The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion. Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

To prepare:

• Review the Bazzano et al. and Mayhew articles in the Learning Resources. Reflect on situations in which children should be prescribed drugs for off-label use.
• Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

With these thoughts in mind:

By Day 3

Post an explanation of circumstances under which children should be prescribed drugs for off-label use. Then, describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

CLASS RESOURCES 

Arcangelo,  V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.).  (2017). Pharmacotherapeutics for advanced  practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams  & Wilkins.
Review Chapter 4, “Principles of Pharmacotherapy in Pediatrics” (pp. 53-63)
This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.

Chapter 17, “Ophthalmic Disorders” (pp. 221-243)
This chapter examines the causes, pathophysiology, diagnostic criteria, and drug treatment for four ophthalmic disorders: blepharitis, conjunctivitis, keratoconjunctivitis sicca, and glaucoma. It also explores methods of monitoring patient response to treatment.

Chapter 43, “Attention-Deficit/Hyperactivity Disorder” (pp. 743-756)  
This chapter explains the process of diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD). It also identifies drugs for treating patients with ADHD, including proper dosages, selected adverse events, and special considerations for each drug.

Chapter 51, “Immunizations” (pp. 906-926)  
This chapter explores vaccines that are licensed for use in the United States and provides a recommended vaccination schedule for pediatric patients and adults.

Chapter 52, “Smoking Cessation” (pp. 927-943)  
This chapter examines clinical implications of smoking. It also covers various approaches for aiding patients who are dependent on nicotine but want to stop smoking.

Chapter 54, “Weight Loss” (pp. 945-956)  
This chapter begins by reviewing patient factors that contribute to obesity. It also examines drug therapy for initiating weight loss in patients, as well as alternative non-drug treatments.

Bazzano, A. T, Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-label prescribing to children in the United States outpatient setting. Academic Pediatrics, 9(2), 81–88.
Note: Retrieved from the Walden Library databases.

This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing.

Mayhew, M. (2009). Off-label prescribing. The Journal for Nurse Practitioners, 5(2), 122–123.
Note: Retrieved from the Walden Library databases.

This article reviews the prevalence of off-label prescribing, including its benefits and risks. It also explores issues regarding the safety of off-label prescribing and when it is unavoidable.

Drugs.com. (2012). Retrieved from http://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

 

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 Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples. 

 

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Choose a patient-care situation in which the RN should intervene and advocate for the patient.  An example of such a situation might be when a patient has not been given complete informed consent.

Include the following in your paper:

• Describe the clinical situation concisely and descriptively. It can be an actual situation or a hypothetical one.
• Apply the Bioethical Decision Making Model to the specific clinical ethical situation that you choose. Address each section of the model in your paper.
• Conclude with a discussion of nursing advocacy in the clinical setting and the nurse’s role as a patient advocate.  

Your paper should be 4-5 pages.

You must reference and cite 1-2 scholarly sources other than your text. Include a title page and a reference page to cite your text and adhere to APA formatting.

 BioethicalDecisionMakingModel 1. Definethedilemma:Useyourownwordstodescribetheproblem.Stateitinaway thatotherscanquicklyunderstandyourdilemma.Review 2. Identifythemedicalfacts:Describethefactsthatarerelevanttothedilemma. 3. Rememberthatthediagnosisandprognosisaremedicalfacts. 4. Identifythenon-medicalfacts(patientandfamily,externalinfluences): a. Patientandfamilyfactssuchasculture,religion,social,economic,the existenceofanAdvanceHealthcareDirective,verbalpreferencesmadeby thepatient,howthepatientlivedhis/herlife. b. Thosethatyoudiscussshouldberelevanttothesituation. 5. Externalinfluencesinclude:organizationalpolicies,federalandstatelaws,practice acts,codeofethics.Theseshouldberelevanttothesituation. 6. Forbothstep2or3,separatethefactsfromtheassumptions:Sometimesall healthcareprofessionalsallowassumptionstoguidetheirdecision-making.These mustbeidentifiedsothattheseassumptionsdonotinterferewiththeprocess. 7. Identifyitemsthatneedclarification.Yourpapershouldidentifyfactsthatyouneed toclarify.Wheninitiallydiscussinganethicalsituation,itisnotunusualtonothave alloftheanswers. 8. Identifythedecisionmakers:Isthepatientanadultcompetenttomaketheirown choices?Isthepatientachildwhoisoldenoughtohaveasayinthedecision.Ifthe patientcannotmaketheirowndecision,whoisthedecisionmaker?Howwasthis personselected? 9. Reviewtheunderlyingethicalprinciples:Reviewwhichonesandwhytheyapplyt thisparticularcase:beneficence,nonmaleficience,veracity,fidelity,autonomyand justice. 10. Definealternatives:One-Waytoproceedmaybeapparentatthispoint.However, sometimestherearedifferentchoices.Theyshouldbeaddressedidentifyingthe benefitsandburdensfordoingonethingversustheother. 11. Follow-up:Definetheprocesstobeusedwiththechosenalternative. ReferenceSource:Levine-Ariff,J.&Groh,D.H.(1990).CreatinganEthicalEnvironment. Nursem  

 

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Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.

What has your experience been with patient involvement in treatment or healthcare decisions? 

In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.

To Prepare:

• Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan. 
• Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.  
  • Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.

NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.

Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.

Rubric:

               

Main Posting–

Levels of Achievement:Excellent 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.  

Supported by at least three current, credible sources. 

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.Good 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.  

At least 75% of post has exceptional depth and breadth.  

Supported by at least three credible sources. 

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.Fair 35 (35%) – 39 (39%) Responds to some of the discussion question(s).  

One or two criteria are not addressed or are superficially addressed.  

Is somewhat lacking reflection and critical analysis and synthesis.  

Somewhat represents knowledge gained from the course readings for the module.  

Post is cited with two credible sources. 

Written somewhat concisely; may contain more than two spelling or grammatical errors.  

Contains some APA formatting errors.Poor 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. 

Lacks depth or superficially addresses criteria.  

Lacks reflection and critical analysis and synthesis.  

Does not represent knowledge gained from the course readings for the module.  

Contains only one or no credible sources. 

Not written clearly or concisely.  

Contains more than two spelling or grammatical errors.  

Does not adhere to current APA manual writing rules and style.Feedback:

Main Post: Timeliness–

Levels of Achievement:Excellent 10 (10%) – 10 (10%) Posts main post by day 3.Good 0 (0%) – 0 (0%)  Fair 0 (0%) – 0 (0%)  Poor 0 (0%) – 0 (0%) Does not post by day 3.Feedback:

First Response–

Levels of Achievement:Excellent 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings.  

Responds fully to questions posed by faculty.  

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.  

Demonstrates synthesis and understanding of learning objectives. 

Communication is professional and respectful to colleagues. 

Responses to faculty questions are fully answered, if posed.  

Response is effectively written in standard, edited English.Good 15 (15%) – 16 (16%) Response exhibits critical thinking and application to practice settings. 

Communication is professional and respectful to colleagues.  

Responses to faculty questions are answered, if posed.  

Provides clear, concise opinions and ideas that are supported by two or more credible sources.  

Response is effectively written in standard, edited English.Fair 13 (13%) – 14 (14%) Response is on topic and may have some depth. 

Responses posted in the discussion may lack effective professional communication.  

Responses to faculty questions are somewhat answered, if posed.  

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.Poor 0 (0%) – 12 (12%) Response may not be on topic and lacks depth. 

Responses posted in the discussion lack effective professional communication.  

Responses to faculty questions are missing.  

No credible sources are cited.Feedback:

Second Response–

Levels of Achievement:Excellent 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. 

Responds fully to questions posed by faculty.  

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.  

Demonstrates synthesis and understanding of learning objectives. 

Communication is professional and respectful to colleagues. 

Responses to faculty questions are fully answered, if posed.  

Response is effectively written in standard, edited English.Good 14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. 

Communication is professional and respectful to colleagues.  

Responses to faculty questions are answered, if posed.  

Provides clear, concise opinions and ideas that are supported by two or more credible sources.  

Response is effectively written in standard, edited English.Fair 12 (12%) – 13 (13%) Response is on topic and may have some depth. 

Responses posted in the discussion may lack effective professional communication.  

Responses to faculty questions are somewhat answered, if posed.  

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.Poor 0 (0%) – 11 (11%) Response may not be on topic and lacks depth. 

Responses posted in the discussion lack effective professional communication.  

Responses to faculty questions are missing.  

No credible sources are cited.Feedback:

Participation–

Levels of Achievement:Excellent 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.Good 0 (0%) – 0 (0%)  Fair 0 (0%) – 0 (0%)  Poor 0 (0%) – 0 (0%) 

 

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