NURS 6521 WEEK 4 Assignment: Case Studies

Walden University NURS 6521 WEEK 4 Assignment: Case Studies– Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6521 WEEK 4 Assignment: 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 4 Assignment: Case Studies

Whether one passes or fails an academic assignment such as the Walden University NURS 6521 WEEK 4 Assignment: 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 4 Assignment: Case Studies

The introduction for the Walden University NURS 6521 WEEK 4 Assignment: 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 4 Assignment: Case Studies

After the introduction, move into the main part of the NURS 6521 WEEK 4 Assignment: 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 4 Assignment: 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 4 Assignment: 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 4 Assignment: Case Studies

Case Scenarios: Gastrointestinal and Hepatobiliary Systems

Case Scenario One

Sara is a 45-year-old female presenting for her annual exam. Her blood pressure

today is 160/90 H.R. 84 R.R. 16. Her height is 64 inches, and her weight is 195. Her

last visit to the clinic 3 months ago shows a B.P. of 156/92. She is currently taking

ibuprofen 600 mg tid for back pain. She has no known allergies.

What is the goal for her blood pressure?

The goal of blood pressure of Sara is to support the target blood pressure to be less than 130/80MmHg according to the 2017 American College of Cardiology (ACC)/ American Health Association (AHA) guidelines for clinical practice in the prevention, detection, evaluation, and management of high blood pressure in adults.

What medication would you prescribe to treat her blood pressure?

The medication that I would prescribe for Sara, considering her elevated blood pressure levels and no contraindications to the drugs, is an angiotensin-converting enzyme inhibitor. The drug works by inhibiting the enzyme that converts angiotensin 1 to Angiotensin 2. As a result, inhibiting the synthesis of angiotensin two causes the arteries and veins to vasodilate, the occurrence of natriuresis, and a decrease in sympathetic activity, leading to a reduction in the blood pressure of an individual, hence stabilizing the overall blood pressure (Cutrell., 2023). 

The medication order for her will be Lisinopril 10mg per oral

What education would you prescribe?

First, I would advise Sara to stop taking Ibuprofen 600mg Tid for back pain because it belongs to a class of drugs known as NSAIDs, and while it reduces pain, it is also responsible for elevating systolic blood pressure (Khan, 2024). I would prescribe Acetaminophen 1g Tid for managing the back pain. I will also educate Sara on lifestyle modification, including weight reduction and dietary changes, including salt reduction and low-fat and high-fiber diets. I will also explain to her the importance of medication adherence and Lisinopril’s potential side effects (Verma, 2021).

References

Cutrell, S., Alhomoud, I. S., Mehta, A., Talasaz, A. H., Van Tassell, B., & Dixon, D. L. (2023). ACE-Inhibitors in Hypertension: A historical perspective and current insights. Current Hypertension Reports, 25(9), 243-250.

Guidelines & Clinical Documents. American College of Cardiology. (n.d.). https://www.acc.org/guidelines

Khan, K. A. (2024, January 2). Does ibuprofen raise blood pressure? Online Doctor Chat 24/7. Retrieved March 29, 2024, from https://yourdoctors.online/does-ibuprofen-raise-blood-pressure/

Verma, N., Rastogi, S., Chia, Y. C., Siddique, S., Turana, Y., Cheng, H. M., … & Kario, K. (2021). Non‐pharmacological management of hypertension. The Journal of Clinical Hypertension, 23(7), 1275-1283.

Sample Answer 2 for NURS 6521 WEEK 4 Assignment: Case Studies

Case Scenario 2

Monty is a 52-year-old male following up on his labs that were drawn last week.

He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is

allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL

cholesterol 180, HDL cholesterol 40, and Triglycerides 185.

What treatment plan would you implement for Monty’s lipid profile?

I would implement the treatment plan for Monty’s lipid profile by beginning the statin therapy (Peters et al., 2020). The statin drugs lower the LDL cholesterol by slowing down the rate at which the liver produces them, and they also increase the rate at which the liver eliminates the LDL in the blood.

What is the goal total Cholesterol (T.C.), HDL-C, and LDL-C level for Monty?

The goal of the total cholesterol, HDL-C, and LLDL-C levels include;

LDL-C goal should be less than 70mg/dl for patients with clinical atherosclerotic cardiovascular disease and less than 100mg/dl for patients without atherosclerotic cardiovascular disease. The High-density Lipoprotein goal should be greater than 50mg/dl, and the total cholesterol level should be less than 200mg/dl.

The clinical guideline for total cholesterol levels should be less than 200mg/dl, the low-density lipoprotein should be less than 100mg/dl, and the high-density lipoprotein should be more significant than 50mg/dl.

How would you monitor the effectiveness of your treatment plan?

The treatment effectiveness will be measured by checking the lipid baseline 6-8 weeks after starting the dose and then checking after every four to six months. It is also essential to check the Liver Functional Tests LFTs 12 weeks after beginning therapy and then annually in the subsequent period (Tsimikas et al.,2020).

How many risk factors for coronary artery disease does this patient have? Identify them specifically.

According to the Centre for Disease Control and Prevention, risk factors for coronary artery disease include dyslipidemia, which is associated with atherosclerosis, which is the narrowing of the arterial valves due to the build-up of plaques in the inner lining of the artery.

Smoking: the chemical in cigarette smoke causes the blood to thicken, forming clots and plaque, thus narrowing the heart muscles and causing coronary artery disease (Peters et al., 2020).

References

Centers for Disease Control and Prevention. (2021, July 19). Coronary artery disease. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/coronary_ad.htm

Peters, F., Kuchenbecker, J., Kreutzburg, T., Marschall, U., Debus, E. S., & Behrendt, C. A. (2020). Long‐Term Effectiveness and Safety of Initiating Statin Therapy After Index Revascularization in Patients with Peripheral Arterial Occlusive Disease. Journal of the American Heart Association, 9(22), e018338.

Tsimikas, S., Gordts, P. L., Nora, C., Yeang, C., & Witztum, J. L. (2020). Statin therapy increases lipoprotein (a) levels. European heart journal, 41(24), 2275-2284.

Sample Answer 3 for NURS 6521 WEEK 4 Assignment: Case Studies

Case Scenario 3

Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days per week over the past 2 months. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough three nights during the last month. She is becoming more short of breath with exercise. She also has a fluticasone MDI, which she uses “most days of the week.” Her current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA, two puffs Q 4–6 H PRN shortness of breath, Yaz one P.O. daily, Propranolol 80 mg PO BID.

What treatment plan would you implement for this patient?

The first thing that I will do is to assess the Asthma Control through evaluation of the symptoms that she has presented with medication use and the impact that asthma has on her activities of daily living. I will also prescribe the influenza vaccine, Fluzone Quadrivalent 0.5 ml I.M., once a year during the flu season. In addition, I will also prescribe a pneumococcal vaccine, Prevnar 13, at 0.5ml I.M. once as a single dose. These vaccines will help boost the patient’s immunity against these diseases.

What medication changes would you make?

The medication changes that I would make for this patient, which is in line with the Global Initiative for Asthma, include increasing the dose of the inhaled corticosteroids of Flovent HFA44mcg two puffs BID to 110mcg two puffs BID. I will also add a Long-Acting Beta Agonist drug to the prescription that is Fluticasone, one inhalation twice a day. In addition, I will give health education on asthma triggers that Beatrice needs to avoid recognizing symptoms of an asthmatic attack and proper inhaler technique (Albertson et al., 2020).

I would stop the Propanolol 80mg P.O Bid. This is because this drug acts on selective cardiac beta one and bronchial beta two receptors, thus causing bronchoconstriction in asthmatic subjects. It may be why she is not getting better. 

How would you monitor the effectiveness of this plan?

Monitoring the effectiveness of the therapy will involve a follow-up appointment with Beatrice within two weeks to assess her response to the adjusted medication. It will also be essential to check for the frequency of albuterol use and the nocturnal awakening and assess lung functions in response to the treatment (Engelkeset.al., 2020).

References

Albertson, T. E., Chenoweth, J. A., Pearson, S. J., & Murin, S. (2020). The pharmacological management of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Expert opinion on pharmacotherapy, 21(2), 213-231.

Global initiative for asthma – a global initiative for asthma. GINA. (2023, August 24). https://ginasthma.org/

Engelkes, M., de Ridder, M. A., Svensson, E., Berencsi, K., Prieto-Alhambra, D., Lapi, F., … & Verhamme, K. M. (2020). Multinational cohort study of mortality in patients with asthma and severe asthma. Respiratory Medicine, 165, 105919.

Sample Answer 4 for NURS 6521 WEEK 4 Assignment: Case Studies

Case Scenario 4

Daute is a 56-year-old man seeking evaluation for increasing shortness of breath. He noticed difficulty catching his breath about 3 years ago. Physical activity increases his symptoms. He avoids activity as much as possible to prevent any SOB. His previous physician had placed him on salmeterol/Fluticasone (Advair Diskus), one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He did not refill the prescription and has not been taking it. Pertinent history – Chronic bronchitis X 8 years with one exacerbation in the last 12 months of treatment with oral antibiotics. He has a 40-pack-year smoking history.

What treatment plan would you implement for this patient?

The treatment plan I would implement for this patient includes bronchodilator therapy to relieve the symptoms of shortness of breath and increase lung function (Stringer et al., 2021). An example is the long-acting beta Agonists combined with inhaled corticosteroids twice daily.

Health education on the importance of refilling Fluticasone-salmeterol is key to ensuring adherence to continuous therapy for the patient. It will be important to explain to the patient that this drug indicates that it is a maintenance dose for treatment in patients with Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and reducing exacerbations.

What medication(s) would you monitor the effectiveness of this plan?

According to Drugs.com, the prescribed medication should be Fluticasone-salmeterol 250/50 mcg: 1 inhalation orally twice a day, approximately 12 hours apart. According to Villa et al. (2022), an important strategy to use when helping a client to quit smoking is providing support through the provision of Nicotine replacement therapy to aid in the process. It will help ensure that the patient does not get withdrawal symptoms from the addiction to nicotine that they were used to.

References

Stringer, W. W., Porszasz, J., Cao, M., Rossiter, H. B., Siddiqui, S., Rennard, S., & Casaburi, R. (2021). The effect of long-acting dual bronchodilator therapy on exercise tolerance, dynamic hyperinflation, and dead space during constant work rate exercise in COPD. Journal of Applied Physiology, 130(6), 2009-2018.

Fluticasone / Salmeterol Dosage Guide + max dose, adjustments. Drugs.com. (n.d.). https://www.drugs.com/dosage/fluticasone-salmeterol.html

Villa, R. S., Diego, G. A., & Roz, A. G. (2022). A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients. International journal of clinical and health psychology, 22(3), 31-40.

Sample Answer 5 for NURS 6521 WEEK 4 Assignment: Case Studies

The biliary system which is made up of the liver, gallbladder and pancreas main function is the production and transportation of bile. Obstruction in any part of this tree or an infection may lead to serious complications and even fat-soluble vitamin deficiencies. Biliary tree disorders clinically present with abdominal pain, nausea, vomiting and jaundice. The purpose of this paper is to explore the symptomatic and medical management of a patient with cholelithiasis.

Diagnosis of the Patient.

            The patient is most likely to be having gall stones(cholelithiasis). This is because her symptoms which include right upper quadrant pain worsened by heavy a meal, nausea and vomiting(Littlefield & Lenahan, 2019). She also has the risk factors of developing gall stones which are the fact that she is female(Lam et al., 2021), she is in her forties and she is obese. It is also reported that gall bladder incidence is higher in patients with type II diabetes(Chen et al., 2018).

Appropriate Drug Therapy Plan and the Justification.

Surgery is the recommended definitive management for gall stones. However, pharmacotherapy can also be used in the management of such cases. The patient will benefit from nonsteroidal anti-inflammatory (NSAIDS) drugs such as ketorolac to manage the RUQ pain(Gutt et al., 2020).Anticholinergic/ spasmolytic drugs such asscopolamine can also be used to reduce the pain instead to the NSAIDs.Gallstone dissolution agents such as ursodiol can also be administered. Antiemetics such as ondansetron will be of great help in the management of nausea and vomiting. Ms. DC might also benefit from antibiotics since her white blood cell levels are elevated indicating an infection(Costanzo et al., 2023). Quinolones such are levofloxacin is considered safe in this patient.

Conclusion

            Even though surgery is preferred management of choice for patients with cholelithiasis, pharmacotherapy is recommended for those patients who are not willing to undergo surgery. The drugs used not only alleviates patients’ symptoms but also dissolve the stones. Pharmacotherapy is also crucial in the prevention of complications.

References.

Chen, C.-H., Lin, C.-L., Hsu, C.-Y., & Kao, C.-H. (2018). Association Between Type I and II Diabetes With Gallbladder Stone Disease. Frontiers in Endocrinology, 9, 720. https://doi.org/10.3389/fendo.2018.00720

Costanzo, M. L., D’Andrea, V., Lauro, A., & Bellini, M. I. (2023). Acute Cholecystitis from Biliary Lithiasis: Diagnosis, Management and Treatment. Antibiotics, 12(3), 482. https://doi.org/10.3390/antibiotics12030482

Gutt, C., Schläfer, S., & Lammert, F. (2020). The Treatment of Gallstone Disease. Deutsches Ärzteblatt International. https://doi.org/10.3238/arztebl.2020.0148

Lam, R., Zakko, A., Petrov, J. C., Kumar, P., Duffy, A. J., & Muniraj, T. (2021). Gallbladder Disorders: A Comprehensive Review. Disease-a-Month, 67(7), 101130. https://doi.org/10.1016/j.disamonth.2021.101130

Littlefield, A., & Lenahan, C. (2019). Cholelithiasis: Presentation and Management. Journal of Midwifery & Women’s Health, 64(3), 289–297. https://doi.org/10.1111/jmwh.12959

ASSIGNMENT: 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 4

Submit the Assignment.

SUBMISSION INFORMATION

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1. To submit your completed assignment, save your Assignment as WK4Assgn_LastName_Firstinitial
2. Then, click on Start Assignment near the top of the page.
3. Next, click on Upload File and select Submit Assignment for review.

Rubric

NURS_6521_Week4_Assignment_Rubric

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