DISCUSSION

3

Read AND RESPOND TO EACH POST SEPARTELY and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.

FRANCESSA SAVAGER COLLAPSE

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Patient Presentation 

     The patient presenting is a 46-year-old woman complaining of hot flushing, night sweats, and genitourinary symptoms. She is up to date with her mammograms and had one abnormal pap smear about five years ago showing atypical squamos cells of undetermined significance (ASCUS). The patient also has a family history of breast cancer. Based on this patient presentation, her diagnosis could go one of two ways. Given that her last menstrual period was one month ago, it would not necessarily be menopause, but that should not be completely ruled out. This certainly could be the start of menopause but only time would be able to confirm this diagnosis. With the patient’s family history of breast cancer and abnormal pap smear, I would be concerned for cervical cancer unless proven otherwise.

Patient’s Health Needs/Education

     This patient’s health needs involve education, managing her symptoms and performing different tests to conclude a diagnosis. She should have a repeat mammogram and pap smear to rule out breast and cervical cancer, because cancer can cause severe night sweats. Nonpharmacological methods to manage hot flashes and night sweats include using fans, lowering room temperature, and avoiding triggers like alcohol and spicy foods. For even more severe hot flashes, hormonal replacement can be an option if menopause is suspected. Estrogen by itself or a combination of progestin and estrogen is recommended as first line therapy. If all of these methods fail, the patient can be placed on a selective serotonin reuptake inhibitor which are the most effective drugs in combating hot flashes after hormonal replacement therapy (Bansal & Aggarwal, 2019).

In managing the patient’s genitourinary symptoms, prescribing medications can go a few different ways based on the specific symptoms she is having. For urinary tract infection, the patient can be prescribed Nitrofurantoin which is an antibiotic that works effectively against gram positive and negative bacteria. This medication is used for acute infections of the lower urinary tract, so it would depend on the patient. She can be prescribed Oxybutynin for an overactive bladder which works by blocking muscarinic receptors on the bladder detrusor which further inhibits the urge to void and bladder contractions. For urinary retention, the patient can be educated on strengthening her pelvic floor muscles through various exercises (Rosenthal & Burchum, 2021).

If this patient receives an unfortunate diagnosis of cancer, chemotherapy drugs can be used to intensify the damaging effects of radiation therapy cells on cervical cancer cells. The patient can be educated on the possible benefit of bringing a family member to doctor visits. In addition, she can be offered individual counseling, support groups, and internet-based discussion groups (Straughn & Yashar, 2020). The patient’s specific health needs would be better determined with further lab tests and imaging studies to confirm a diagnosis which can change the outcome of treatment plans.

References

Bansal, R., & Aggarwal, N. (2019). Menopausal hot flashes: A concise review. Journal of mid-life health, 10(1), 6–13. https://doi.org/10.4103/jmh.JMH_7_19

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Straughn, J. M., & Yashar, C. (2020). Patient education: Cervical cancer treatment; Early-stage cancer (beyond the basics). Up to Date. https://www.uptodate.com/contents/cervical-cancer-treatment-early-stage-cancer-beyond-the-basics/print

 

 

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Post 2

Anna Bolima 

Anna Bolima Initial Post week 9

COLLAPSE

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Week 9: Pharmacology. Anna Bolima

Initial post

This discussion post is in reference to case study #1, which deals with a 86 year old male diagnosed with community-acquired pneumonia for the last three days. Other diagnoses for this patient include hypertension, hyperlipidemia, and diabetes. The patient is currently on therapy of antibiotics (Ceftriaxone and Azithromycin). Presently, his clinical status has improved, and he is not demanding oxygen as much as before. The patient, however, complained of nausea and vomiting. He weighs 89kg and is allergic to penicillin. 

Description of patient’s health needs

Three immediate health needs stand out from a review of this case study. The first and most apparent is oxygenation status (Karch, 2011). Given the diagnosis of COPD and pneumonia for the last three days, oxygenation is the essential thing that will keep the patient alive. Oxygen perfusion becomes very important and should receive the highest priority. Pneumonia is an infection that compromises breathing and putting the patient in distress. The following health need is that metabolic status (Karch, 2011). With the complaints of nausea & vomiting and his diagnosis of diabetes, this patient may be at risk for metabolic compromise if he is not quickly stabilized. Finally, is health needs due to infection (Frandsen & Pennington, 2014). The patient is currently on two antibiotic medications, and the priority here is to ensure the infections do not spread to other body systems.  

Treatment regimen/ Choice of Pharmacotherapeutics and rationale

I would recommend the treatment regimen to continue with the current medications that the patient is already on. The patient is taking Ceftriaxone 1g IV q day. He is also on Azithromycin 500 mg IV q day. The rationale for these choices is because Ceftriaxone is the preferred drug of choice for bacterial infections, and they work by stopping the growth of bacteria (Karch, 2011). Like the above, Azithromycin is also an antibiotic used for bacterial infections but specifically lung infections such as pneumonia, which this patient has (Frandsen & Pennington, 2014). For the above reasons, I will continue with this current medication regimen.

Patient education strategy that will assist patients with their health needs.

An education strategy for this patient will include teaching the patient about side effects and compliance with antibiotic therapy, which will be essential for successful outcomes. Education will also include dietary management to reduce/address the complaints of nausea & vomiting that the patient experiences, especially as this may be a contributory factor for his low weight status and might also cause electrolyte imbalances (Karch, 2011). With his COPD, it will also be essential to teach the patient about strategies to conserve energy given his oxygenation status. Diet and metabolic issues are also important because the patient has diabetes. Managing his condition through diet and medication will be critical as it may be a knowledge deficit, or the patient may hold inaccurate information about his condition. Referral to a diabetic nurse educator will be essential. Education will include management of symptoms and treatment choices. The treatment care plan will identify and incorporate particular patient preferences, patient risk factors, and treatment options (Frandsen & Pennington, 2014). When patients are educated and engaged in the care planning process, it enhances their compliance and upholds their rights to be equal decision-makers in their care (Karch, 2011).

References:

Frandsen G. Pennington S. (2014). Clinical drug therapy: Rationales for nursing practice. Lippincott Williams & Wilkins

Karch A. (2011). Focus on nursing pharmacology. Lippincott Williams & Wilkins.

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