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Walden – NURS 6521 – Off-Label Drug Use in Pediatrics

What’s Coming Up in Week 10?

Next week, you will continue working on your Discussion assigned in Week 9, as you examine the types of drugs used to treat infections and disorders of the hematologic system.

Next Week

To go to the next week:

Week 10: Women’s and Men’s Health/Infections and Hematologic Systems, Part II

Bacterial and viral infections may spread through the direct contact of bodily fluids such as blood or through vectors, who help to spread infections via the blood. When you think of infections and the hematologic system, what comes to mind?

Infectious diseases, such as malaria, dengue, or other hemorrhagic fevers are some examples of infections that impact the hematologic system. However, disorders of the hematologic system, such as anemia or blood clotting factor disorders, can also have a deleterious effect on a patient’s health and well-being. As an advanced practice nurse, you will need to understand the different types of pharmacotherapeutics used to treat infections and disorders of the hematologic system as you work to enhance patient-centered approaches for safe, quality, and effective care.

This week, you will examine infections and hematologic disorders, as well as the types of drugs used to treat aspects of these disorders or health systems.

Learning Objectives

Students will:

Evaluate patients for treatment of complex health issues
Evaluate patients for treatment of infections
Evaluate patients for treatment of hematologic disorders
Analyze patient education strategies for the management and treatment of complex comorbidities

Learning Resources

Required Readings

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

Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)
Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396)
Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436)
Chapter 51, “Birth Control” (pp. 437–446)
Chapter 52, “Androgens” (pp. 447–453)
Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)
Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661)
Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662–668)
Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694)
Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699)
Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714)
Chapter 79, “Antifungal Agents” (pp. 715–722)
Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770)

Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5–15. doi:10.3109/13685538.2015.1004049

This article presents recommendations on the diagnosis, treatment, and monitoring of hypogonadism in men. Reflect on the concepts presented and consider how this might impact your role as an advanced practice nurse in treating men’s health disorders.

Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting. PLoS ONE, 9(2), e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872

This study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality, and HIV transmission.

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

This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition.

Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html

This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, and counseling.

Document: Final Exam Study Guide (PDF)

Required Media

Laureate Education (Producer). (2019h). Pathopharmacology: Pharmacology and immunological disorders: Improvements in medications and drug administration [Video file]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 8 minutes.
Nurse Manager, Bette Nunn discusses how technology has improved the practice of administering drugs and created new and improved drug therapies. The importance of using technology as well as a patient’s knowledge of their own drug history is also discussed.

Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

To Prepare

Review the resources for this module and reflect on the different health needs and body systems presented.
Review your peers case studies from Week 9.
Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

By Day 6 of Week 10

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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

What’s Coming Up in Module 8?

In the next module, you will examine prescribing drugs and the off-label use of drugs to treat pediatric patients. You will also complete your Final Exam.

Looking Ahead: Final Exam

Please review the Resources and content in the previous modules in preparation for your Final Exam in Module 8.

To go to the next week:

Module 8

Module 8: Pediatrics

As an advanced practice nurse, you provide patient care across all stages of the lifespan. While you may not necessarily specialize in pediatrics, you will likely come across pediatric patients and may be involved in developing, implementing, and recommending drug therapy plans for pediatric patients. Of special note, the proper dosing and administration of pharmacotherapeutics for pediatric patients ensures their continued growth, development, and promotion of positive health outcomes.

What’s Happening This Module?

Module 8: Pediatrics is a 1-week module, Week 11 of the course. In this module, you will examine the practice of prescribing off-label drugs to children and explore strategies for making off-label drug use safer for children. You also complete your Final Exam.

What do I have to do?	When do I have to do it?
Review your Learning Resources	Days 1-7, Week 11
Assignment: Off-Label Drug Use in Pediatrics	Submit your Assignment by Day 5 of Week 11.
Final Exam	Complete by Day 7 of Week 11.

Go to the Week’s Content

Week 11: Pediatrics

Children, like adults, deal with variety of health issues, but they also have issues that are more prevalent within their population. One issue that significantly impacts children is the prescription of drugs for off-label use. As an advanced practice nurse, how do you determine the appropriate use of off-label drugs in pediatrics? Are there certain drugs that should be avoided with pediatric patients?

This week, you examine the practice of prescribing off-label drugs to children. You also explore strategies for making off-label drug use safer for children from infancy to adolescence, as it is essential that you are prepared to make drug-related decisions for pediatric patients in clinical settings.

Learning Objectives

Students will:

Evaluate the practice of prescribing off-label drugs to children
Analyze strategies to make the off-label use of drugs safer for children
Identify key terms, concepts, and principles related to prescribing drugs to treat patient disorders

Learning Resources

Required Readings

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

Chapter 9, “Drug Therapy in Pediatric Patients” (pp. 58—60)

Corny, J., Lebel, D., Bailey, B., & Bussieres, J. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives. The Journal of Pediatric Pharmacology and Therapeutics, 20(4), 316–328. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557722/

This article highlights pediatric governmental initiatives to prevent unlicensed and off-label drug use in children. Review these initiatives and guidelines and how they might impact your practice as an advanced practice nurse.

Panther, S. G., Knotts, A. M., Odom-Maryon, T., Daratha, K., Woo, T., & Klein, T. A. (2017). Off-label prescribing trends for ADHD medications in very young children. The Journal of Pediatric Pharmacology and Therapeutics, 22(6), 423–429. doi:10.5863/1551-6776-22.6.423

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

Document: Final Exam Study Guide (PDF)

Required Media

Laureate Education (Producer). (2019i). Therapy for pediatric clients with mood disorders [Interactive media file]. Baltimore, MD: Author.

Assignment: Off-Label Drug Use in Pediatrics

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 interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
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.

By Day 5 of Week 11

Write a 1-page narrative in APA format that addresses the following:

Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
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.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

Submission and Grading Information

Sample Paper Week 11

Walden NURS 6521 – Off-Label Drug Use in Pediatrics

Advanced Pharmacology

Student’s Name:

Institutional Affiliation:

Circumstances under which Children Should be Prescribed Drugs for Off-label Use

More than 50% of drugs approved by the Food and Drug Administration (FDA) do not contain labeling for children. Therefore, pediatricians have to decide the appropriate prescription based on their clinical judgment. There is however specific guidance by various pediatric associations such as the American Academy of Pediatrics (AAP) on circumstances under which physicians can use drugs off-label on children.

These circumstances include absence of safe and licensed therapeutic options for a specific disease, the failure of the existing standard therapy to achieve success in treating the condition and lack of alternative forms of therapy for children. Other circumstances include lack of clinical trials and availability of convincing evidence on their effectiveness and safety of the of label drugs in children (Panther, Knotts, Odom-Maryon, Daratha, Woo & Klein, 2017).

Strategies to Make the Off-label Use and Dosage of Drugs Safer for Children from Infancy to Adolescence

The risk of adverse drug reaction is high in off-label use compared to approved medication. The risk is even higher for outpatients compared to hospitalized patients due to limited monitoring. Off label, medication requires maximum monitoring since they have not been previously tried on children thus the pediatricians are uncertain of reactions. Safety strategies include administering of label medication to inpatients only to maximize monitoring of the adverse effect. Secondly, physicians should report adverse reactions of off label medication as required by their professional code for purposes of documentation thus reference in subsequent cases (Tanemura, Asawa, Kuroda, Sasaki, Iwane & Urushihara, 2019).

Other strategies include use of electronic health systems to improve the quality of prescribing by integrating parameters such as age, weight, body surface area and renal function status in complex dosage calculations, which is essential in off-label medication. electronic health records facilitates correct dosage and putting of precaution on negative drug interactions by sharing patients medical information to all additional participants in the treatment process (Corny, Lebel, Bailey & Bussières, 2015).

Another strategy is increasing access to evidence-based information regarding off label children medication and integrating pharmacists in pediatric wards for consultation in decisions regarding pediatric prescription of off label medication.

One of the off-label drugs that require extra care and attention when used in pediatrics is Budesonide. It is an inhaled corticosteroid used for asthma treatment. The children’s inability to use inhalers poses a danger of overdose of the drug. Other asthma drugs like mometasone and ciclesonide are new in the market therefor there lacks existing evidence on the implications of their use on children. They should therefore be cautiously prescribed for pediatric use.

References

Corny, J., Lebel, D., Bailey, B., & Bussières, J. F. (2015). Unlicensed and off-label drug use in children before and after pediatric governmental initiatives. The Journal of Pediatric Pharmacology and Therapeutics, 20(4), 316-328.

Tanemura, N., Asawa, M., Kuroda, M., Sasaki, T., Iwane, Y., & Urushihara, H. (2019). Pediatric off-label use of psychotropic drugs approved for adult use in Japan in the light of approval information regarding pediatric patients in the United States: a study of a pharmacy prescription database. World Journal of Pediatrics, 15(1), 92-99.

Final Exam

This Exam covers the content you have explored throughout this course.

This exam is a test of your knowledge in preparation for your certification exam. No outside resources—including books, notes, websites, or any other type of resource—are to be used to complete this exam. You are not allowed to take screenshots or record the exam questions in any other format while taking the exam. You are expected to comply with Walden University’s Code of Conduct.

By Day 7 of Week 11

Complete the Final Exam.

Submission and Grading Information

Complete the Exam by Day 7 of Week 11

To Complete this Exam:

Week 11 Exam

Module in Review

In this module, you evaluated the practice and circumstances of prescribing off-label drugs to children and analyzed the strategies used to make their use and dosage safer for children. After you have completed the Discussion and the Final Exam for this week, you have finished the course. Congratulations! Please complete the Course Evaluation form and submit by Day 7.

Congratulations! After you have finished all of the assignments for this week, you have completed the course. Please submit your Course Evaluation by Day 7.

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Walden

Walden – NURS 6521 – Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

What’s Coming Up in Module 7?

In the next module, you will examine types of drugs prescribed to address women’s and men’s health, infections, and disorders of the hematologic system.

Next Week

To go to the next week:

Module 7: Women’s and Men’s Health, Infections, and Hematologic Systems

What’s Happening In This Module?

Module 7: Women’s and Men’s Health, Infections, and Hematologic Systems is a 2-week module, Weeks 9 and 10 of the course. In this module, you will examine women’s and men’s health, infectious diseases, and hematologic disorders as well as the types of drugs used to treat aspects of these disorders or health systems.

What do I have to do?	When do I have to do it?
Review your Learning Resources	Days 1-7, Weeks 9 and 10
Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders	Post by Day 3 of Week 9, and respond to your colleagues by Day 6 of Week 10.

Go to the Week’s Content

Week 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part I

As an advanced practice nurse, you will likely encounter many disorders associated with women’s and men’s health, such as hormone deficiencies, cancers, and other functional and structural abnormalities. Disorders such as these not only result in physiological consequences but also psychological consequences, such as embarrassment, guilt, or profound disappointment for patients. For these reasons, the provider-patient relationship must be carefully managed. During evaluations, patients must feel comfortable answering questions so that you, as a key health-care provider, will be able to diagnose and recommend appropriate treatment options. Advanced practice nurses must be able to educate patients on these disorders and help relieve associated stigmas and concerns.

This week, you examine women’s and men’s health concerns as well as the types of drugs used to treat disorders that affect women’s and men’s health. You also explore how to treat aspects of these disorders on other health systems.

Learning Objectives

Students will:

Evaluate patients for treatment of complex health issues
Evaluate patients for treatment of infections
Evaluate patients for treatment of hematologic disorders
Analyze patient education strategies for the management and treatment of complex comorbidities

Learning Resources

Required Readings

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

Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 364–371)
Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396)
Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436)
Chapter 51, “Birth Control” (pp. 437–446)
Chapter 52, “Androgens” (pp. 447–453)
Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)
Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661)
Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662–668)
Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694)
Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699)
Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714)
Chapter 79, “Antifungal Agents” (pp. 715–722)
Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770)

This study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality, and HIV transmission.

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

This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, and counseling.

Required Media

Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?

For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.

To Prepare

Review the Resources for this module and reflect on the different health needs and body systems presented.
Your Instructor will assign you a complex case study to focus on for this Discussion.
Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

By Day 3 of Week 9

Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

You will respond to your colleagues’ posts in Week 10.

Sample Paper Week 9 Discussion

Walden NURS 6521 – Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Woman’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Student’s Name:

Institutional Affiliation:

Woman’s and Men’s Health, Infectious Disease and Hematologic Disorders

Health is important for both men and women. It is a state of comprehensive physical, social, and mental well-being and not just the absence of illness or infirmity. Men and women are different. The fundamental observation spreads to their weakness and response to diverse infectious illnesses reasons for the observation being different, counting pathogens, and exposure to the common genetic aspects that control immune responses contrary to the pathogens. Also, hormonal factors that can alter vulnerability or illness progression and reaction to treatment are included. Men and women are prone to hematologic illnesses involving blood and include complications with the red blood cells, platelets, white blood cells, bone marrow, spleen, and lymph nodes. This paper will explore the Woman’s and Man’s health, infectious disease and hematologic disorders concerning the patient presented in the case study.

Patients health needs from a case study

The patient presents with complaints of night sweats, hot flushing, and genitourinary symptoms that require immediate attention. She is 46 years old with a history of hypertension, and upon Blood Pressure (BP) check, it is at 150/90, an elevated blood pressure. The patient’s LMP is a month back and had ASCUS in pap in the last five years, which causes no problem in the late period. It can be concluded that her present symptoms indicate that she is in the perimenopausal period. When the women’s menopausal period begins, it causes a hot flush, depression, night flush, high BP, and changes in the genitourinary (Sturdee et al. 2017). She, therefore, requires to manage her symptoms to prevent more problems.

Treatment Regimen

To treat the patient, I would recommend hormone therapy, Estrogen-progestin therapy. On its own, estrogen improves menopause symptoms but, in another context, raises the risk of uterus cancer (endometrial cancer). Adding a progestin to estrogen will lower endometrial cancer’s danger to normal (Prior et al., 2017). I would also commend vaginal estrogen to avoid genitourinary complications. Vaginal estrogen, meant to deliver estrogen right to the local tissue, remains active in minimizing genitourinary symptoms like vaginal burning and dryness, painful sexual intercourse, urinary urgency and frequency, painful urination, and recurrent UTIs. Reducing the systemic estrogen exposure, even the lowest-dose vaginal ring, successfully can minimize frequency and urinary in postmenopausal females. Besides, I would commend the patient to take a low dose of antidepressants such as SSRIs to decrease symptoms and calm the mood disorder, take gabapentin to reduce night sweats and hot flush she is experiencing, clonidine to treat high blood pressure, and calcium and vitamin D supplements to strengthen her bones (Yoon et al., 2020).

Patient Education

The patient needs to manage her health needs and to help her; I would advise increasing fluid intake. Fluid intake will help flush any irritations through the bladder and out of a individuals’ body. I would also recommend the patient enhance the aerobic activity, stretching activity, and weight-bearing since these exercises reduce the risk of many hematologic disorders. It would also be good to take calcium diets. Calcium is an important mineral for the human body. It helps maintain and form healthy bones preventing disorders such as Osteoporosis (Cano et al., 2018). The patient will be required to increase the fiber intake rate, eat five portions of food, limit salt intake, and avoid tea, alcohol, coffee, and smoking that cause hot flushes. She should also avoid saturated fats and high-calorie diets taking omega 3fatty acids for a healthy heart, and have consistent screening to prevent cervical and breast cancer.

Conclusion

Health is important for both men and women. It is a state of comprehensive physical, social, and mental well-being and not just the absence of illness or infirmity. Men and women are different, and the fundamental observation spreads to their weakness and response to diverse infectious illnesses following diverse reasons. Men and women as well are prone to hematologic illnesses. As revealed in the case study, the patient’s complaints of night sweats, hot flushing, and genitourinary symptoms indicate that she is in the perimenopausal period and requires immediate attention in terms of treatments. Some of the treatments that can be recommended following her condition include hormone therapy, Estrogen-progestin therapy, vaginal estrogen, and a low dose of antidepressants such as SSRIs to decrease symptoms and calm mood disorder. Patient education would also be important, such as fluid intake, aerobic activity, and taking calcium diets to manage her needs fully.

References

Cano, A., Chedraui, P., Goulis, D. G., Lopes, P., Mishra, G., Mueck, A., … & Tuomikoski, P. (2018). Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide. Maturitas, 107, 7-12.

Prior, J. C., Seifert-Klauss, V. R., Giustini, D., Adachi, J. D., Kalyan, S., & Goshtasebi, A. (2017). Estrogen-progestin therapy causes a greater increase in spinal bone mineral density than estrogen therapy-a systematic review and meta-analysis of controlled trials with direct randomization. Journal of musculoskeletal & neuronal interactions, 17(3), 146.

Sturdee, D. W., Hunter, M. S., Maki, P. M., Gupta, P., Sassarini, J., Stevenson, J. C., & Lumsden, M. A. (2017). The menopausal hot flush: a review. Climacteric, 20(4), 296-305. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/13697137.2017.1306507

Yoon, S. H., Lee, J. Y., Lee, C., Lee, H., & Kim, S. N. (2020). Gabapentin for the treatment of hot flushes in menopause: a meta-analysis. Menopause, 27(4), 485-493. Retrieved from https://journals.lww.com/menopausejournal/Abstract/2020/04000/Gabapentin_for_the_treatment_of_hot_flushes_in.17.aspx

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Walden – NURS 6521 Asthma and Stepwise Management

Week 3: Respiratory System

Asthma and chronic obstructive pulmonary disease (COPD) are significant public health burdens. Currently, more than 25 million people in the United States have asthma (HealthyPeople.gov, 2019). As an advanced practice nurse, you will likely encounter patients who will present with respiratory disorders, including asthma or COPD. Understanding specific treatment protocols as well as the types of pharmacotherapeutics used to treat respiratory disorders is important to ensure the effective and safe delivery of advanced nursing practice.

This week, you will evaluate drug therapy plans for patients who present with asthma and analyze the stepwise approach to asthma treatment and management from a patient in your professional practice.

Reference: HealthyPeople.gov. (2019). Respiratory diseases. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/respiratory-diseases

Learning Objectives

Students will:

Evaluate drug therapy plans for asthma
Assess the impact of asthma treatments on patients
Analyze the stepwise approach to asthma treatment and management

Learning Resources

Required Readings (click to expand/reduce)

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

Chapter 62, “Drugs for Asthma and Chronic Obstructive Pulmonary Disease” (pp. 557–579)

Chapter 63, “Drugs for Allergic Rhinitis, Cough, and Colds” (pp. 580–588)

Document: APA Presentation Template

Optional Resources (click to expand/reduce)

National Heart Lung and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines for the diagnosis and management of asthma. Retrieved from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

This web resource presents guidelines for diagnosing and managing asthma and outlines treatment recommendations for specific age groups.

Assignment: Asthma and Stepwise Management

Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.

One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.

To Prepare

Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.

By Day 7 of Week 3

Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:

Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
Explain the stepwise approach to asthma treatment and management for your patient.
Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

Submit Your Assignment by Day 7 of Week 3

Sample Paper Week 3 Assignment

Walden NURS 6521 Asthma and Stepwise Management

Asthma and Stepwise Management

Student’s Name:

Institutional Affiliation:

Objectives

Brief discussion of Asthma and its symptoms.
Description of options for treatment for quick-relief long-term control.
Explanation of stepwise approach in treating and managing asthma.
Explanation of benefits of the stepwise strategy for care providers and asthma patients.

Asthma

Chronic illness severely impacting the airways.
Results in airways swelling, narrowing and producing excessive mucus.
As a consequence, breathing becomes difficult and wheezing and coughing is triggered.
Condition varies from person to person.
Can be minor nuisance or a severe effect interfering with daily activities.
It cannot be cured but symptoms can be managed.

Long Term Controls

Therapy’s goal involves controlling asthma through;

– Impairment reduction

– Reducing Risk

Involves taking vital medications to keep asthma under control.
Preventive medications used in treating airway inflammation that causes symptoms like coughing or breathlessness.
Medications are used daily to eliminate or reduce asthma flair-ups.
Examples include:

– Corticosteroids

– Immunomodulators,

– Methylxanthines, and

– Long acting beta agonists (Can et al., 2020).

Quick Relief

Also referred to as rescue medications or inhalers.
Utilized as needed for quick opening of airways to make breathing easier.
The medications can aid in preventing impeding asthma attacks.
Involves fast-acting medications like:

– Anticholinergics

– Short acting beta agonists.

Stepwise Approach

Involves appropriate monitoring of medication utilized in controlling and managing asthma.
Involves increasing or decreasing medications as necessary to achieve or maintain control.
Applicable to all patients with asthma.
It decreases morbidity and improves self-management.
Includes six steps used in ensuring the best results are attained.

Benefits to Care Providers and Patients

Patient empowerment and education
Providers can control the environment around the asthma condition to manage it effectively.
Reduction of exacerbations.
Control of comorbidities and reduction of impairments.
Guidance to providers on how to balance medications for the patient.

Conclusion

Asthma is a chronic illness severely impacting the airways.
Long-term control medications are the key to keeping your asthma controlled and in the green zone.
Quick relief medications give fast relief for asthma symptoms and can prevent impeding asthma attacks
Asthma management recommendations integrate various therapy components into a stepwise therapeutic approach where medications are adjusted for achievement and maintenance of control.
The stepwise approach is beneficial to both care providers and patients in attaining control and management of asthma.

References

Blake, K., & Raissy, H. (2018). Asthma Guidelines from the National Asthma Education and Prevention Program: Where Are We Now?. Pediatric Allergy, Immunology, and Pulmonology, 31(1), 37-39.

Can, C., Akkelle, E., Özdemir, P. G., Yazıcıoğlu, M., & Süt, N. (2020). Assessment of regular drug use and inhaler technique skills in asthmatic children. Allergologia et Immunopathologia, 48(2), 124-129.

FitzGerald, J. M., Tavakoli, H., Lynd, L. D., Al Efraij, K., & Sadatsafavi, M. (2017). The impact of inappropriate use of short acting beta agonists in asthma. Respiratory medicine, 131, 135-140.

Gosens, R., & Gross, N. (2018). The mode of action of anticholinergics in asthma. European Respiratory Journal, 52(4), 1701247.

Qian, C. J., Coulombe, J., Suissa, S., & Ernst, P. (2017). Pneumonia risk in asthma patients using inhaled corticosteroids: a quasi-cohort study. British Journal Of Clinical Pharmacology, 83(9), 2077–2086. https://doiorg.ezp.waldenulibrary.org/10.1111/bcp.13295

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

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What’s Coming Up in Week 10?

Week 10: Women’s and Men’s Health/Infections and Hematologic Systems, Part II

Learning Resources

Required Readings

Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

What’s Coming Up in Module 8?

Module 8: Pediatrics

What’s Happening This Module?

Week 11: Pediatrics

Learning Objectives

Learning Resources

Required Readings

Assignment: Off-Label Drug Use in Pediatrics

Sample Paper Week 11

Walden NURS 6521 – Off-Label Drug Use in Pediatrics

Circumstances under which Children Should be Prescribed Drugs for Off-label Use

Strategies to Make the Off-label Use and Dosage of Drugs Safer for Children from Infancy to Adolescence

References

Final Exam

Module in Review

What’s Coming Up in Module 7?

Module 7: Women’s and Men’s Health, Infections, and Hematologic Systems

What’s Happening In This Module?

Week 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part I

Learning Objectives

Learning Resources

Required Readings

Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Sample Paper Week 9 Discussion

Walden NURS 6521 – Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Woman’s and Men’s Health, Infectious Disease and Hematologic Disorders

Patients health needs from a case study

Treatment Regimen

Patient Education

Conclusion

References

Week 3: Respiratory System

Learning Objectives

Learning Resources

Assignment: Asthma and Stepwise Management

Sample Paper Week 3 Assignment

Walden NURS 6521 Asthma and Stepwise Management

Objectives

Asthma

Long Term Controls

Quick Relief

Stepwise Approach

Benefits to Care Providers and Patients

Conclusion

References

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