Mr. JD is a 24-year-old who presents to Urgent Care with a 2-week history of cough and congestion. He says it started out as a “normal cold” and it will not go away. He has a productive cough for green mucous and has green nasal discharge. He says he has had a low-grade temperature for the past 2 days. John reports an intermittent frontal headache with this cold. He is otherwise healthy, with no known allergies. 
In his assessment it is found that his vital signs are stable, temperature is 99.9 degrees F, tympanic membranes (TMs) are clear bilaterally, pharynx is erythematous with no exudate; there is greenish postnasal drainage; turbinates are swollen and red; frontal sinus tenderness; no cervical adenopathy, and lungs are clear bilaterally.

• Is there any additional subjective or objective information you need for this client? Explain.

In addition to what we have been told there are several things that may be identified. On first glance it would be important to assess the patients skin color, assess if they were sweating or were cold. It would be necessary to ask about allergies and see if he has been exposed to any possible allergens or irritants. It would need to be determined if this was the first time this has happened or has been a common occurrence. Assessing any recent traumatic injuries, headaches, or nose bleeds may help the clinician determine the root cause of the problem. Family history, patients past medical history, social history, and any current medications is a definite must. His vitals are stable besides the climb in temperature, so you could ask how he was sleeping and if he was getting enough fluid intake.

• Would you treat Mr. JDs cold? Why or why not?

I would definitely treat JD’s symptoms. He has been down and out for two weeks and his condition is not getting any better. His temperature is increasing, and he is symptomatic with tender mucous membranes, post nasal drip, and erythema. These are signs of an infection that should be treated. Not only is he at risk for getting worse but he could potentially expose others to his current illness.  Clinical diagnosis of acute bacterial sinusitis requires prolonged, nonspecific upper respiratory signs such as rhinosinusitis and cough without improvement for more than 10 days, and symptoms such as fever, facial swelling, or facial pain (Woo & Robinson, 2016).

What would you prescribe and for how many days? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.

Many times, antibiotics are prescribed too quickly and often times will not be effective if it is a viral infection. Based on the assessment findings and the little we know about the patient; the patient could have possible sinusitis. The first-line treatment for sinusitis in adults is amoxicillin/clavulanate (875 mg amoxicillin/125 mg clavulanate) for 5 to 7 days (Woo & Robinson, 2016). This medication has a half-life of 1-1.3 hours, is metabolized by the liver and eliminated in the urine. It usually takes 30 minutes to be effective and peaks in 1-2 hours. This medication is an oral antibacterial combination that consist of the semisynthetic antibiotic amoxicillin and the β-lactamase inhibitor (FDA, n.d.). This bactericidal hinders bacterial growth by inhibiting the biosynthesis of bacterial cell wall mucopeptide (Woo & Robinson, 2016). For JD, it would be necessary to check a comprehensive metabolic panel to assess liver and kidney function. There is not a black box warning and usually does not have any side effects other than a possible rash. It is usually safe during pregnancy however before prescribing it would be necessary to assess allergies and inform the patient about potential side effects like a rash.  

Would this treatment vary if Mr. JD was a 10 year-old 78 lb child? Include the class of the medication, mechanism of action, dosing, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings

Amoxicillin is first-line therapy for sinusitis in children (Woo & Robinson, 2016). If the child has not recently been on antibiotics, they should be on a dose of 25-50mg/kg/d in divided doses. This bactericidal medication is an aminopenicillin that is taken orally, has a half-life of 1.3hrs, is metabolized in the liver and excreted in the urine, and works by inhibiting the bacterial cell wall mucopeptide (Woo & Robinson, 2016). As stated before, it does not have any black box warnings and patients kidney and liver functioning is a concern before use.

What health maintenance or preventive education is important for this client based on your choice medication/treatment?

I would instruct this patient to take the medication until it is gone; not stop it early. In addition, if they failure to respond within 3 to 5 days he should prompt notify his PCP and a change in therapy should be considered (Woo & Robinson, 2016). I would instruct the patient to get plenty of sleep, increase fluid intake, and take a probiotic once they are done with their regimen. Antibiotics have been known to kill of not only the bad bacteria in the gut but the good as well. Preventing side effects like diarrhea should be taken prophylactically.  They should be taken on an empty stomach, 1 hour before a meal or 2 hours after meals (Woo & Robinson, 2016). For additional resources, I would tell the patient the pharmacist is a great tool for resource if they had questions when they picked up the medication but to always call the PCP for further questioning.

 References:

 

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I really enjoyed reading your response to this week’s discussion topic. You made some really great points and provided excellent fact-based information. I agree with you that technologies are highly dependent on Internet access, server functionality, and user knowledge. Do you feel like you were appropriately and adequately trained on the EHR that your healthcare facility uses? What improvements could your facility make to their computer training programs? My main complaint about EHR training at hospitals overall is that the focus of the training is only on medsurg and floor nursing charting standards. The computer training that I have experienced never takes into account that there are other specialties that need to know appropriate charting measures.   According to the authors Cowie et al. (2017), “electronic health records provide opportunities to enhance patient care, embed performance measures in clinical practice, and facilitate clinical research.” I think this is one of the main reasons that it is so important to have an EHR. Future technological innovation is going to keep transforming healthcare, yet while technologies will drive innovation, human factors will remain one of the stable limitations of breakthroughs (Thimbleby, 2013).         

Cowie, M. R., Blomster, J. I., Curtis, L. H., Duclaux, S., Ford, I., Fritz, F.,                     . . . Zalewski, A. (2017). Electronic health records to facilitate                     clinical research. Clinical Research in Cardiology, 106(1).      Thimbleby, H. (2013). Technology and the Future of Healthcare. Journal of      Public Health Research, 2(3).

 

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Thanks for your discussion on UTI. Women and older adults are at a higher risk for UTIs. Many people are prone to recurrent UTIs. Proper management and prevention is essential. UTI may be either cystitis (lower UTI) or pyelonephritis (upper UTI). The most common offending uropathogen in sporadic and recurrent UTIs is Escherichia coli or E. coli. Other bacteria that commonly are the offending organisms are Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis (Aydin, Ahmed, Zaman, Khan, & Dasgupta 2014). 

With recurrent UTIs, prophylaxis is often necessary. One particular prophylaxis treatment that may be recommended is consumption of cranberry juice or tablets. While some studies indicate that cranberry juice inhibits adherence of pathogens to the uroepithelial cells, effectiveness of cranberry juice as prevention of UTIs remains debated. With conflicting data regarding effectiveness among many studies, the provider will have to decide if recommending cranberry juice for prophylaxis will be a part of a patient’s treatment plan. What would be your recommendations for the patient with recurrent UTI & why?

 

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Complementary and Alternative Therapies for Nursing Practice. 

BOOK Fontaine,K.L (2014) .

 Chapter 4 – Traditional Chinese
Chapter 5 –  Ayurvedic Medicine 

Question(s):   

Discuss Ayurvedic medicine .

· What is Ayurvedic medicine? 

· Explain the meaning of the word Ayurvedic. 

· Do you see any value of Ayurvedic medicine in the United States now days? (Explain your answer). 

· Would you integrate any of the Ayurveda practices into your nursing practice while caring for patients.

Guidelines: 

Apa format Time New Roman Format 12 font.

The answer should be based on the knowledge obtained from reading the book, no just your opinion. 

If there are 4 questions in the discussion, you must answer the four of them.   

Complementary and Alternative Therapies for Nursing Practice. 

BOOK Fontaine,K.L (2014) .

 Chapter 4 – Traditional Chinese
Chapter 5 –  Ayurvedic Medicine 

Question(s):   

Discuss Ayurvedic medicine .

· What is Ayurvedic medicine? 

· Explain the meaning of the word Ayurvedic. 

· Do you see any value of Ayurvedic medicine in the United States now days? (Explain your answer). 

· Would you integrate any of the Ayurveda practices into your nursing practice while caring for patients.

Guidelines: 

Apa format Time New Roman Format 12 font.

The answer should be based on the knowledge obtained from reading the book, no just your opinion. 

If there are 4 questions in the discussion, you must answer the four of them.   

Complementary and Alternative Therapies for Nursing Practice. 

BOOK Fontaine,K.L (2014) .

 Chapter 4 – Traditional Chinese
Chapter 5 –  Ayurvedic Medicine 

Question(s):   

Discuss Ayurvedic medicine .

· What is Ayurvedic medicine? 

· Explain the meaning of the word Ayurvedic. 

· Do you see any value of Ayurvedic medicine in the United States now days? (Explain your answer). 

· Would you integrate any of the Ayurveda practices into your nursing practice while caring for patients.

Guidelines: 

Apa format Time New Roman Format 12 font.

The answer should be based on the knowledge obtained from reading the book, no just your opinion. 

If there are 4 questions in the discussion, you must answer the four of them. 

 

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Question for Discussion

Chapter 3 – The Intervention and Assessment Models
Chapter 4 – Tools of the Trade

Question(s): Case of Elizabeth.

Maria is a 48-year-old white female who is recently divorced. She is not doing well in her love life and comes to you to get some immediate help because she is depressed and thinking about suicide. She spends the first ten minutes weeping uncontrollably and has a hard time putting words together.  Of the nine intentional strategies depicted in your book, which ones are the most important ones in this situation (mention 3 in the order of priorities) and why (explain and justify your answer)?  

Guidelines: 500 words . Time New Roman, APA Format 12 font 

The answer should be based on the knowledge obtained from reading the book, no just your opinion. If there are 2 questions in the discussion, you must answer both of them. 

 First question: Mention the adequate strategy for this case scenario (50%). Second part of this question:  explain / justify your answer (50%). 

 

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