NUR 635 Topic 1 DQ 2

Sample Answer for NUR 635 Topic 1 DQ 2 Included After Question

Based on the first letter of your last name, complete the case to which you are assigned:

  • If your last name starts with A through J: Case 1 Pediatric.
  • If your last name starts with K through S: Case 2 Geriatric.
  • If your last name starts with T through Z: Case 3 Pregnancy.

Case 1 Pediatric

The mother of a 43 lb. five-year-old boy is concerned that her child has a low-grade fever but is unable to get to the drug store to pick up ibuprofen. The mom wants to know if aspirin is okay to use for her child. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • Can aspirin be a safe and efficacious treatment option? Explain your rationale.
  • Based on the guidelines in the topic Resources, what information would you present to the mom to ensure safest efficacious drug regimen?

Case 2 Geriatric

Fred, a 79-year-old male, is having trouble sleeping, and his son tells him of a drug called Ativan that has helped him sleep. Fred wants to know if Ativan is a good option for his sleep disorder. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • Can Ativan be a safe and efficacious treatment option? Explain your rationale.
  • Based on the guidelines in the topic Resources, what is a strong non-pharmacologic approach for the treatment of insomnia? Include the components of therapy.

Case 3 Pregnancy

Kim is a 29-year-old pregnant female in her last trimester. She is suffering from a urinary tract infection. For urinary tract infections prior to being pregnant, she has been prescribed nitrofurantoin. She currently has leftover pills from her last prescription. Kim would like to know if it is okay to use this to start treatment. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • What is the Pregnancy Category of nitrofurantoin?
  • Can nitrofurantoin be a safe and efficacious treatment option? Explain your rationale.
  • Based on the committee opinion in the topic Resources, what do you recommend as a safer alternative? Be sure to include the dose, frequency, and duration with your recommendation.

Participate in follow-up discussion by reviewing the case discussed by classmates that is different than the one assigned to you.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2

A Sample Answer For the Assignment: NUR 635 Topic 1 DQ 2

Title: NUR 635 Topic 1 DQ 2

Case 1 Pediatric

The mother of a 43 lb.. five-year-old boy is concerned that her child has a low-grade fever but cannot get to the drug store to pick up ibuprofen. The mom wants to know if aspirin is okay for her child. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • Can aspirin be a safe and productive treatment option? Explain your rationale.
  • Based on the guidelines in the topic Resources, what information would you present to the mom to ensure the safest, most efficacious drug regimen?

The literature states that administering salicylate acids like aspirin and administration to children is contraindicated due to the history of influenza and chickenpox. Children develop what is known as Reyes Syndrome. In addition, the syndrome is rare. If given to younger than 18 y/o, there is a high risk for a mortality rate of 20-30% (Rosenthal & Burchum, J. R. 2020). Moreover, the acid-base disturbance results from the effects of using ASA on the respiratory system, causing CNS to stimulate breathing and, therefore, increase CO2 loss, producing respiratory alkalosis.

Information for the safest efficacious drug regimen is to educate on the child’s comfort and explain in detail what a true fever is and why a fever does not necessarily represent the severity of the illness. Furthermore, I would focus on the child’s comfort and not the fever as the culprit for the problem.

References

McCance, K. L., & Huether, S. E. (2018). Pathophysiology – e-book (8th ed.). Elsevier Health Sciences.

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.

A Sample Answer 2 For the Assignment: NUR 635 Topic 1 DQ 2

Title: NUR 635 Topic 1 DQ 2

Fever is a common occurrence for children that will concern parents. Cleveland Clinic defines a low-grade fever as body temperature between 99.5 and 100.3 Fahrenheit (37.5-38.3 Celsius) (n.d). Not all fevers require treatment. Children generally are tested for fever by parents due to symptoms of chills, malaise, fatigue, and other symptoms. Low grade fevers that do not cause symptoms may not require treatment. In this situation, a practitioner should assess the presumed cause of the fever and identify and potentially infectious diseases that require reporting. Aspirin is not the safest treatment for the patient, although it may effectively reduce fever. Aspirin use in children younger than 18-years old has been correlated with a rare, but serious condition named Reye Syndrome, which carries a mortality rate of 20-30% (Rosenthal & Burchum, 2020).

The causative relationship between aspirin and this condition is not directly supported by research. However, the CDC recommended that children and teenagers suspected of having influenza or chickenpox should avoid aspirin and other NSAIDs. Due to the severity of Reye syndrome, aspirin became a medication only for adults and is not routinely used in pediatrics (Rosenthal & Burchum, 2020). Tylenol is a better option for the pediatric patient with a fever. The mom should understand that aspirin could lead to potential harm and should not be given to the child.

References

Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.

Cleveland Clinic [CC]. (n.d.). What is considered a fever?. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/10880-fever

A Sample Answer 3 For the Assignment: NUR 635 Topic 1 DQ 2

Title: NUR 635 Topic 1 DQ 2

Can Ativan be a safe and efficacious treatment option? Explain your rationale.

Ativan (lorazepam) is a Benzodiazepine prescribed for treating anxiety, insomnia, and certain seizure disorders. Ativan augments the sedative effects of the neurotransmitter GABA in the brain, thereby reducing anxiety and enhancing relaxation (Rosenthal & Burchum, 2021). It carries a higher risk of tolerance and dependence on the novel variations of the CNS depressant due to its adverse effects and development. Many clinicians use it with extreme caution. Although Fred’s weight was not specified, Ativan is swiftly absorbed, broadly distributed, highly protein-bound, and has prolonged activity in obese patients. The fact that Benzodiazepines are metabolized in the liver and bio-transformed through conjugation makes them more tolerable for patients with impaired liver function, the elderly, and smokers. In contrast, those pharmaceuticals metabolized by oxidation may have prolonged effects in older individuals (Woo & Robinson, 2020).

Due to its high potency and rapid short-term action, Ativan is more likely to result in dependence, which can be both physical and psychological. In general, benzodiazepines should not be prescribed to elderly patients. The safety and efficacy of Ativan depend on proper dosing, low dose, careful monitoring, and a clear comprehension of the potential risks and benefits; it should be considered only as a short-term solution when other treatments have proved ineffective or inadequate (Woo & Robinson, 2020). Patients and families should not engage in in-depth discussions regarding the efficacy of Ativan for a particular condition and its benefits. 

Based on the guidelines in the topic Resources, what is a strong non-pharmacologic approach for the treatment of insomnia? Include the components of therapy.

The prevalence of chronic insomnia in our society is between 10 and 30 percent. It is a significant cost to society regarding healthcare expenditures and lost productivity. Research has shown that nonpharmacologic interventions can produce reliable and long-lasting improvements in the sleep patterns of patients with insomnia (Maness & Khan, 2015). Multiple components of cognitive behavior therapy for insomnia include cognitive psychotherapy, sleep hygiene, stimulus control, sleep restriction, paradoxical intention, and relaxation therapy. In cognitive psychotherapy, dysfunctional beliefs about sleep are identified, their validity is questioned, and they are replaced with more adaptive beliefs.

Education regarding sleep hygiene teaches patients about healthy sleeping behaviors. Stimulus control therapy enables patients to associate the bedroom with sleep and intercourse only, not other wakeful activities. Sleep restriction therapy aims to maximize sleep efficacy by limiting sleep duration. The paradoxical intent is to alleviate the patient’s dread of sleep by advising them to remain alert. Relaxation therapies are techniques taught to patients to reduce arousal levels that impede sleep. Cognitive behavior therapy consists of four to eight sessions per week, each lasting 60 to 90 minutes, and should be used more often as an initial treatment for chronic insomnia (Maness & Khan, 2015).

References

Maness. D, & Khan. M, (2015). American Family Physician. Nonpharmacologic Management of Chronic Insomnia. Retrieved from https://www.aafp.org/pubs/afp/issues/2015/1215/p1058.html

Rosenthal, L. D., & Rosenjack Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). 

Woo, T. & Robinson, M. (2020). Drugs Affecting the Central Nervous System. Pharmacotherapeutics for Advance Practice Prescribers (5thEds.), Philadelphia, PA: F.A. Davis Company