NR 565 Week 1: Building A Community

Sample Answer for NR 565 Week 1: Building A Community

As part of NR 565 Week 1: Building A Community, I watched the Netflix series too. It is crazy how the hospital was going to let him go so they could get the funding they needed. I bet that was sad but very interesting working on that case. Our system needs a lot of work. Look at the case with RaDonda Vaught giving the wrong medication which led to the death of a patient. From what I got out of it, the hospital did not report what happened and when it got out they went after her when she reported it to the hospital right away. She should have been more careful and was negligent, but the hospital also had flaws that led to the incident as well. 

My name is Autumn, I am from Maryland but moved to Pennsylvania about two years ago. I have been a psychiatric nurse for three years and truly do enjoy it. When I am not working, I enjoy drawing, going for walks, and spending time with my pets. I also really enjoy traveling when I have time. I am choosing to become a nurse practitioner and specializing in psych because I want to contribute to my patients care as much as possible and help them achieve the best outcome. I find psych very interesting and enjoy growing my knowledge in this area, I also want to help contribute to the shortage of providers in the mental health field and help decrease the stigma around mental health. Along with my new role comes much autonomy and sometimes that can be stressful however I look forward to this new chapter and the growth that comes along with it. I am the type of person that loves to be challenged. I know that prescribing medications is an important role of the nurse practitioner  and I look forward to gaining more knowledge in pharmacology so I can educate and work with my patients when prescribing them medications.

I look forward to working with everyone!

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Sample Answer 2 for NR 565 Week 1: Building A Community

My name is Heidi. I live in the far right corner of the United States in the smallest state in the union called Rhode Island. I have been a nurse for 8 years and prior to becoming a nurse, I was a nursing assistant for nearly twelve years.

My experience ranges from med surge to free standing inpatient hospice unit, nurse case manager for hospice and now I am the charge nurse of a small, private family owned nursing home. Hospice will always have my heart; however, I am truly enjoying working in long term care with the geriatric population.

Free time. What is that? I feel like I do not have much downtime these days. I do enjoy cooking, traveling, going to the beach and spending time with my family. I have a wonderful boyfriend and 11-year-old bonus son. We have 3 kitties and my pup Stella who is my absolute baby.

Since I was a young child, I was always helping “heal” or care for others. Prior to becoming a nursing assistant, I helped care for my grandfather at home with Hospice. I can remember suctioning him and administering him his Morphine. I always knew I wanted to help people to my fullest capacity, but never saw myself entering med school. Nurse Practitioner is the next best thing. I appreciate the autonomy Rhode Island allows nurse practitioners to have.

In a previous life, I worked as a pharmacy technician. Prior to enrolling in nursing school I considered become a pharmacist. However, pharmacy didn’t “feel right”. I wanted to do more to help my patients, so I selected nursing. I am very comfortable around medication. While I was a hospice case manager, I had the authority to make medication changes and liked having the autonomy and trust. As a nurse practitioner, I look forward to working with patients and using prescription medication to help manage their symptoms, giving them a better quality of life.

Hi class! My name is Lia and I am an avid outdoors enthusiast and dog lover. I have two rescue dogs and have a big heart for rescue. I have fostered dogs and rehomed over 20+ dogs for my local rescues (over the last 2 years) and typically take on medically fragile, behavioral issues and large breed dogs. I am fortunate to live surrounded by Yosemite, Sequoia and Kings Canyon National Park along with the beautiful Sierra Nevada mountains and love to backpack, hike, dirtbike and paddleboard the area with my dogs.

Oh, and I am a nurse too! I have been a nurse for 11 years with experience in adult cardiothoracic and complex vascular surgery with a couple years experience in a pediatric intensive care unit as well. I am also a RNFA and have assisted in surgery such as helping surgeons open/close the chest and getting patients on and off cardiopulmonary bypass. 

I chose to be a NP because I already do a lot of caretaking for my elderly parents. They came here post-Vietnam war and I have always had to act as their advocate for as long as I can remember. Seeing how much gets lost in translation linguistically and cross-culturally has opened my eyes up to becoming a provider that can be more understanding and culturally competent to help the underserved. I cannot imagine how much would be overlooked if I were not there at every medical appointment to advocate for my parents who, culturally, tend to be agreeable to anything providers tell them to do and, linguistically, have a hard time understanding English. 

When it comes to prescribing medications in our new role as stated in NR 565 Week 1: Building A Community, I think it’s a very complex and huge responsibility that falls upon our shoulders. We must not only understand the mechanics and pathophysiology behind the drug, but we must take into account the individual patient and their home dynamics and how it will adversely affect them. For example, when going to a follow-up appointment with my dad for his oral insulin medication, the provider noted that his HbgA1c had increased (meaning noncompliance) and his daily glucose log revealed the same. The provider was going to increase his medication but after further investigation on my part, I found out that my father did not quite understand diabetes management and that if he did not take his medication with food in the mornings, it would drop his blood sugar with corresponding side effects. In reality, my father did not like the side effects (and didn’t understand the consequences of not taking it with food) so he actually stopped taking it in the mornings altogether. It wasn’t an issue of medication or dietary noncompliance, it was a complete misunderstanding of the drug and disease process of diabetes. As providers, our role is not just to prescribe and heal, we become detectives and must put the pieces of formal medical knowledge and individual disease management together to help our patients. 

Sample Answer 3 for NR 565 Week 1: Building A Community

Fostering is very rewarding in so many ways and I highly encourage it! May not be the best in terms of time constraints now but I still get suckered into taking in a dog here and there during this program.

Becoming an RNFA was an easy transition for me as I was fortunate enough to be trained in cardiothoracic surgery as a scrub nurse, as well as a nurse circulator. I was already familiar with surgical procedures and instrumentation. However, there are many programs but the most accessible one was online via NIFA and they have a didactic portion followed by acquiring hands-on clinical hours in an operating room. Like Chamblerlain, you are responsible for finding your own precepting surgeons. You finish it off by successfully completing all your hours and passing the didactic portion. It is self-paced and aggressive students can finish it in as little as 6 months, but you do have up to 2 years to complete it all. 

Oh, I’ve trained my parents not to tell anyone that I’m a nurse when I take them to their appointments LOL. I like to fly under the radar! I saw that you have a cattle dog! I do too! He’s a blue heeler and has actually saved my life a couple times on my outdoor adventures. Best dogs out there!

NR 565 Week 2 Hypertension & Lipid Treatment Protocol

HYPERTENSION PROTOCOL: INITIAL VISIT  

1. RATIONALE  

1. This protocol will assist in the differentiation between essential hypertension and renal artery stenosis to aid in the identification of patients in need of referral to nephrology to prevent further renal damage from an unidentified renal artery stenosis. The design of the protocol for UTI encompasses these principles.  

1. SYMPTOMS 

1. HYPERTENSION 

1. Blood pressure >140/90 mmHg 

1. Other possible subjective symptoms 

1. Headache 

1. Visual changes 

1. Dyspnea 

1. Chest pain 

1. Sensory or motor deficit  

1. RENAL ARTERY STENOSIS 

1. Onset of hypertension age >55 years or <30 years 

1. History of accelerated, malignant, or resistant hypertension 

1. History of unexplained kidney dysfunction 

1. History of multivessel coronary artery disease 

1. History of other peripheral vascular disease 

1. Abdominal bruit 

1. Sudden or unexplained recurrent pulmonary edema 

1. Other possible factors 

1. Absence of family history of hypertension 

1. Other bruits 

1. History of acute kidney injury after administration of ACE inhibitor or angiotensin II receptor antagonist (ARB) 

1. HISTORY  

1. Continue with treatment of hypertension but consult supervising physician if patient has:  

1. History of accelerated, malignant, or resistant hypertension 

1. History of unexplained kidney dysfunction 

1. History of multivessel coronary artery disease 

1. History of other peripheral vascular disease 

1. Abdominal bruit 

1. Sudden or unexplained recurrent pulmonary edema 

1. PHYSICAL EXAM  

1. Perform the following examinations:  

1. Vital Signs (blood pressure, pulse) 

1. Auscultation for bruits (carotid, abdominal, and femoral) 

1. Palpation of thyroid 

1. Cardiac 

1. Respiratory 

1. Lower extremities for edema and pulses 

1. Neurological 

1. Consult supervising physician if findings of:  

1. Abdominal bruit 

1. Another bruit 

1. LAB TESTS  

1. Metabolic panel 

1. Cholesterol 

1. Blood sugar 

1. Uric acid level 

1. Glomerular filtration rate 

1. Consult supervising physician if:  

1. GFR indicates chronic kidney disease (CKD) or renal failure 

1. PHARMACOLOGICAL TREATMENT  

1. List the hypertension drug classifications and examples you would prescribe in order of treatment according to clinical practice guidelines without consideration of race or ethnicity: (Provide generic names for examples. Doses are not needed or required.) 

Citation (Provide (Author, year) and not full reference): ​(James et al., 2014)​ 

1. 1st line pharmacological treatment if warranted in a non-African American patient after a thiazide diuretic has been given and no compelling contraindications/comorbidities are identified: (Choose a generic drug from the drug class you would like to prescribe to either add to existing treatment or replace a thiazide.) 

1. Drug: ​Lisinopril​ 

1. Dose: ​10mg if not on diuretic/5mg if on diuretic ​ 

1. Route: ​PO (by mouth)​ 

1. Frequency: ​Daily​ 

1. Instructions to provide patient: ​Take 1 tablet by mouth daily, ​ 

1. Caution/Precautions: ​Do not take if pregnant or suspect you are pregnant, fetal toxicity. May cause angioedema, do not take if you have history of angioedema. ​ 

1. Using a source such as GoodRX, what is an estimated cost of this drug for a 30-day supply? ​10 mg 30 day supply is $2.50 as a one-time offer at Walgreens pharmacy.​ 

1. What patient education is needed for this drug?​You may take with or without food. Follow instructions on prescription label and read all medication guides/instructions. If you miss your dose take it as soon as possible, but skip dose if almost time for your next dose. Change positions slowly. Use exactly as directed.​ 

Citation (Provide (Author, year) and not full reference): ​(Epocrates, 2023)​ 

1. 1st line pharmacological treatment if warranted in an African American patient after a thiazide diuretic has been given and no compelling contraindications/comorbidities are identified: (Choose a generic drug from the drug class you would like to prescribe to either add to existing treatment or replace a thiazide.) 

1. Drug: ​Amlodipine​ 

1. Dose: ​5mg or 10mg, 2.5mg if small, fragile, or elderly pts.​ 

1. Route: ​PO​ 

1. Frequency: ​Daily​ 

1. Instructions to provide patient: ​Can be taken with or without food. Take as prescribed. Take at same time every day.​ 

1. Caution/Precautions: ​May cause hepatic impairment, or aortic stenosis. Use cautiously in elderly. ​ 

1. Using a source such as GoodRX, what is an estimated cost of this drug for a 30-day supply? ​10mg 30 day supply at SAMS Club is $6.49.​ 

1. What patient education is needed for this drug?​Use only as directed. Tell doctor if you ever had aortic stenosis or other heart problems, coronary heart disease or liver disease. Check your blood pressure often. Skip dose if more than 12 hours late for the dose. Don’t take two doses at same time.​ 

Citation (Provide (Author, year) and not full reference): ​Epocrates, 2023)​ 

1. When should ACEIs be used in African Americans according to the course textbook? Include a citation with matching reference in the reference section.  

1. ​​They should be used when African American patients have diagnosed DM I with proteinuria.​ 

1. ​​African Americans should be prescribed ACEI with comorbidity of nephrosclerosis.​ 

1. ​​African Americans with uncontrolled blood pressure with a single medication.​ 

Citation (Provide (Author, year) and not full reference): ​(Rosenthal et. al., 2021)​ 

1. Prescribe statin therapy according to the prescription table which follows:  

Complete the following table to indicate which drug at which dose would be used for different intensity statin therapies to treat high low-density lipoprotein (LDL) as noted in the course textbook. Each drug listed in each column should be a different drug with a specific dose or dose rans as indicated in your course textbook. 

Citation (Provide (Author, year) and not full reference): ​(Grundy et al., 2019) (Rosentha et. al., 2021) (Epocrates, 2023)​ 

1. TREATMENT MONITORING  

1. How long until a follow up appointment should be done with patient?  

​​1-3 months when first starting, then every 3-12 months.​ 

1. Monitoring needs for blood pressure medication prescribed: (Include physical assessments as well as lab/diagnostics as applicable.  If not applicable, enter N/A to show you find it not applicable.) 

1. Physical Assessments: 

​​Thorough physical assessment should be performed before prescribing any BP meds, with : 
i) Vital Signs (blood pressure, pulse) 
ii) Auscultation for bruits (carotid, abdominal, and femoral) 
iii) Palpation of thyroid 
iv) Cardiac 
v) Respiratory 
vi) Lower extremities for edema and pulses 
vii) Neurological​ 

1. Labs/Diagnostics:  

​​EKG, ECHO, CMP, LFT, Total cholesterol HDL/LDL & tryglycerides, 
a) Metabolic panel 
i) Cholesterol 
ii) Blood sugar 
iii) Uric acid level 
b) Glomerular filtration rate 
c) Consult supervising physician if:  
i) GFR indicates chronic kidney disease (CKD) or renal failure 
​ 

Citation (Provide (Author, year) and not full reference): ​(Rosentha et. al., 2021)​ 

1. Monitoring needs for statin medication prescribed: (Include physical assessments as well as lab/diagnostics as applicable.  If not applicable, enter N/A to show you find it not applicable.) 

1. Physical Assessments: 

​​Thorough physical assessment should be performed before prescribing STATINS, weight, BMI, and cardiac function. Assess risk factors such as age and dietary habits.​ 

1. Labs/Diagnostics:  

​​Total Cholesterol LDL/HDL & Triglycerides, CMP, Creatinine Kinase, CMP, LFT, Inflammatory markers​ 

Citation (Provide (Author, year) and not full reference): ​(Rosentha et. al., 2021)​ 

1. TREATMENT FAILURE  

1. How will you know if the treatment is not working or needs to progress? Include a citation with matching reference in the reference section.  

​​The objective of treating hypertension in adults is maintaining SBP below 130mmHg and DBP below 80mmHg. If blood pressure remains above target then the current regimen is ineffective and must be adjusted. If there is an adverse effects, modifying the adjusted dose or switching to another class of antihypertensive meds is recommended.​ 

Citation (Provide (Author, year) and not full reference): ​(Rosenthal et. al., 2021)​ 

References (Full APA References) 

Epocrates Web. (n.d.). Copyright 2006-2023, Epocrates.com. https://www.epocrates.com/online/results?query=lisinopril%20adult%20dosing 

Goodrx.com. (n.d.). https://www.goodrx.com/lisinopril?c=homepage-lander-sem-7&optly_audience=%257bnextbestaction%257d&utm_campaign=127243741&utm_content=121594327845&utm_source=google&utm_medium=cpc&utm_term=kwd-88186969736&gclid=CjwKCAiAgeeqBhBAEiwAoDDhn_n0cTxuiQsbbWpkTKqS4rg-lI3I-375UhsyyVx75E3pXtps4d3GXxoCO1cQAvD_BwE&gclsrc=aw.ds&ajs_prop_experiment_name=NFD%2520Promo%2520Drawer&ajs_prop_variation_name=Variation_1&ajs_prop_path=%2Fgo%2Fhomepage-lander-sem-7-tl-2&form=tablet&dosage=10mg&quantity=30&label_override=lisinopril 

James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Himmelfarb, C. D., Handler, J., Lackland, D. T., Lefevre, M., MacKenzie, T. D., Ogedegbe, O., Smith, S. C., Svetkey, L. P., Taler, S. J., Townsend, R. R., Wright, J. T., Narva, A. S., & Ortíz, E. (2014). 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAMA, 311(5), 507. https://doi.org/10.1001/jama.2013.284427 

Rosenthal, L. & Burchum, J. (2021). Chapter 41. Drugs for Hypertension. Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier. 

Rosenthal, L. & Burchum, J. (2021). Chapter 44. Prophylaxis of Atherosclerotic Cardiovascular Disease. Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.