formatted reference list for any sources that you cited specifically in your video or used to inform your presentation.
    • The Example Kaltura Reflection will show you how to cite scholarly sources in the context of an oral presentation.
  • Notes: 
  • Refer to the Campus tutorial Using Kaltura [PDF] as needed to record and upload your reflection.
  • If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact [email protected] to request accommodations.
  • If, for some reason, you are unable to record a video, please contact your faculty member as soon as possible to explore options for completing the assessment.

Additional Requirements

  • References: Cite at least 3 professional or scholarly sources of evidence to support the assertions you make in your video. Include additional properly cited references as necessary to support your statements.
  • APA Reference Page: Submit a correctly formatted APA reference page that shows all the sources you used to create and deliver your video.
    • You may wish to refer to the Campus APA Module for more information on applying APA style.
  • Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final Capstone course.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

  • Competency 1: Explain strategies for managing human and financial resources to promote organizational health.
    • Identify ways poor collaboration can result in inefficient management of human and financial resources, supported by evidence from the literature.
  • Competency 2: Explain how interdisciplinary collaboration can be used to achieve desired patient and systems outcomes.
    • Reflect on an interdisciplinary collaboration experience, noting ways in which it was successful and unsuccessful in achieving desired outcomes.
    • Identify best-practice interdisciplinary collaboration strategies to help a team to achieve its goals and work together more effectively.
  • Competency 4: Explain how change management theories and leadership strategies can enable interdisciplinary teams to achieve specific organizational goals.
    • Identify best-practice leadership strategies from the literature that would improve an interdisciplinary team’s ability to achieve its goals.
  • Competency 5: Apply professional, scholarly, evidence-based communication strategies to impact patient, interdisciplinary team, and systems outcomes.
    • Communicate via video with clear sound and light.
    • The full reference list is from relevant and evidence-based (published within 5 years) sources, exhibiting nearly flawless adherence to APA format.

Dietitian vs Nutritionist

Careers in Pharmacy and Dietetics

The lecture from our registered dietician touched on the point that a dietician and a nutritionist are very different in terms of their training and educational background. More specifically anyone can call themselves a nutritionist, there is no formal license or standard certification process for this designation.  However, as you now know, the path to become a registered dietician is much more complicated and comes with extensive educational, training and licensure/certification requirements.  Most people are surprised to find this out!

I’d like you to reflect on the difference and address each of the following questions:  (a) Did this information surprise you or did you already know the difference between the two designations?  (b) Have you or someone close to you had any personal experience with a nutritionist that you now question? (c) Will you look more closely at what kind of professional endorses the supplements, vitamins, etc. that you consider taking? Feel free to post any other thoughts related to this topic. Responses may be only one paragraph, but no more than two.

After posting your response, read your peers’ thoughts and reply to at least one classmate.

Be sure to review requirements for discussion board posts from the syllabus. Don’t forget to review the rubric prior to writing your post. 

PLEASE READ LECTURE TRANSCRIPTS ATTACHED

Pharm C Poly-pharmacy

Module 01 Content

1.

Top of Form

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

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

· Even more staggering than the CDC findings, currently more than half of Americans take two prescription medications, and 20 percent of Americans are on at least five prescription medications.

· More women than men receive prescription medications.

· Antidepressant prescriptions are more common among women than men and are most common among women ages 50 to 64.

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

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

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

The three parts of this assignment are:

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

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

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

When setting the environment for the interview, make sure the client (and others) are comfortable and you are comfortably seated facing the client. If possible, interview in a quiet place. Ask questions slowly giving the client time to answer. Pay attention to the client's hearing and ability to respond to the questions. Be sure your non-verbal communication demonstrates you are calm and relaxed.

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

1. What medications are you taking?

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

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

1. How long have you taken each of these medications?

1. Do you know why you are taking these medications?

1. Who told you about the medications and why do you need to take them? Were you able to ask any questions about the medications and if so were they answered so you understood what was said?

1. How do you feel about taking these medications?

1. Are you taking other medication purchased “over the counter” such as in a drug store? If so, what is it and why are you taking it?

1. How and when do you take your medications?

1. Do you have any difficulty taking the medications? If so, what happens and how do you deal with any difficulties?

1. Have you ever felt any uncomfortable feelings and body reactions to taking these medications? If so, what were they and how were they handled?

1. If you had the above reaction, did they take you off the medication and replace it with another medication? Were you told why this happened?

1. Do you have any reason not to take the medications?

1. Have you ever not taken the medication? If so, what was the reason?

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

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

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

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

1. List one goal for this teaching plan

1. Describe two to three teaching resources that might be used

1. Identify two teaching strategies that can be used based on the client interviewed

1. List specific client instructions regarding the medications what adverse reactions they should be aware of/and what to do

1. Identify at least one factor that may negatively influence adherence to the medications and how it can be overcome

1. If, appropriate, describe how the family might be involved in ensuring the client is on a proper and safe medication regime

Bottom of Form

key populations and ethical considerations

Week 3 Key Populations and Ethical Considerations

· Points 50

 This week, compose the key population and ethical considerations portion of your research. In this section, address the following: 

1. Describe the key populations in your study, both the participants and the researchers. 

2. Describe any ethical considerations in relation to recruitment of the participants and your plans to address them. 

3. Explain any ethical concerns related to data collection/intervention activities (these can include participants refusing participation or early withdrawal from the study and response to any predicable adverse events) and your plan to address them.

4. Describe the treatment of data, who has access to the research data and the protection of confidential material. 

5. Explain any conflicts of interest that may arise if your study were to be implemented. 

This section of your research should be 3–4 pages in length, written in APA format with cited references. 

Review the rubric for grading criteria.

Points Possible: 50

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Journal Entry

  • Refer to the “Population-Focused Nurse Practitioner Competencies” found in the Week 1 Learning Resources, and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.
  • Refer to your Clinical Skills Self-Assessment Form you submitted in Week 1, and consider your strengths and opportunities for improvement.

Learning From Experiences

  • Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
  • Reflect on the three (3) most challenging patients you encountered during the practicum experience. What was most challenging about each?
  • What did you learn from this experience?
  • What resources were available?
  • What evidence-based practice did you use for the patients?
  • What would you do differently?
  • How are you managing patient flow and volume?
  • How can you apply your growing skillset to be a social change agent within your community?

pn1 written 9

 

Your written assignment for this module is a worksheet that describes the following:

  • The differences between acute and chronic pain
  • Reasons that a patient would experience acute versus chronic pain and patient presentation examples of each.

informatics

Identify at least 3 key concepts from the selected part of the textbook and provide clear and correct explanations. Writing shows a clear logical link between those concepts. Synthesize information from multiple sources (lectures, readings, activities) and derive a conclusion in your own words. The terminology used is clearly defined. Notes: – The reflection should be 500-600 words. – A part of points will be taken off for each criterion that was not met. – A late submission will be subjected to a point reduction each day after the deadline until it runs down to zero.