NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES

Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES- Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6521 Week 9: 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 Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES

Whether one passes or fails an academic assignment such as the Walden University NURS 6521 Week 9: 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 Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES

The introduction for the Walden University NURS 6521 Week 9: 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 Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES

After the introduction, move into the main part of the Walden University NURS 6521 Week 9: 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 Walden University NURS 6521 Week 9: 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 Walden University NURS 6521 Week 9: 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 9: ASSIGNMENT: CASE STUDIES

Scenario 1

The scenario depicts Jamie, a 38-year-old homeless bipolar patient diagnosed with an acute psychotic episode. He has been on lithium and was recently initiated on Amitriptyline. In this case, I would continue Lithium as a maintenance mood stabilizer for Jamie since it is efficacious in the prevention and relapse of depressive and manic episodes (Goes, 2023). However, I would discontinue Amitriptyline since studies show that Tricyclic antidepressants can increase the risk of mania or rapid cycling and have the potential to cause heart rhythm problems (Irizarry et al., 2022). Amitriptyline can be hazardous and potentially fatal in overdose, and its use in bipolar patients is limited. I would add Olanzapine to the patient’s treatment since it is recommended as an adjunctive to lithium. The combination treatment has been efficacious in preventing the relapse of both depression and mania (Nierenberg et al., 2023). Olanzapine 10 mg/day orally initially; Maintenance dose- 20 mg/day orally. Lithium 450 mg twice daily orally.

Scenario 2

The case is about a 68-year-old woman with a history of rheumatoid arthritis who has been on nabumetone (Relafen) 1000 mg PO QID for 2 years. Lately, the arthritis pain has worsened, and she is requesting additional medication for her rheumatoid arthritis. An appropriate additional therapy for this patient would be Methotrexate 7.5 mg orally as a single weekly dose. The patient will also be prescribed Folic acid 5mg once a day orally to lower the risk of methotrexate adverse reactions (Salamoun et al., 2021). Methotrexate is indicated for managing severe, active rheumatoid arthritis with an insufficient response or intolerance to an adequate trial of first-line therapy, including full-dose NSAIDs (Rubio-Romero et al., 2024). This patient has been on a full dose of Relafen for two years but reports insufficient pain relief.  The patient will be monitored closely for early signs of bone marrow suppression and renal or hepatic toxicity (Mustafa et al., 2022). Thus, monitoring will include renal function tests and liver function tests.

Scenario 3

The case concerns Sheila, a 26-year-old with a history of head injury and tonic-clonic seizures. She reports “funny” eye movements, feeling uncoordinated, blurred vision, and feeling lethargic. The patient’s symptoms are due to the current phenytoin (Dilantin) levels. Phenytoin levels between 10 and 20 are characterized by occasional mild nystagmus (Shah et al., 2023). The patient has nystagmus, which explains the reported symptoms. A Dilantin level of 11 confirms the diagnosis. Besides, the patient is on a high dose of Dilantin at 300 mg twice daily, which has contributed to the elevated Dilantin levels (Prasertsup et al., 2023).  The treatment plan will be to lower the Dilantin dose to 300 mg once daily orally. In addition, the patient will be prescribed Diazepam 5 mg PO 8houlyr PRN for muscle spasms (Manoj et al., 2024).

Scenario 4

The case is about Xavi, a 44-year-old man complaining of low back pain following a motor vehicle accident that occurred 7 days ago. He rates his pain 8 out of 10. He was prescribed Lortab 5 / 325, which  just barely makes him comfortable. The treatment plan for Xavi will be to increase the Lortab dose to 10mg/325mg orally every 4-6 hours. In addition, I will prescribe a skeletal muscle relaxant as an adjunct to Lortab. This will be Flexeril 10 mg orally TDS (Alorfi, 2023). Lortab has Hydrocone, an opioid, which exposes the patient to the risks of opioid addiction, abuse, and misuse. Therefore, the patient will be assessed and monitored for risk of opioid addiction. The patient will be educated that Lortab increases his risk of opioid addiction (Gudin et al., 2020). Thus, he must take it as per the prescribed dose. He will also be educated on other non-pharmacological pain management measures like physical therapy that can help relieve the pain (Steinmetz, 2022).

References

Alorfi, N. M. (2023). Pharmacological Methods of Pain Management: Narrative Review of Medication Used. International Journal of General Medicine, 16, 3247–3256. https://doi.org/10.2147/IJGM.S419239

Goes, F. S. (2023). Diagnosis and management of bipolar disorders. BMJ (Clinical research ed.), 381, e073591. https://doi.org/10.1136/bmj-2022-073591

Gudin, J., Kaufman, A. G., & Datta, S. (2020). Are Opioids Needed to Treat Chronic Low Back Pain? A Review of Treatment Options and Analgesics in Development. Journal of Pain Research, 13, 1007–1022. https://doi.org/10.2147/JPR.S226483

Irizarry, R., Sosa Gomez, A., Miles, S., & Tamayo Acosta, J. (2022). Managing Bipolar Disease Complicated with Psychosis in Conjunction with Polypharmacy, Parkinson’s Disease, and Multiple Comorbidities. Case Reports in Psychiatry, 2022, 3813929. https://doi.org/10.1155/2022/3813929

Manoj, R., Meher, A., & Winner G, J. (2024). Ataxia and Seizures despite Phenytoin: A Case Report Highlighting the Importance of TDM and Genetic Influences. Case Reports in Neurological Medicine, 2024, 2888895. https://doi.org/10.1155/2024/2888895

Mustafa, S. H., Ahmad, T., Balouch, M., Iqbal, F., & Durrani, T. (2022). Safety Profile of Methotrexate Therapy in Patients With Rheumatoid Arthritis. Cureus, 14(7), e27047. https://doi.org/10.7759/cureus.27047

Nierenberg, A. A., Agustini, B., Köhler-Forsberg, O., Cusin, C., Katz, D., Sylvia, L. G., Peters, A., & Berk, M. (2023). Diagnosis and Treatment of Bipolar Disorder: A Review. JAMA, 330(14), 1370–1380. https://doi.org/10.1001/jama.2023.18588

Prasertsup, W., Chomchai, S., Mekavuthikul, P., & Phuditshinnapatra, J. (2023). Phenytoin Intoxication in a Patient Receiving a Therapeutic Dose for Postoperative Seizure Prophylaxis: A Case Study. Therapeutic Drug Monitoring, 45(5), 573–575. https://doi.org/10.1097/FTD.0000000000001129

Rubio-Romero, E., Díaz-Torné, C., Moreno-Martínez, M. J., & De-Luz, J. (2024). Methotrexate treatment strategies for rheumatoid arthritis: a scoping review on doses and administration routes. BMC Rheumatology, 8(1), 11. https://doi.org/10.1186/s41927-024-00381-y

Salamoun, Y. M., Polireddy, K., Cho, Y. K., Medcalf, M. R., & Funk, R. S. (2021). Methotrexate Disposition, Anti-Folate Activity, and Metabolomic Profiling to Identify Molecular Markers of Disease Activity and Drug Response in the Collagen-Induced Arthritis Mouse Model. Metabolites, 12(1), 24. https://doi.org/10.3390/metabo12010024

Shah, K. C., Patel, N. S., Vasani, P., Khadela, A., Chavda, V. P., & Vora, L. (2023). Phenytoin-induced dyskinesia: a case report. Journal of Medical Case Reports, 17(1), 313. https://doi.org/10.1186/s13256-023-04033-6

Steinmetz, A. (2022). Back pain treatment: a new perspective. Therapeutic Advances in Musculoskeletal Disease, 14, 1759720X221100293. https://doi.org/10.1177/1759720X221100293

Sample Answer 2 for NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES

Sickle cell anemia is an inherited disease where blood cells are sickle or crescent shape and are very sticky and ridged unlike regular blood cells which are round and flexible (Mayo Clinic, 2018).

The current treatment for sickle cell includes hydroxyurea which works by increasing the water content of red blood cells which increases the deformability of sickled cells and alters the adhesion of red blood cells to endothelium (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Side effects include upset stomach, nausea, vomiting, diarrhea, constipation, skin changes (color changes or peeling), flu like symptoms, hair loss, rash, headache, dizziness, drowsiness, and weight gain. Serious side effects include anemia, myelosuppression, and leukemia (Rxlist, 2017).

In July 2017 the FDA approved a new therapy for Sickle cell anemia called L-glutamine oral powder “in phase 3 of the trial patients taking this drug had 25% fewer hospital visits for sickle cell crisis, were hospitalized 33% less often, were discharged an average of 4.5 days sooner, and were 65% less likely to experience acute chest syndrome compared with the placebo group” (Karon, 2017). The way L-glutamine oral powder works is not totally understood but what is believed is it “may improve the NAD redox potential in sickle RBCs through increasing the availability of reduced glutathione” (Rxlist, 2017). The side effects if this medication are constipation, nausea, headache, abdominal pain, cough, pain in extremities, back pain, chest pain, indigestion, burning sensation, and hot flashes (Rxlist, 2017). Other drugs used to help control sickle cell attacks are short and long acting opioids and NSAIDs.

Sickle cell anemia is a genetic disease that not only effects adults but also children. About 10% of people from African decent have sickle cell anemia. Treatment for children include pain medications, a blood transfusion, drinking plenty of water, folic acid to help prevent anemia and sometimes a bone marrow transplant (Stanford Children’s Health, n.d.). Life expectancy has increase for individuals with Sickle cell anemia over the last 30 years.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: a practical approach. Philadelphia, PA: Lippincott Williams & Wilkins.

Karon, A. (2017, December 15). A new drug and more on the way for sickle cell disease. Retrieved from https://acphospitalist.org/archives/2017/12/new-drug-and-more-for-sickle-cell-disease.htm

Mayo Clinic. (2018, March 8). Sickle cell anemia – Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876

Rxlist. (2017, July 14). Common Side Effects of Hydrea (Hydroxyurea) Drug Center – RxList. Retrieved from https://www.rxlist.com/hydrea-side-effects-drug-center.htm

Rxlist. (2017, July 19). Common Side Effects of Endari (L-glutamine Oral Powder) Drug Center – RxList. Retrieved from https://www.rxlist.com/endari-side-effects-drug-center.htm

Stanford Children’s Health. (n.d.). Sickle cell disease in children. Retrieved from https://www.stanfordchildrens.org/en/topic/default?id=sickle-cell-disease-in-children-90-P02327

Sample Answer 3 for NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES

1. Jamie is a 38-year-old homeless bipolar patient who has been diagnosed with an acute psychotic episode. He tells you that he has been on lithium for years and was recently started on amitriptyline (Elavil) 25mg PO TID by someone at a free clinic. What treatment plan would you develop for Jamie? Would you discontinue any medications? What medications would you add?

Jamie’s primary healthcare issues that need attention include bipolar illness, acute psychotic episodes, and homelessness. He is now taking lithium and amitriptyline as part of his pharmaceutical regimen. The proposed treatment method involves reviewing the drug, slowly stopping amitriptyline, and introducing additional antipsychotic medicines such as Risperidone, Quetiapine, and Olanzapine to address the acute psychotic episode (Radu & Bungău, 2021). Psychotherapy, including cognitive-behavioral therapy or family-focused therapy, may also be helpful. Supportive services like housing aid and vocational training are essential for Jamie’s welfare. The approach is tailored to Jamie’s symptoms, side effects, and general health condition. Seeking guidance from a healthcare expert is crucial for tailored treatment recommendations. Jamie is now on lithium, and it requires frequent monitoring. Administering Risperidone, Quetiapine, and Olanzapine may be required to control the acute psychotic episode.

2. A 68-year-old woman has a history of rheumatoid arthritis and has been taking nabumetone (Relafen) 1000 mg PO qd for 2 years. Other pertinent past medical history includes occasional incontinence, Crohn’s disease with frequent exacerbations, and well-controlled diabetes type 2. Recently, her arthritis pain has been much worse, and she is requesting additional medication for her rheumatoid arthritis. What would be appropriate additional therapy for this patient? What monitoring would be appropriate to monitor this medication? What monitoring would be appropriate to monitor this medication?

Rheumatoid arthritis may be managed with a disease-modifying antirheumatic medication (DMARD) such as methotrexate, often used with nabumetone. Consider the patient’s Crohn’s disease and occasional incontinence while using methotrexate since it may exacerbate gastrointestinal adverse effects. Prior to initiating methotrexate, it is advisable to get advice from the patient’s gastroenterologist. Regular monitoring of methotrexate is essential because of its possible adverse effects. It is advised to have routine liver function testing every 1-3 months (McIntyre et al., 2020). Regularly monitor complete blood counts to identify bone marrow suppression, which may result in anemia, leukopenia, and thrombocytopenia. Kidney function tests should be performed to verify that the patient’s renal function is adequate. Additional evaluations, such as chest X-ray and pulmonary function testing, may be required to evaluate lung toxicity. The required frequency and monitoring method depend on the patient’s general health condition, other prescribed drugs, and methotrexate dosage. Monitor the patient for any deterioration of Crohn’s disease or incontinence.

3. Sheila is a 26-year-old with a history of head injury and tonic-clonic seizures. She is seen today with complaints of “funny” eye movements, feeling uncoordinated, blurred vision, and feeling lethargic. Her current medications include Ritalin 10 mg PO BID, Dilantin 300 mg PO BID, Paxil 20 mg PO daily, and Lasix 20 PO daily. Lab Values from today Dilantin level of 11 Albumin 2 WBC 9.9 Plt 177 Na 141 K 4.2 Hg 13.2. What do you think is causing the patient’s symptoms? What lab values and calculated corrected medication level support your diagnosis? What is your treatment plan for this patient?

Sheila’s symptoms, such as abnormal eye movements, lack of coordination, blurred vision, and tiredness, along with her past head injury and tonic-clonic seizures, indicate a potential case of Dilantin (phenytoin) poisoning. Lab results confirm the diagnosis, showing a phenytoin level of 11 and a low albumin level of 2 g/dL (Fordington & Manford, 2020). The optimal therapeutic range for phenytoin is usually 10 to 20 mcg/mL. However, toxicity may still arise within this range, particularly in individuals with decreased levels of albumin. The adjusted phenytoin level is 27.5 mcg/mL, beyond the therapeutic limit, confirming phenytoin toxicity. Sheila’s blood shows signs of phenytoin intoxication.

Sheila’s treatment strategy includes tapering down or decreasing the dosage of Dilantin to decrease her phenytoin levels and relieve her symptoms. Regularly monitoring phenytoin and albumin levels is essential to maintain them within the therapeutic range (Hausted et al., 2020). Addressing low albumin levels may require dietary assistance or therapy for the root problem. Treatment for symptoms may include addressing impaired vision and tiredness. Regular follow-up sessions allow the monitoring and modification of the treatment strategy. The treatment strategy should be customized according to Sheila’s health and other relevant circumstances. Seek advice from a healthcare professional for suitable therapy.

4. Xavi is a 44-year-old man with complaints of low back pain following a motor vehicle accident. The accident occurred 7 days ago. He rates his pain 8 out of 10. He was prescribed Lortab 5 / 325 in the ER last week. He is requesting a refill of the Lortab today and indicates it barely makes him comfortable. What treatment plan would you implement for Xavi? What medications would you prescribe, and how would you monitor them? What education would you provide regarding his treatment plan?

Xavi’s treatment strategy includes medicine, physical therapy, and patient education. The dose of the present medicine, Lortab 5/325, a mix of hydrocodone and acetaminophen, may need modification if it is not effectively alleviating symptoms. If the pain is tolerable, one may seek different drugs, such as NSAIDs or muscle relaxants (Corp et al., 2020). Physical therapy may assist in controlling lumbar discomfort by enhancing mobility and strength. A physical therapist may provide exercises and methods to enhance back functionality. Educating the patient by outlining the treatment strategy, addressing possible adverse effects, and encouraging active involvement is essential. Periodic check-ins are planned to evaluate Xavi’s development and modify the treatment strategy as needed. This involves evaluating pain, reviewing medications, and monitoring progress in physical therapy.

Xavi’s lower back pain needs comprehensive management, including medication, physical therapy, and patient education (Popescu & Lee, 2020). Consistent monitoring guarantees that the treatment strategy is successful and modified as needed. Xavi can enhance his well-being and pain management by teaching him about his disease and treatment plan.

References

Corp, N., Mansell, G., Stynes, S., Wynne‐Jones, G., Morsø, L., Hill, J., & Van Der Windt, D. (2020). Evidence‐based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. European Journal of Pain, 25(2), 275–295. https://doi.org/10.1002/ejp.1679

Fordington, S., & Manford, M. (2020). A review of seizures and epilepsy following traumatic brain injury. Journal of Neurology, 267(10), 3105–3111. https://doi.org/10.1007/s00415-020-09926-w

Hausted, H. S., Nielsen, J. F., & Odgaard, L. (2020). Epilepsy after severe traumatic brain injury: frequency and injury severity. Brain Injury, 34(7), 889–894. https://doi.org/10.1080/02699052.2020.1763467

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López‐Jaramillo, C., Kessing, L. V., Malhi, G. S., Nierenberg, A. A., Rosenblat, J. D., Majeed, A., Vieta, E., Vinberg, M., Young, A. H., & Mansur, R. B. (2020). Bipolar disorders. Lancet, 396(10265), 1841–1856. https://doi.org/10.1016/s0140-6736(20)31544-0

Popescu, A., & Lee, H. (2020). Neck pain and lower back pain. Medical Clinics of North America/˜the œMedical Clinics of North America, 104(2), 279–292. https://doi.org/10.1016/j.mcna.2019.11.003

Radu, A., & Bungău, S. (2021). Management of Rheumatoid Arthritis: An Overview. Cells, 10(11), 2857. https://doi.org/10.3390/cells10112857

NURS_6521_Week9_Assignment_Rubric