refer to the attached file 

 

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1-maceda

What other assessment data would be helpful for the nurse practitioner to have?

           The diagnosis of UTI by clinical criteria alone has an error rate of approximately 33%; therefore, the NP should be vigilant and pay attention to additional assessment data (Allen, Manilal & Gezmu, 2019).  For example, patient population is typically premenopausal women of any age with risk factors of diabetes, diaphragm use, especially those with spermicide, history of UTI or UTI during childhood, mother or female relatives with history of UTIs, and sexual intercourse.

What are the organisms most likely to cause an UTI?

           Urinary tract infections are primarily caused by gram-negative bacteria, but gram-positive pathogens may also be involved. More  than  95%  of  uncomplicated  UTIs  are  monobacterial.  The most common pathogen for uncomplicated UTIs is E.coli (75%–95%), followed by Klebsiella pneumoniae, Staphylococcus saprophyticus,  Enterococcus  faecalis,  group  B  streptococci,  and Proteus  mirabilis (Bollestad, Vik, Grude& Lindbæk, 2018).

What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

           The first step in treating Shelly is to classify the type of infection, such as acute uncomplicated cystitis or pyelonephritis, acute complicated cystitis or pyelonephritis, CA-UTI, asymptomatic  bacteriuria  (ASB),  or  prostatitis  (Allen, Manilal & Gezmu, 2019).  The Infectious Diseases Society of America (IDSA) recommends that  empiric  regimens  for  uncomplicated  UTIs  be  guided  by  the  local  susceptibility,  particularly  to  E.  coli.  They  recommend   considering   trimethoprim/sulfamethoxazole if the local resistance rate is less than 20% and fluoroquinolones if the resistance rate is less than 10% (Bollestad, Vik, Grude& Lindbæk, 2018). The empiric regimen for complicated UTIs should also be guided by local susceptibility trends of uropathogens,  and  definitive  regimens  should  be  tailored  according  to  susceptibility  results,  when available.

What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

           The teaching priority for Shelly is hydration.  During  UTI  management,  hydration  dilutes  the  uropathogen  and  removes  infected  urine  by  frequent  bladder  emptying.  However, the bacterial count returns to the prehydration  level  after  hydration  is  discontinued.  Potential problems with forcing fluids include urinary retention in a  patient  with  a  partially  obstructed  bladder  and  decreased  urinary antibiotic concentration. 

References

Allen, M., Manilal, A., Gezmu, T., (2019). Prevalence and associated factors of urinary tract infections among women. Journal of Urology, 45(1), 56–62. https://doi.org/10.5152/tud.2018.32855

Bollestad, M., Vik, I., Grude, N., & Lindbæk, M. (2018). Predictors of Symptom Duration and Bacteriuria in Urinary Tract Infection. Scandinavian Journal of Primary Health Care, 36(4), 446–454. https://doi.org/10.1080/02813432.2018.1499602

2-alberto

What other assessment data would be helpful for the nurse practitioner to have?

           Nurse practitioners are well positioned to have important roles in the assessment and management of UTIs.  The bacterial count is an assessment data helpful to the NP.  Urine dip sticks are one of the most frequently used instruments for diagnostic testing if there is clinical evidence that a patient is suffering from UTI. Multistix are most often used, which may be able to detect nitrite (a metabolic product of typical pathogens of the urinary tract), leukocyte esterase, protein and blood (as a marker of inflammation).

What are the organisms most likely to cause an UTI?

           Infection of the bladder (cystitis). This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible.  Infection of the urethra (urethritis). This type of UTI can occur when GI bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

           Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on your health condition and the type of bacteria found in your urine.

Drugs commonly recommended for simple UTIs include:

   Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)

   Fosfomycin (Monurol)

   Nitrofurantoin (Macrodantin, Macrobid)

   Cephalexin (Keflex)

   Ceftriaxone

What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

           In many states, NPs already have the authority to manage UTIs, to varying degrees.  Teaching priority includes drinking plenty of water. Water helps to dilute the urine and flush out bacteria.  Avoiding drinks that may irritate the bladder. Avoid coffee, alcohol, and soft drinks containing citrus juices or caffeine until your infection has cleared. They can irritate the bladder and tend to aggravate the frequent or urgent need to urinate.  Use a heating pad. Apply a warm, but not hot, heating pad to the abdomen to minimize bladder pressure or discomfort.

           Some alternative remedies may include drinking cranberry juice to prevent UTIs. There’s some indication that cranberry products, in either juice or tablet form, may have infection-fighting properties. Researchers continue to study the ability of cranberry juice to prevent UTIs, but results are not conclusive.

References 

Collins, L. (2019). Diagnosis and management of a urinary tract infection. British Journal of Nursing, 28(2), 84–88. https://doi.org/10.12968/bjon.2019.28.2.84

Duncan, D. (2019).  Alternative to antibiotics for managing asymptomatic and non-symptomatic bacteriuria.  British Journal of Community Nursing, 24(3), 116–119. https://doi.org/10.12968/bjcn.2019.24.3.116

 

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Peer replies

1-Alberto :

Polypharmacy is an area of concern for many patients, especially the elderly.  Elderly patients are at a greater risk for adverse drug reactions (ADRs) because of the reduced drug clearance associated with aging and because of metabolic changes (Boris, Cafiero & Smith, 2014).  Some risk factors associated with polypharmacy are potential of drug-drug interactions because it is further increased by use of multiple drugs.  Another risk factor is hip fractures, associated with adverse drug reactions and losing balance or fainting (Boris, Cafiero & Smith, 2014).  Polypharmacy may sometimes lead to “prescribing cascades.”4 Prescribing cascade is said when signs and symptoms (multiple and nonspecific) of an ADR is misinterpreted as a disease and a new treatment/drug therapy is further added to the earlier prescribed treatment to treat the condition (Piere & Farrell, 2012).

       In my practice working with the elderly population, to reduce the incidence of polypharmacy medication, patients are evaluated on a monthly basis.  Additionally, a single drug is be prescribed instead of multiple drugs for the treatment of a single condition, if possible.  Another strategy we use is staring medication with the lower drug dosage and slowly increasing as indicated.

           A strategy that seems to be effective, according to research, is prescribe drugs that can be given once or twice a day instead of prescribing drugs that require to be taken three times a day (Thomas, Liao, & McCliar, 2016).  The reasoning behind this is to lower the risk of forgetting to take the medication or taking the medication together with other drugs.  Another strategy that can be employed is that if the drug taken has no therapeutic beneficial effect or clinical indication it should be eliminated. Unessential drugs should be identified and eliminated prescribed by different health care providers for the same condition/disease (Thomas, Liao, & McCliar, 2016).

2-maceda 

Polypharmacy refers to the effects of taking multiple medications concurrently to manage coexisting health problems, such as diabetes and hypertension (Piere & Farrell, 2014).  Too often, polypharmacy becomes problematic, such as when patients are prescribed too many medications by multiple healthcare providers working independently of each other. Also, drug interactions can occur if no single healthcare provider knows the patient’s complete medication picture. Nurses have a unique opportunity to help identify patients at risk for inappropriate polypharmacy and to educate patients and families about risk reduction. Nurses can use strategies such as patient teaching and consistency in care plan (Piere & Farrell, 2014). 

Some of the risk factors of polypharmacy are age and chronic conditions.  The elderly are more sensitive to the effects of certain drugs, particularly those that affect the central nervous system.  As a consequence, drug classes such as benzodiazepines should be used with caution, and if absolutely necessary, then at a reduced dose to minimize the risk of falls and other adverse events (Thomas, Liao & McCliar, 2016). In addition, age is associated with decreased regulatory functions, therefore anti-hypertensives can more easily result in postural hypotension and opiates in respiratory depression.  Communication barriers often go undetected in health care settings and can have serious effects on the health and safety of patients. Limited literacy skills are one of the strongest predictors of poor health outcomes for patients (Thomas, Liao, & McCliar, 2016).  If the patient is deaf, can’t see or is illiterate there are various strategies the nurse can use for example, advise the patient to bring someone with them to the visit.  Nurses who are responsible for checking patients in should be friendly and helpful. The length and number of forms patients are asked to fill out should be limited.

 

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Peer 1 

 

The state where I plan to practice as a nurse practitioner is Florida. In terms of contraceptives under the Comprehensive Family Planning Act, statue 381.0051, states that their “access to service prohibitions except as otherwise provided that no medical agency or institution of this state or unit of local government shall interfere with the right of any patient or physician to use medically acceptable contraceptive” (Daley, 2016, p. 34). Furthermore, the act further claims that there are also allowances made and highlighted inside the statue that enables to treat medical complications apart from pregnancy that may be attributed toward to using contraceptive methods (Daley, 2016). 

      The laws and regulations that govern abortion in Florida tend to be more severe and restrictive compared to other states. “In 2013 Governor Ron Scott signed legislation requiring that doctors performing an abortion offer emergency health care when the baby is in some way born alive. This law is really a first degree misdemeanor that’s punishable with a year in prison along with a fine of $1000” (Sharma, Frederiksen, Malcolm, Rollison & Carter, 2018). Health care professionals and employees must highlight and report all instances towards the department of health. This can be a prime illustration of the significance and the seriousness of the laws and regulations that govern abortion in Florida. These laws and regulations broadly cover patients with and without use of insurance. The condition of Florida comes with an infant and mortality rate of 6 for each 1000 live births as stated by the connected press.  The bond between contraceptive access and also the infant mortality rate appear to become congruent.  But, there’s no definitive conclusion the two are associated.          

           Poverty is linked to the maternal and infant mortality, and issues such as diabetes, obesity, asthma and depression. The rates in Florida were 6.0 in 2016 for infant mortality compared to 7.2 as the national rate.                                                        

Peer 2 

After having conducted a detailed investigation regarding the selected case, it turned out that Florida experiences a high increase in the aspect of infant and maternal mortality rates. Without a doubt, this statistic cannot be underestimated under any pretext, as such situation remains rather alarming. Comparing this data with the general numbers received within other states, it is worth admitting that infant and maternal mortality rates in Florida are 1.5 times higher than in any other state or region of the U.S (March of Dimes Foundation, 2018). That is why there is a growing necessity in analyzing such state of things from different perspectives and providing a comprehensive understanding of such a dramatic situation. 

           According to the resented investigation, such medical program as Medicaid appears to regulate the nursing sphere and cover the healthcare expenditures of the low-income patients. It is worth remarking that around 65% of patients use this insurance, while around 30% of them are women (Hajizadeh, 2014). Relatively speaking, the program covers only 1/3 risks and dangers among the women related to the contraception and abortion (Hajizadeh, 2014, p. 301). Subsequently, the medical treatment of women with and without an appropriate insurance differs significantly on a daily basis.  

           As a result, the risks concerning the high mortality among infants have a tendency to augment. Conventionally, this state of things is interdependent with the number of regulating external factors, including healthcare environment, clinical setting and economic well-being of the patients (Hajizadeh, 2014, p. 280). Due to such a complicated situation, the local government is called to take into an accurate consideration the dependence of infant mortality rates on the inefficient healthcare system and on the lack of proper medical services.  

All in all, it can be stated that the external factors and a scarcity of financial funding provoke numerous difficulties not only in the context of preventive strategies related to contraception and abortion among the women but also aggravate the medical situation in this state in general. 

-I need a respond for these 2 classmates. Response posts must be minimum 150 words each. Double space. References must be cited in APA format (6th) 

This is the original activity if you needed 

Select the state where you plan to practice as a nurse practitioner and/or nurse leader and investigate the state’s policies on access to contraception and abortion for women with insurance and those without. What are the state’s infant and maternal mortality rates? Discuss the possible relationship between these factors. 

 

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