Various characteristics of effective relationships in nursing include: a) Confidentiality b) Trust c) Self-reflection d) Social conversation e) Creating a therapeutic environment. How you could apply each of these characteristics in your nursing interactions with Ben in the below scenario Scenario 1 You are a nurse working in the medical ward. Ben Adams is a 28-year-old man who was admitted with palpitations for investigation.

Ben has had no previous hospital admissions and is generally well. Ben has a history of Asthma that he has had from childhood and uses a Ventolin puffer and a preventer medication to manage this condition. Ben undertakes vigorous exercise as a basketball player. Ben has pressed the call bell for assistance as he needs to use the toilet and requires assistance with moving the intravenous pump to the bathroom. You return to Ben’s bed after assisting him to the bathroom. You notice Ben has two packets of cigarettes in his drawer. The doctor strongly recommended Ben not smoke since it could aggravate his asthma. Ben requested you not notify his family or doctor about this…PowerPoint presentation

A 30-year-old woman with a history of cystic fibrosis was admitted to the hospital for the management of a spontaneous left pneumothorax (collapse of her lung). She required urgent thoracostomy (chest tube) placement in the emergency department.

The chest tube was connected to wall suction in order to promote the re-expansion of her lung.

Over the next 2 days, the patient improved, and repeat imaging showed a re-expansion of her lung.

The consulting pulmonary team felt that the chest tube might be able to be removed, so they requested that the tube be disconnected from suction and clamped.

The plan was to obtain a chest radiograph 1 hour after clamping the tube, and if the pneumothorax had not recurred, the tube would be removed.

About 45 minutes after the tube was clamped, the patient complained of acute, sharp pain radiating to her left arm. The nurse gave the patient pain medication.

She noted that the radiograph had not yet been done but assumed that it would be done soon. Unfortunately, the radiograph was not done, and the nurse became busy with another acutely deteriorating patient.

Approximately 2 hours later (3 hours after the tube was clamped), the nurse found the patient unresponsive, in cardiac arrest with a rhythm of pulseless electrical activity.

A code blue was called. The code team recognized that the arrest could have been due to a tension pneumothorax, reconnected the chest tube to suction, and eventually performed needle decompression.

Despite these measures, the patient did not recover spontaneous circulation for more than 30 minutes and sustained a severe anoxic brain injury as a result.

The patient required tracheostomy and feeding tube placement, and she was eventually transferred to a long-term care facility with a poor neurologic prognosis.

 

The hospital conducted a root cause analysis (RCA). The RCA committee found that there was considerable variation around chest tube removal practices between services. For example, the trauma surgery service did not routinely perform a clamping trial before chest tube removal.

Although other services did perform such a trial, there was variation in when the radiograph was performed after clamping the tube.

The committee noted that this variation led to confusion among bedside nurses about how to monitor patients and communicate with physicians immediately after chest tube removal.

As a result, the committee felt the complication might still have occurred even if the radiograph had been performed.

Instructions: Choose 1 paper option. The paper is to be completed before the Final Exam in this course. Each paper is to be 3-5 full pages long, in paragraph form, all double-spaced. Full-sentences are expected, as are opening and closing paragraphs. Be sure to answer the question prompts fully.

Grading information: Each paper is worth 100 points. The paper may be completed any time before the Final Exam. The grading turnaround for papers is one week (that is, you should expect to have a submitted paper graded by one week from the date of submission).

The point distribution for the papers is as follows:

20 points: Writing. Criteria: appropriate grammar, appropriately edited for syntax and phrasing, complete sentences, structured in paragraph and essay form, meets page length requirements. Please use 12-pt font, Times New Roman.

20 points: Follows the prompt: all portions of the paper are complete. Answers fully address the questions in the prompt and address them in a sufficiently detailed way.

20 points: Evidence. In each paper, you are required to support evidence for your written points, whether the evidence is specific detail from the internet, the modules, or your observations (and, in all cases, the evidence needs to be stated in your own words and not plagiarized). These sources should be appropriately cited. For example: (Scott, 2010) or (www.sciencedaily.com, “What is Keeping Your Kids Up At Night,” para. 2). Sufficient referencing and integration (without plagiarism) of other sources is necessary to achieve full points in this area. A reference page is also needed.

20 points: Evaluation. In each paper, you are to include your own thoughts and evaluations, whether it involves thinking about module content and evaluating the meaning, deciding on nature/nurture, or evaluating observations. Your thoughts need to be described in sufficient detail and identified as your thoughts, compared to information that you may obtain elsewhere. Sufficient explanation is necessary to achieve full points in this area.

20: Content. Accuracy of your written positions and appropriateness of content given the question prompts are necessary to achieve full points in this area. This is the heart of the papers—answering the questions correctly, accurately, and appropriately. In the cases of providing your opinions, these should still be grounded correctly in the theory or module topic that you are addressing.

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Paper Option #1 Nature/Nurture
Developmental science focuses on the various contributions to development, and whether they lean toward the genetic side of things (nature) or environmental (nurture). Choose from one of the following topics discussed in the modules:

Child obesity
Eating disorders
Adolescent depression

For this paper, review the module material on your specific topic. Then, write a paper describing in detail the “nature” (primarily genetic, inherited) contributions to this condition as well as the “nurture” contributions. You will need to conduct internet research and cite the sources to obtain additional information on your topic. For example, explaining the inherited reasons for a child to be obese will require that you visit, read, summarize, and cite medical sites on the internet. It is crucial that you rephrase material in your own words and cite it or put phrases from the sources in quotation marks and cite it. No more than a few sentences should be directly quoted, however, in order for you to receive credit for writing this paper (in other words, no credit is given for a paper that is a string of other people’s quotes). As a general rule of thumb, at least 1.5 pages should focus on “Nature” contributions to the issue at hand and at least 1.5 pages should focus on “Nurture” contributions.

Your research must include at least 2 journal articles or books. That is, websites can be very helpful and informative, but your final paper must include full, published research articles or books on the topic. Sources should be reputable and consistent with what you learned in the module as well as other sources. GoogleScholar and PDF articles from the internet can be helpful resources. Make sure you use good search terms when trying to find articles. You may want to start broad (for example, “Bystander effect”) and then narrow to your particular area. This paper requirement means that you need to include at least two primary sources in your paper; articles from the internet can be included, but they would be in addition to the two minimum primary sources. Primary sources are firsthand accounts; thus, they involve the author writing about his or her own work.

Week 1: Basic Pharmacotherapeutic Concepts/Ethical and Legal Aspects of Prescribing

How do beta-blockers work? What exactly do antibiotics do to the bacteria they target? What effects does an anti-depressant have on blood flow?a

Questions like these are related to the underlying pharmacokinetic and pharmacodynamic processes of pharmacotherapeutics. As an advanced practice nurse, understanding these fundamental pharmacotherapeutic concepts is important to ensure that the prescription drugs you recommend for your patients will be safe and effective to treat and/or manage their symptoms. Additionally, as the advanced practice nurse, it is your responsibility to ensure that when prescribing prescription drugs, you adhere to the ethical and legal principles set forth for prescribing drugs as an added layer of protection and safety for the patients you will treat.

This week, you will analyze factors that may influence pharmacokinetic and pharmacodynamics processes of a patient and assess the details of a personalized plan of care that you develop based on influencing factors and patient history. You will also evaluate and analyze ethical and legal implications and practices related to prescribing drugs, including disclosure and nondisclosure, and analyze the process of writing prescriptions to avoid medication errors.

Learning Objectives

Students will:

• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients
• Assess patient factors and history to develop personalized plans of care
• Evaluate ethical and legal implications related to prescribing drugs
• Analyze ethical and legal practices of prescribing drugs
• Analyze strategies to address disclosure and nondisclosure
• Justify advanced practice nurse strategies to guide prescription drug decision-making
• Analyze the process of writing prescriptions to avoid medication errors

Learning Resources

Required Readings (click to expand/reduce)

 

Required Media (click to expand/reduce)

 

Discussion: Pharmacokinetics and Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

 

To Prepare

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history in your case study.
•  

By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

By Day 6 of Week 1

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.