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.

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

Sample Answer 2 for NURS 6521 Week 1: Assignment 1: Case Studies

Case Study: Adult Geriatric Depression

The case study patient (CSP) is a 70-year-old Hispanic American male who was referred to the clinic by his primary care provider to rule out depression. There is no other significant past medical history and health concerns other than occasional back pain and shoulder stiffness, which he associates with his work as a laborer in a warehouse. The CSP immigrated to the United States as a teenager and always felt like an ‘outsider.’ He stated that he had few friends but described his home life as good. He reported a recent 15-pound weight gain, reduced interest in daily activities, difficulty sleeping, and diminished concentration at work.

The CSP is alert and oriented to person, place, time, and event during the mental status exam. Speech is clear but soft; emotional expression and eye contact were low. The CSP is verbalizing feelings of depression. He denies visual and auditory hallucinations, delusional, paranoid thoughts, and current suicidal thoughts. Judgment and insight are intact, and he obtained a score of 51 on the Montgomery-Asberg Depression Rating Scale, which indicates severe depression. 

Treatment Decisions Recommendations

First, in decision point one, the CSP is started on Zoloft (sertraline) 25 mg po once daily. He described a 25% reduction of symptoms on the four-week follow-up appointment and is concerned about the new-onset erectile dysfunction. Second, in decision point two, his current dose of  Zoloft (sertraline) was augmented with Wellbutrin IR (bupropion) 150 mg po once daily in the morning. After four weeks, this intervention improved his depressive symptoms and decreased sexual dysfunction; however, the CSP started experiencing nervousness and agitation. Lastly, in decision point three, Wellbutrin IR (bupropion) was changed to Wellbutrin XL (bupropion) 150 mg po once daily in the morning to attenuate the neurological adverse effects. 

Drug’s Pharmacotherapeutic Effects Impact on Patient’s Pathophysiology 

A depressive mood state is believed to be one of the core symptoms of major depressive disorder. Saiz-Ruiz et al. (2011) explained that several neuroimaging studies revealed a link between depressive mood state and altered neuronal activity in the prefrontal anterior cingulate and orbitofrontal cortices. Depressed mood is related to the low serotonin levels (5-hydroxytryptamine [5-HT]), norepinephrine, and dopamine. Accordingly, drugs that elevate these levels demonstrated improvement of depressive symptoms. For instance, Zoloft (sertraline) is an antidepressant associated with a family of selective serotonin inhibitor reuptake inhibitors (SSRIs). Rosenthal and Burchum (2018) discussed that SSRIs prevent the neuronal uptake of 5-HT, which amplifies its concentration in the synapse and increases its postsynaptic receptor activation. 

Zoloft (sertraline) has linear pharmacokinetics and has peak plasma levels of 4-6 hours after a single oral dose. The agent is highly bound to plasma protein (approximately 98%) and has a half-life of 24 hours (Saiz-Rodriguez et al., 2018). The common side effects include gastrointestinal disturbances, anxiety, sexual incapacity, altered cognition, and possible serotonin syndrome. Saiz-Rodriguez et al. (2018) claimed that 40% of patients do not achieve a positive response to SSRI, and 50% do not attain remission. Practice guidelines usually endorsed SSRIs as a first-line pharmacological treatment due to their tolerability rather than superior efficacy (Patel et al., 2016). 

Alternatively, Wellbutrin (bupropion) is a monocyclic phenylethylamine of the aminoketone group, a structure unique from other antidepressants. Saiz-Ruiz et al. (2011) described that the drug’s direct action inhibits neuronal reuptake of norepinephrine and dopamine. Furthermore, the drug does not have anticholinergic and direct sympathomimetic effects, and its cardiac depressant activity is ten times lower than tricyclic antidepressants (Saiz-Ruiz et al., 2011). Wellbutrin (bupropion) is not associated with sexual side effects but carries a low risk of psychotic symptoms (delusions, hallucinations). Other side effects include agitation, jitteriness, mild cognitive impairment, insomnia, and gastrointestinal distress (American Psychiatric Association, 2010). 

Drug’s Pharmacotherapeutic Effects Impact on the Treatment Plan 

The pharmacotherapeutic side-effects of antidepressant medications are attributed to approximately 30% of non-compliant cases (Balikci et al., 2013). The authors discovered that at least half of the individuals on SSRI therapy experienced significant side-effects that lead to nonadherence or discontinuation of the treatment. SSRIs such as Zoloft (sertraline) can result in erectile or ejaculatory dysfunction in men and decreased libido in both sexes (American Psychiatric Association, 2010). This side effect can be concerning and needs to be addressed to improve treatment outcomes. The American Psychiatric Association (2010) stated that administering Wellbutrin (bupropion) 150 mg orally twice a day is an effective rescue drug to mitigate the sexual adverse effects. 

Subsequently, concurrent use of Wellbutrin (bupropion) and SSRI may increase the risk of seizures, as both agents are linked with lowering the seizure threshold. Their additive effects may cause tremors, anxiety, and panic symptoms, and psychotic reactions. Interestingly, Wellbutrin (bupropion) is a potent inhibitor of cytochrome P450 2D6, an enzyme responsible for SSRIs’ metabolism (Munhoz, 2004). This mechanism indicates that the concomitant use of Wellbutrin (bupropion) and SSRI may cause SSRI accumulation, thus enhancing its serotonin activity. It is recommended to monitor patients’ responses closely for any evidence of serotonin syndrome and seizures while on this combined drug therapy. 

Serotonin syndrome is a rare but fatal adverse effect of SSRIs that occurs 2 to 72 hours after the treatment. Signs and symptoms include altered mental status, loss of coordination, myoclonus, hyperreflexia, extreme sweating, tremor, and elevated temperature (Rosenthal & Burchum, 2018). The syndrome is usually dissipated when the drug is discontinued. Similarly, seizures are of significant concern in Wellbutrin (bupropion) therapy. Rosenthal and Burchum (2018) suggested that to reduce the risk; the drug should not be given in high doses (above 450 mg per day), avoid rapid titration, and prevent drug administration in high-risk individuals (head trauma, history of seizure, and CNS tumor).

References

American Psychiatric Association. (2010). Practice guideline for the treatment of patients with major depressive disorder (revision). The American Journal of Psychiatry, 157(4), 1–45.

Balikci, A., Uzun, O., Erdem, M., Doruk, A., Cansever, A., & Ates, M. A. (2013). Side effects that cause noncompliance to antidepressant medications in the course of outpatient treatment. Bulletin of Clinical Psychopharmacology, 24(1), 69–75. https://doi.org/10.5455/bcp.20120827114140

Munhoz, R. P. (2004). Serotonin syndrome induced by a combination of bupropion and SSRIs. Clinical Neuropharmacology, 27(5), 219–222. https://doi.org/10.1097/01.wnf.0000142754.46045.8c

Patel, K., Allen, S., Haque, M. N., Angelescu, I., Baumeister, D., & Tracy, D. K. (2016). Bupropion: A systematic review and meta-analysis of effectiveness as an antidepressant. Therapeutic Advances in Psychopharmacology, 6(2), 99–144. https://doi.org/10.1177/2045125316629071

Rosenthal, L., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.

Saiz-Rodríguez, M., Belmonte, C., Román, M., Ochoa, D., Koller, D., Talegón, M., Ovejero-Benito, M. C., López-Rodríguez, R., Cabaleiro, T., & Abad-Santos, F. (2018). Effect of polymorphisms on the pharmacokinetics, pharmacodynamics, and safety of sertraline in healthy volunteers. Basic & Clinical Pharmacology & Toxicology, 122(5), 501–511. https://doi.org/10.1111/bcpt.12938

Saiz-Ruiz, J., Gibert, J., Gutiérrez Fraile, M., Bobes, J., Vallejo, J., Iglesias, C., & Iriarte, V. (2011). Bupropion: Efficacy and safety in the treatment of depression. Actas Espanolas de Psiquiatria, 39(1), 1–25.

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. 

WEEKLY 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.

SUBMISSION INFORMATION

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1. To submit your completed assignment, save your Assignment as WK1Assgn1_LastName_Firstinitial
2. Then, click on Start Assignment near the top of the page.
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Rubric

NURS_6521_Week1_Assignment1_Rubric