The Management Of Chronic Diseases Discussion

 The Management Of Chronic Diseases Discussion

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Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.
INSTRUCTIONS:
Respond ONLY to POST ONE and POST TWO separately and each response should have two references. My POST ABOVE is my own discussion post that will serve as a guide to respond to POST ONE and POST TWO.
PLEASE, DO NOT RESPOND TO MY POST. POSTS ONE AND TWO ARE WRITTEN BY MY CLASSMATES THOSE ARE THE POSTS WE ARE RESPONDING TO. MY POST IS MY OWN DISCUSSION I WROTE SO PLEASE DO NOT RESPOND TO IT. THANK YOU.  The Management Of Chronic Diseases Discussion

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Post One;

Thank you for sharing your thoughts and ideas with us. Chronic illnesses may complicate the underlying condition, especially if the patient has chronic conditions and experiences complications associated with this disorder. For instance, since the patient has diabetes, the acute illness may result in hyperglycemia and affect the patient’s ability to achieve the desired effects. Therefore, it is necessary to understand the underlying issues and needs and develop an individualized strategy for enhancing patient outcomes and attaining the best quality of care (Woo & Wright, 2024). At this step, I believe obtaining samples for microbial assessment is necessary for enhancing the patient’s outcomes. Since the conditions have improved, it is necessary to implement strategic measures and mechanisms for enhancing the best quality of care. It is necessary to implement strategies and mechanisms for enhancing the patient’s ability to promote the highest level of healthcare services (Wu et al., 2023). The healthcare team members should enhance patient-centered approaches and mechanisms that enhance the capacity to manage the client’s pneumonia.

Providing the patient with detailed information strategies and mechanisms for attaining good health and providing adequate patient information and approaches for attaining the best healthcare goals. Some of the patient education strategies include maintaining adequate hydration and ensuring small, frequent meals are necessary for attaining the best outcomes through strategies and mechanisms that achieve optimal results. Healthcare professionals must encourage the client to verbalize their concerns and issues associated with the underlying needs. Providing adequate fluid and electrolyte rehabilitation is necessary for enhancing the mechanisms and approaches for enhancing individualized and achieve the best quality of care. Professionals must ensure that strategic measures and approaches meet the underlying strategies and mechanisms are adequately addressed.  The Management Of Chronic Diseases Discussion

References

Woo, T. M., & Wright, W. L. (2024). Pharmacotherapeutics for Advanced Practice Nurse Prescribers.

Wu, H., Lin, W., & Li, Y. (2023). Health education in the management of chronic diseases among the elderly in the community with the assistance of a Mask R-CNN model. American Journal of Translational Research, 15(7), 4629–4638. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10408518/  The Management Of Chronic Diseases Discussion

Post Two:

Thank you for sharing your thoughts with us. Managing chronic illnesses is a critical role that the nurse practitioner can participate in and should focus on enhancing the wellbeing and the safety of the patient. For instance, in the 68-year-old male client’s case, the underlying comorbidities require the implementation of evidence-based strategies, which are vital to ensuring the underlying strategies and mechanisms are critical for achieving the desired outcomes. Wu et al. (2023) indicate that chronic illnesses require the implementation of complex strategies and mechanisms for attaining the best outcomes. Therefore, in this case, the scenario requires the nurse practitioner to assess and identify the client’s underlying needs and determine the best outcomes for attaining the desirable measures and mechanisms that address the client’s needs in a holistic approach.

Although the client’s condition has improved, it is necessary to explore other factors that enhance his wellbeing. On the third day, the client has completed the full course of azithromycin. However, since ceftriaxone should be administered for a minimum of 5-days, the nurse practitioner should ensure that the patient completes the prescribed antibiotics and attains the desired level of healthcare services (Woo & Wright, 2024). Since the patient’s underlying condition has improved, changing the treatment plan is not indicated at this time, therefore, continuing with the prescribed treatment is necessary for promoting adequate management and minimizing the risks and issues associated with the underlying condition. The nurse practitioner should offer supportive management and ensure that they understand the underlying condition are adequately managed. It is therefore vital to offer the patient with information and directions regarding the management of the condition, maintaining adequate hydration, and maintaining small and frequent meals for attaining the desired goals. The Management Of Chronic Diseases Discussion

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References

Woo, T. M., & Wright, W. L. (2024). Pharmacotherapeutics for Advanced Practice Nurse Prescribers.

Wu, H., Lin, W., & Li, Y. (2023). Health education in the management of chronic diseases among the elderly in the community with the assistance of a Mask R-CNN model. American Journal of Translational Research, 15(7), 4629–4638. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10408518/

The Management Of Chronic Diseases Discussion

 NURS 6521N RESPONSE TO WEEK 9 DISCUSSION INSTRUCTIONS

 TOPIC: WOMEN’S AND MEN’S HEALTH, INFECTIOUS DISEASE, AND HEMATOLOGIC DISORDERS           

 MY POST    

 (Please, DO NOT respond to this post (MY POST). It is just a guide)

 Patient Health Needs Assessment

The 46-year-old patient comes in with a number of health issues. First of all, she gets yearly mammograms and has a family history of breast cancer. Her blood pressure is higher than normal (150/90), suggesting that even with her present medication, her hypertension (HTN) is not adequately controlled (Norvasc 10mg and HCTZ 25mg daily). She claims to be having genitourinary symptoms, such as hot flashes and nocturnal sweats, which are typical for perimenopausal women. Although the results of her most recent Pap smear were normal, she has a history of abnormal results. Her last menstrual cycle was one month ago.

Pharmacotherapeutic Recommendations

A multimodal strategy is needed to treat her medical history and symptoms. Her antihypertensive medication may need adjustment for her hypertension (HTN). Options include raising her Norvasc dosage or switching to other antihypertensive classes. Hormone replacement treatment (HRT) is considered, but caution is needed due to her family’s history of breast cancer(Rosenthal & Burchum, 2021). Non-hormonal alternatives like SSRIs or gabapentin may be better for vasomotor symptoms. Vaginal estrogen may also be considered for genitourinary problems (Roberts & Hickey, 2016) The Management Of Chronic Diseases Discussion.

Patient Education Strategy

Education is crucial for a patient managing hormone replacement therapy (HRT) and menopausal symptoms (Penvose et al., 2024). Lifestyle changes like a low-sodium, high-potassium diet, regular exercise, and stress management are recommended. The patient should be informed about the benefits and drawbacks of HRT, including non-pharmacologic strategies like layering clothes and avoiding hot flashes triggers. Regular mammograms and self-breast exams are also important. Regular follow-ups are necessary to monitor blood pressure and overall well-being. It’s essential to stay in touch with the patient for any questions or concerns about side effects.

References

Penvose, K. N., Reed, S. D., Sepulveda, J. M. G., Mastylak, A., Scott, A., Hayes, T., … & Havrilesky, L. J. (2024). Development and testing of patient-centered education about hormone replacement therapy for women at high genetic risk of breast and ovarian cancer. Gynecologic Oncology, 181, 91-98.https://www.sciencedirect.com/science/article/pii/S0090825823015664Links to an external site.

Roberts, H., & Hickey, M. (2016). Managing the menopause: An updateLinks to an external site.Links to an external site.. Maturitas, 86(2016), 53–58. https://doi.org/10.1016/j.maturitas.2016.01.007

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

                                                POST ONE

The patient, HH, is a 68- year-old male suffering from community acquired pneumonia (CAP). He also has a history of COPD, HTN, hyperlipidemia, and diabetes. He has been taking empiric antibiotics such as ceftriaxone 1 g IV q day and azithromycin 500 mg IV; obtaining a sputum sample may benefit the patient’s antibiotic regimen, however, the current antibiotics are proving to be effective at this point. HH’s clinical status has improved and he requires decreased oxygen requirements, however, he has been experiencing nausea/vomiting and not tolerating his diet. It is imperative to regularly monitor both his respiratory rate and saturation level, and to keep an eye out for any indications of fluid retention. Monitoring his HTN along with the use of antibiotics is also important, this is because antibiotics have the potential to cause hypo/hypertension (Lee, 2020) The Management Of Chronic Diseases Discussion. Monitoring the patient’s blood pressure is particularly important because it can also fluctuate with the presence of infection (Thourani, 2023). Finally, it is imperative to check blood glucose levels. Patients with CAP frequently experience hyperglycemia, which may be a sign of the infection’s severity; hyperglycemia is associated with mortality in patients with CAP (Jensen et al, 2019). If the patient is experiencing nausea it is also important to keep him on strict I&Os to ensure proper nutrition.

Recommended Treatment Regimen

The patient is allergic to penicillin, which should be considered with any new medication prescribed. Given the patient’s condition, allergies, and medical history the current antibiotic regimen of ceftriaxone and azithromycin appear to be appropriate; this is also evident by the clinical improvements made by the patient with a decreased need for oxygen. However, the patient is unable to tolerate his diet which is evident by the presence of nausea/vomiting. An antiemetic should be added to manage these symptoms; I would also order something intravenous to avoid further upset of the GI system and for quick results. I would order 2 mg Zofran IV push Q6 PRN which should subside the patient’s symptoms and allow him to keep food down; I would recommend this administration before large meals (Cleveland Clinic, n.d.). If the patient is unable to keep down fluids, I would recommend IV fluid therapy. Based on the patient’s weight, according to the EBM Consult formula I would recommend IV fluid replacement therapy with normal saline 0.9 at 120 ml/hr; infusion rate = total fluid volume per day ÷ 24 hours (EBM Consult, n.d.) The Management Of Chronic Diseases Discussion.

Additionally, I would order daily CMPs to assess the patient’s fluid and electrolyte balance, since the patient is vomiting, and to monitor glucose levels as well (Cleveland Clinic, 2021).  I would continue this at least until his vomiting subsides and the patient’s diet/intake has resumed back to normal. To ensure sugar control I would place the patient on a low-dose sliding insulin scale (Humalog) to ensure proper diabetes management (Colunga-Lozano, 2018); blood sugars would be ordered ACHS and at bedtime to maintain appropriate levels.

Patient Education Strategy

To educate the patient I would first ensure he understands his diagnosis. I would explain to HH that pneumonia may be caused by bacteria, viruses, or fungi. In adults, pneumonia is most frequently caused by bacteria; a person’s mouth, sinuses, and nose can harbor bacteria and viruses that can travel to the lungs (Hadjiliadis & Harron, 2022) The Management Of Chronic Diseases Discussion. HH must be educated on the importance of following the prescribed medication regimen. He may feel better before the full course of his antibiotics are over but he still needs to complete the full treatment; the use of written material, along with verbal education, may be important for reference when he leaves the hospital.

I will educate and provide HH with written material on the importance of a balanced diet and regular exercise; considering his history of diabetes and hyperlipidemia this is important. HH should be educated that if emergency symptoms of pneumonia begin to occur the patient should seek medical attention immediately (e.g. shortness of breath, persistent fevers, confusion, excessive sweating/clammy skin) (Hadjiliadis & Harron, 2022). Finally, the use of an incentive spirometer is important. I will instruct HH that to maintain the health of his lungs he should use the incentive spirometer and take 10 -15 breaths every one to two hours (MedlinePlus, 2023). I will teach HH how the incentive spirometer (IS) ball will rise as he inhales, then he should hold his breath for 3-5 seconds and repeat. The use of an IS is important to prevent pneumonia and strengthen the lungs (MedlinePlus, 2023) The Management Of Chronic Diseases Discussion. I will have HH demonstrate a few breaths using the IS to ensure he understands how to use it properly.

References

Cleveland Clinic. (n.d.). Zofran (Ondansetron): Uses, Interactions & Side Effects. Cleveland Clinic. Retrieved January 21, 2024, from https://my.clevelandclinic.org/health/drugs/18477-ondansetron-solution

Cleveland Clinic. (2021, November 4). Basic Metabolic Panel (BMP): What It Is, Procedure & Results. Cleveland Clinic. Retrieved January 21, 2024, from https://my.clevelandclinic.org/health/diagnostics/22020-basic-metabolic-panel-bmp

Colunga-Lozano, L. E., Gonzalez Torres, F. J., Delgado-Figueroa, N., Gonzalez-Padilla, D. A., Hernandez, A. V., Roman, Y., & Cuello-García, C. A. (2018). Sliding scale insulin for non-critically ill hospitalised adults with diabetes mellitus. The Cochrane database of systematic reviews, 11(11), CD011296. https://doi.org/10.1002/14651858.CD011296.pub2

POST TWO

Brief Description of Patient Health Needs

HH is a 68-year-old male with several chronic health conditions, including COPD (Chronic Obstructive Pulmonary Disease), HTN (hypertension), hyperlipidemia, and diabetes, who has been admitted with community-acquired pneumonia. His current treatment regimen for pneumonia includes ceftriaxone and azithromycin, which are appropriate choices for empiric antibiotic therapy in the context of community-acquired pneumonia (CAP), especially in a patient with COPD. However, the fact that he is experiencing nausea and vomiting could indicate an adverse reaction to the antibiotics or could be related to his underlying conditions or other medications. Patient health Needs include management of community-acquired pneumonia,  addressing the newly developed symptoms of nausea and vomiting, and nutritional support given the intolerance to diet.  The Management Of Chronic Diseases Discussion

Recommended Treatment Regimen

The patient’s current empiric antibiotic regimen of ceftriaxone and azithromycin is appropriate for CAP, targeting typical and atypical pathogens. I choose to continue the medication regimen especially given his clinical improvement. However, his new symptoms of nausea and vomiting need to be addressed, as they could interfere with oral intake and medication adherence. I prefer to treat the nausea and vomiting because the patient Is responding to the antibiotic regimen. If nausea and vomiting are suspected to be side effects of antibiotics, considering that he is improving, a switch to oral antibiotics could be assumed if his gastrointestinal symptoms improve and he can tolerate oral intake. Antiemetics such as ondansetron can be given for the symptomatic relief of nausea and vomiting. Ondansetron is a selective 5-HT3 receptor antagonist that can control nausea and vomiting in various clinical situations and has a favorable side effect profile (Rosenthal et al., 2021). It is also essential to regularly monitor his blood glucose levels, as infections and stress can alter glycemic control. Fluid and electrolyte balance should be maintained with intravenous fluids, especially if the patient cannot maintain adequate oral intake due to nausea (Mantero et al., 2017

Patient Education Strategy

I will explain the importance of completing the entire course of antibiotics to treat pneumonia and prevent resistance, even if he starts feeling better. I will also discuss the management plan for his chronic conditions, emphasizing the significance of adherence to medication regimens and regular monitoring (See & Lau, 2023). I will also educate HH on the potential side effects of his medications and what to do if he experiences them, provide guidance on dietary modifications to manage his diabetes and hyperlipidemia effectively and discuss strategies to address his current intolerance to diet (See & Lau, 2023) The Management Of Chronic Diseases Discussion.

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References

Mantero, M., Tarsia, P., Gramegna, A., Henchi, S., Vanoni, N., & Di Pasquale, M. (2017). Antibiotic therapy, supportive treatment and management of immunomodulation-inflammation response in community-acquired pneumonia: Review of recommendations. Multidisciplinary Respiratory Medicine, 12(1). https://doi.org/10.1186/s40248-017-0106-3

Rosenthal, L. D., Burchum, J. R., & Rosenthal, L. D. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. Elsevier.

See, K., & Lau, Y. (2023). Acute management of pneumonia in adult patients. Singapore Medical Journal, 64(3), 209. https://doi.org/10.4103/singaporemedj.smj-2022-050

INSTRUCTIONS:

Respond ONLY to POST ONE and POST TWO separately and each response should have two references. My POST ABOVE is my own discussion post that will serve as a guide to respond to POST ONE and POST TWO.

PLEASE, DO NOT RESPOND TO MY POST. POSTS ONE AND TWO ARE WRITTEN BY MY CLASSMATES THOSE ARE THE POSTS WE ARE RESPONDING TO. MY POST IS MY OWN DISCUSSION I WROTE SO PLEASE DO NOT RESPOND TO IT. THANK YOU.

Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.  The Management Of Chronic Diseases Discussion