NUR 635 Topic 15 DQ 2

Sample Answer for NUR 635 Topic 15 DQ 2 Included After Question

Josh is a 17-year-old male who presents to your clinic with self-esteem issues. He is currently on a SSRI for depression. Upon talking to the patient, you find his acne has caused issues with his social life which contributes to his depression. Based on your visualization, his acne is prominent with many comedones, presence of nodules, and some scarring. Use the guidelines and relevant literature in your topic Resources to discuss the following: 

  • Based on Josh’s presentation, how would diagnose his acne (mild or moderate to severe)? Explain your rationale.
  • How do you manage treatment expectations to ensure maximum patient adherence?
  • What are some non-pharmacological approaches to the treatment of acne?
  • Based on the AAFP guidelines, what treatment strategy is considered first-line?
  • Be sure to include the drug, dose, frequency, and treatment length, and explain your rationale for choosing this medication. Include spectrum of coverage, if applicable, and mechanism of action.
  • Determine monitoring, side effects, and drug-drug interactions associated with each medication.
  • After 12 weeks of adherence to the medication regimen, Josh’s confidence has improved and now he wants to stop his SSRI today. How would you advise the patient?

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 15 DQ 2

Title: NUR 635 Topic 15 DQ 2

Based on Josh’s presentation, how would diagnose his acne (mild or moderate to severe)? Explain your rationale.

Mild acne is the lowest classification for acne. Your acne is categorized as mild when you routinely only have a few breakouts. While you may consistently have blackheads and bumpiness, you will only occasionally have an inflamed pimple. While annoying, these breakouts are considered minor. Mild acne can progress into a moderate or severe form of acne, so it is best to treat your mild acne (Regula, 2020). 

Moderate acne is characterized by noticeable breakouts. These breakouts often include not only blackheads and bumpy skin, but also papules and pustules. Papules are red and irritated looking bumps that can be painful to the touch. They are caused by hair follicles that become clogged by excess skin cells and oil. Papules often turn into pustules by becoming infected and filled with white, yellow, or cream-colored pus (Regula, 2020). 

How do you manage treatment expectations to ensure maximum patient adherence?

Hurdles to primary nonadherence where the medication is not even started, include lack of knowledge, confusion about usage, weak physician patient relationship, fear of adverse reactions, and cost. Secondary nonadherence hurdles where the medication is started but is not taken as directed include lack of results, complex regimens, side effects, busy lifestyle, forgetfulness, inconvenience, and psychiatric comorbidity. Solutions to these hurdles include treatment simplification, technology, and dynamic education (Tychayi, 2016).

What are some non-pharmacological approaches to the treatment of acne?

The most commonly used non-pharmacological therapies for acne vulgaris are laser and light-based therapies, chemical peels, microneedling, (micro)dermabrasion and (mechanical) lesion removal, and they are generally used for patients with chronic acne who require long term therapy (Torjesen, 2018).

Based on the AAFP guidelines, what treatment strategy is considered first-line?

First line treatment for acne includes benzoyl peroxide or topical retinoid. For moderate acne, an oral antibiotic can be added (AAD, n.d.). 

Antibiotic:

Doxycycline is an antibiotic appropriate for treatment, meaning it is a medication used to kill bacteria. Appropriate dose would be Doxycycline 50 mg to 100 mg orally twice a day. This medication is often limited to 3 months treatment to prevent resistance (Mikhail, 2023). 

Side effects/Monitoring:

The most common side effects are sun sensitivity and nausea. Since bacteria can become resistant, don’t take doxycycline for longer than 3 to 4 months, and use it with another medication, like benzoyl peroxide. If your acne doesn’t get better, talk with a provider about other acne treatment options (Mikhail, 2023). 

After 12 weeks of adherence to the medication regimen, Josh’s confidence has improved and now he wants to stop his SSRI today. How would you advise the patient?

I would advise josh, that when it comes to medicine, the healthcare providers are his biggest allies. I would tell him to have an open and honest conversation with the healthcare provider who prescribed the antidepressants about any skin side effects. They may be able to offer an alternative antidepressant or counteractive acne medication, such as prescription-strength retinoids (Gronich, 2023). 

References:

Acne clinical guideline. American Academy of Dermatology. (n.d.). https://www.aad.org/member/clinical-quality/guidelines/acne 

Mikhail, M. (2023, July 7). Doxycycline for acne: How long do side effects last?. GoodRx. https://www.goodrx.com/conditions/acne/doxycycline-for-acne-how-it-works 

Moradi Tuchayi S, Alexander TM, Nadkarni A, Feldman SR. Interventions to increase adherence to acne treatment. Patient Prefer Adherence. 2016 Oct 11;10:2091-2096. doi: 10.2147/PPA.S117437. PMID: 27784999; PMCID: PMC5067002.

Regula, C. (2021, March 17). Mild vs moderate acne: How to tell the difference: Vujevich dermatology. Vujevich Dermatology Associates. https://www.vucare.com/2020/11/06/mild-vs-moderate-acne/  Torjesen, I. (2020, November 13). The best and worst of acne treatment options. Dermatology Times. https://www.dermatologytimes.com/view/best-and-worst-acne-treatment-options

A Sample Answer 2 For the Assignment: NUR 635 Topic 15 DQ 2

Title: NUR 635 Topic 15 DQ 2

Acne vulgaris is a chronic skin disease involving the pilosebaceous follicles and overproduction of abnormal follicular epithelium, leading to lesions on the face, chest, or upper back (Oge et al., 2019).  In addition, based on Josh’s condition of prominent acne, many comedones, nodules, and scarring, the severity classifies him in severe cases (Oge et al., 2019).

I am managing treatment to ensure maximum patient outcome and focus on reassuring that acne conditions do not only happen to one patient or is the first time the condition presents in clinical practice and that results are not seen from one day to the next but is a process that takes time and improvement will be seen in due time.  Moreover, nonpharmacological management of acne can include overall protection from the sun, sleep quality, and physical activity in conjunction with the care plan regarding the patient burden, patient experience, factors that may affect adherence to treatment, comorbidities, and goal setting (Tan et al., 2021).

The first-line treatment for severe acne vulgaris is oral antibiotics, benzoyl peroxide, topical antibiotics, topical retinoids, or both (Hauk, 2017).

In prescribing for severe acne, several points need to be considered to provide the patient the opportunity to receive treatment in conjunction with the provider, adhere to medication, educate the patient, and emphasize the importance of notifying the clinician of expected side effects, adverse effects, and outcomes.  In addition, starting with the safest minocycline, 50mg, take one pill twice a day for six weeks religiously, and Retinoid Tretinoin 0.025% cre, am a thin film to be applied once daily in the evening for two (2) weeks only (Tan et al., 2021). 

Minocycline is indicated for adjunctive treatment for moderate to severe inflammatory acne by inhibiting protein synthesis by binding to 30S ribosomal subunit, causing inhibition of the binding of RNA transfer to mRNA-ribosome complex preventing of amino acids in growth chain well known for bacteriostatic (Rosenthal & Burchum, 2020).  Drug-drug interactions with specific metal ions, Ca++, Fe++, Mg++, Aluminum, and zinc, include milk products, supplements, most antacids, and digoxin.  Elimination is primarily in the urine of patients with kidney disease and is not recommended as the drug of choice; education is highly recommended to patients if diarrhea develops due to superinfection in GIT (Rosenthal & Burchum, 2020).

Tretinoin is derived from vitamin A and is used for mild to moderate acne.  It can cause sunburn and localized reactions, and sensitivity may induce blistering, peeling, crusting, and edema; therefore, educating the patient is highly recommended to follow up in 2 weeks for compliance and careful monitoring (Tan et al., 2021).

In patients with SSRI, the literature recommends that clinicians consider that antidepressants come into question in the starting, holding, continuing, or changing any form of antidepressant.  The help of a psychiatrist is needed to navigate this area for proper responsible management (McFarland et al., 2023).

References

Hauk, L. (2017).  Acne vulgaris: Treatment guidelines from the AAD.  American Family Physician, 95(11), 740–741.

McFarland, D., Merchant, D., Khandai, A., Mojtahedzadeh, M., Ghosn, O., Hirst, J., Amonoo, H., Chopra, D., Niazi, S., Brandstetter, J., Gleason, A., Key, G., & di Ciccone, B. L. (2023).  Selective serotonin reuptake inhibitor (SSRI) bleeding risk: Considerations for the consult-liaison psychiatrist.  Current Psychiatry Reports, 25(3), 113-124.  https://doi.org/10.1007/s11920-023-01411-1

Oge’, L. K., Broussard, A., & Marshall, M. D. (2019). Acne vulgaris: Diagnosis and treatment.  American Family Physician, 100(8), 475-484.

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

Tan, J., Alexis, A., Baldwin, H., Beissert, S., Bettoli, V., Del Rosso, J., Dréno, B., Gold, L. S., Harper, J., Lynde, C., Thiboutot, D., Weiss, J., & Layton, A. M. (2021). The personalized acne care pathway-recommendations to guide longitudinal management from the personalizing acne: Consensus of experts.  JAAD International, 5, 101-111.  https://doi.org/10.1016/j.jdin.2021.09.006

Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., Bowe, W. P., Graber, E. M., Harper, J. C., Kang, S., Keri, J. E., Leyden, J. J., Reynolds, R. V., Silverberg, N. B., Stein Gold, L. F., Tollefson, M. M., Weiss, J. S., Dolan, N. C., Sagan, A. A., . . . Bhushan, R. (2016).

Guidelines of care for the management of acne vulgaris.  Journal of the American Academy of Dermatology, 74(5), 945-973.e33.  https://doi.org/10.1016/j.jaad.2015.12.037