NURS 6521 Week 1: Assignment 1: Case Studies
Walden University NURS 6521 Week 1: Assignment 1: Case Studies– Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6521 Week 1: Assignment 1: Case Studies assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NURS 6521 Week 1: Assignment 1: Case Studies
Whether one passes or fails an academic assignment such as the Walden University NURS 6521 Week 1: Assignment 1: Case Studies depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NURS 6521 Week 1: Assignment 1: Case Studies
The introduction for the Walden University NURS 6521 Week 1: Assignment 1: Case Studies is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for NURS 6521 Week 1: Assignment 1: Case Studies
After the introduction, move into the main part of the NURS 6521 Week 1: Assignment 1: Case Studies assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NURS 6521 Week 1: Assignment 1: Case Studies
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NURS 6521 Week 1: Assignment 1: Case Studies
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NURS 6521 Week 1: Assignment 1: Case Studies
Scenario 1
The 52-year-old man developed drug-drug interaction. Drug-drug interactions affect the anticoagulation intensity and increase the risk of excessive bleeding among patients taking warfarin. Amiodarone has considerable interactions with several medications. Amiodarone use with warfarin results in potentiated effects of warfarin. It also prolongs the International Normalized Ratio (INR), which translates into an increased risk of bleeding. Evidence shows that co-administration of the two drugs results in the inhibition of warfarin metabolism via the blockage of the CYP enzyme in the liver (Miano et al., 2020). Desethlamiodarone is an active metabolite of Amiodarone that increases the anticoagulation effects of warfarin.
One of the changes that should be implemented in this case study is stopping warfarin administration. The provider should stop warfarin to prevent further adverse outcomes until the INR is normal (Wang et al., 2021). The second step would be the administration of Vitamin K. Vitamin K is the recommended antidote for warfarin toxicity, which reverses anticoagulation. Thirdly, the patient’s INR should be monitored closely. The aim is to detect any risks of adverse outcomes in the management of his condition (Miano et al., 2020). Lastly, an anticoagulant that does not interact with Amiodarone should be administered if the INR does not return to normal.
Scenario 2
Protein binding has a significant effect on drug availability. A change in blood protein concentration that binds drugs implies that healthcare providers should change their dosing regimes appropriately to prevent the risk of harm. Changes in the protein binding of a drug also affect the relationship between unconjugated concentrations of a drug and the drug’s total concentration in the blood. This relationship means that a slight change in the drug binding on the proteins affects the efficacy of the prescribed medications in the patient. It is also shown that drug-protein binding affects drug entry into body tissues, elimination, and metabolism (Celestin & Musteata, 2021). The effects include changes in the drug’s therapeutic effects as well as drug-induced side effects.
Some strategies should be considered for the patient in the case study. Firstly, healthcare providers should titrate the dose of the prescribed drugs to prevent adverse effects. Medications with high protein binding can cause adverse outcomes if dosing is not titrated. Secondly, the healthcare provider should adapt the client’s dosing based on the pharmacodynamics and pharmacokinetic properties of the drugs (Celestin & Musteata, 2021; Gorham et al., 2022). Thirdly, the patient should be followed to identify any adverse events and adjust the drug dosing appropriately for safety outcomes. For example, ceftriaxone’s effectiveness is largely concentration-dependent and time-dependent in destroying bacteria. Clinicians should monitor parameters such as white blood cell count and symptom changes to determine the effectiveness of ceftriaxone and adjust the dosage appropriately.
Scenario 3
The two drugs that are highly affected by the first-pass effect include cimetidine and buprenorphine. A prescriber can consider some options to counter the first-pass effect. One of them is administering the above drugs using alternative routes other than the gastrointestinal tract. The provider can consider other routes of drug administration such as inhalation, transdermal, nasal, or intravenous routes to counter the first pass effect. These routes are effective since the drug enters the bloodstream directly via the lungs or skin. The second consideration for healthcare providers is that the blood concentration of the drugs that undergo first-pass metabolism should be monitored. Close monitoring to ensure that the serum concentration of the drug is within its desired therapeutic windows for optimum efficacy. Thirdly, patients should be monitored for response to treatment. This includes relying on improvements in clinical symptoms or the development of any undesired effects from the treatments. The other consideration is that nurses and other healthcare providers must be aware that several doses of a drug might be required for the desired serum concentration to be reached (Herman & Santos, 2024; Maxwell, 2024). Therefore, a patient might be prescribed higher doses of the drug to ensure that the required serum concentration is reached.
Scenario 4
Atenolol is one of the drugs that are prescribed for hypertension. I will inform James that treatment adherence is important for the effective management of his high blood pressure. I will educate him that poor treatment adherence in hypertension increases the risk of other complications, including cardiomegaly, heart failure, stroke, myocardial infarction, and renal damage. I will also educate him about the importance of reminders to help him remain on course with his treatment (Algabbani & Algabbani, 2020). I will also educate him about the expected side effects of atenolol such as dizziness, fatigue, stomach pain, and diarrhea.
I will manage his medication by assessing any adverse effects that James has developed, which could be affecting his treatment adherence. Adverse events such as cough and shortness of breath should be determined since they can affect treatment adherence. I will also assess if the medication has been effective in controlling the blood pressure despite James’s non-adherence. The assessment data will guide James’s treatment plan. In addition, I will determine other factors such as forgetfulness, the presence of comorbidities, and the use of dietary supplements and complementary medicines, which affect treatment adherence among patients with hypertension (Chang et al., 2021).
References
Algabbani, F. M., & Algabbani, A. M. (2020). Treatment adherence among patients with hypertension: Findings from a cross-sectional study. Clinical Hypertension, 26(1), 18. https://doi.org/10.1186/s40885-020-00151-1
Celestin, M. N., & Musteata, F. M. (2021). Impact of Changes in Free Concentrations and Drug-Protein Binding on Drug Dosing Regimens in Special Populations and Disease States. Journal of Pharmaceutical Sciences, 110(10), 3331–3344. https://doi.org/10.1016/j.xphs.2021.05.018
Chang, S.-M., Lu, I.-C., Chen, Y.-C., Hsuan, C.-F., Lin, Y.-J., & Chuang, H.-Y. (2021). Behavioral Factors Associated with Medication Nonadherence in Patients with Hypertension. International Journal of Environmental Research and Public Health, 18(18), Article 18. https://doi.org/10.3390/ijerph18189614
Gorham, J., Taccone, F. S., & Hites, M. (2022). Ensuring target concentrations of antibiotics in critically ill patients through dose adjustment. Expert Opinion on Drug Metabolism & Toxicology, 18(3), 177–187. https://doi.org/10.1080/17425255.2022.2056012
Herman, T. F., & Santos, C. (2024). First-Pass Effect. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK551679/
Maxwell, S. R. (2024). Pharmacodynamics and pharmacokinetics for the prescriber. Medicine, 52(1), 1–10. https://doi.org/10.1016/j.mpmed.2023.10.008
Miano, T. A., Yang, W., Shashaty, M. G. S., Zuppa, A., Brown, J. R., & Hennessy, S. (2020). The magnitude of the warfarin-amiodarone drug-drug interaction varies with renal function: A propensity-matched cohort study. Clinical Pharmacology and Therapeutics, 107(6), 1446–1456. https://doi.org/10.1002/cpt.1819
Wang, M., Zeraatkar, D., Obeda, M., Lee, M., Garcia, C., Nguyen, L., Agarwal, A., Al-Shalabi, F., Benipal, H., Ahmad, A., Abbas, M., Vidug, K., & Holbrook, A. (2021). Drug–drug interactions with warfarin: A systematic review and meta-analysis. British Journal of Clinical Pharmacology, 87(11), 4051–4100. https://doi.org/10.1111/bcp.14833
ASSIGNMENT 1: CASE STUDIES
Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To Prepare:
- Review the case study posted in “Announcements” by your Instructor for this Assignment
- Review the information provided and answer questions posed in the case study
- When recommending a medication, write out a complete prescription for the medication
- Whenever possible, use clinical practice guidelines in developing your answers when possible
- Include at least three references to support your answer and cite them in APA format.
BY DAY 7 OF WEEK 1
Submit the Assignment.
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- To submit your completed assignment, save your Assignment as WK1Assgn1_LastName_Firstinitial
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Rubric
NURS_6521_Week1_Assignment1_Rubric
| Criteria | Ratings | Pts | |
|---|---|---|---|
| This criterion is linked to a Learning OutcomeScenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| Total Points: 100 | |||
NURS 6521 Week 1 Discussion Pharmacokinetics and Pharmacodynamics Sample
I work on a cardiac surgical unit. A majority of our patients have undergone coronary artery bypass surgery. Pain medications are important to facilitate recuperation and recovery post-operatively. Often, patients undergo surgery that have chronic pain issues and have a history of long term opioid use. Long term opioid use can influence a patient’s pharmacokinetic and pharmacodynamics process decreasing their responsiveness to post-operative acute pain management. It becomes a challenge to control the patient’s acute pain on top of the chronic pain.
Drug tolerance is defined as a decreased responsiveness to a drug as a result of repeated drug administration (Rosenthal & Burchum, 2021). Patients who are drug tolerant require higher doses of the medication to produce effects seen before tolerance developed. Pharmacodynamic tolerance refers to an adaptive process in response to chronic receptor occupation associated with long term drug administration. “Because increased drug levels are required to produce an effective response, the minimum effective concentration (MEC) of a drug becomes abnormally high” (Rosenthal & Burchum, 2021, p. 44). It can be challenging to manage these patient’s pain levels. Understanding the biological basis for their tolerance and need for increase dosing is vital. Also, it is important for practitioners to set aside biases and preconceived notions of those suffering from chronic pain. “Chronic pain is different from acute pain in that it alters the patient’s experience of pain physiologically and emotionally” (Dever, 2017).
A treatment plan should be individualized for these patients who are opioid tolerant in order to optimize pain control and management. It is imperative to involve a PharmD to help facilitate a pain regimen while in the hospital. Effective communication is essential surrounding goals of care as well as allowing the patients to verbalize concerns and fears in reference to potentially addictive substances. Also, providing a combination of medications with different mechanisms of action results in enhanced pain control with these patients (National Institutes of Health, n.d.).
References
Dever, C. (2017). Treating acute pain in the opiate-dependent patient. Journal of Trauma Nursing, 24(5), 292-299. https://doi.org/10.1097/jtn.0000000000000309
National Institutes of Health. (n.d.). Pain Consortium. https://www.painconsortium.nih.gov/sites/default/files/UW_Eric_PainManagementWithOUD_508C_0.pdf
Rosenthal, L., & Burchum, J. (2021). Lehne’s Pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences.