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:

 

"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "Newclient"

 

PLEASE PAY ATTENTION TO THE CASE STUDY and CHAPTERS ATTACHED

PLEASE FOLLOW THE PROMPTS OF THE WAY THE QUESTIONS WERE ASKED.

ZERO PLAGIARISM

FIVE REFERENCES

The Assignment

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following: Decision #1 Which decision did you select? Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Decision #2 Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Decision #3 Why did you select this decision? Support your response with evidence and references to the Learning Resources. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

 

"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "Newclient"

Re: Topic 2 DQ 1  Workplace violence in the health industry is greater than any other sector of employment, in fact the Federal Bureau of Statistics reports that violence in the healthcare is “3.8 times higher than all of private industry.” (Wolfe, 2018) In fact, the National Nurses United, the largest union of registered nurses reported workplace violence rates increased by 110% from 2005 to 2014. Examples of workplace violence include direct physical assaults (with or without weapons), written or verbal threats, physical or verbal harassment, and homicide (Occupational Safety and Health Administration OSHA, 2015). Nurses in the Emergency Room are at greatest risk for violence. Three out of four nurses routinely experience acts of verbal and physical violence, including, hitting, kicking, yelling and cursing from patients and visitors according to the January 2015 issue Journal of Emergency Nursing.  Statistically violence in emergency rooms is on the rise, however, our organization has specifically seen a drastic increase of violence in the emergency room. Long wait times due to failing healthcare systems, patients suffering from mental health issues and substance abuse are contributing factors. Law enforcement in our county readily bring patients who are altered on drugs or suffering from mental health issues to our facility because other hospitals mental health services have shrunk or they have removed the programs their services and other hospitals require them to stay with the patient while we readily accept them and dismiss the officers, making our hospital the easier and more time efficient option for them. Because of the growing higher population of older adults in our specific area due to several large senior living communities and long term care/rehab facilities within the vicinity of our campus, we see a large number of patients that suffer from situations and diseases that alter the mental status of the individual.  The implications are devastating. Nurses who experience violence in the workplace often suffer emotional, psychological, physical and professional consequences. Nurses often experience symptoms of post-traumatic stress after a violent incident. They may avoid talking about the event, have flashbacks, feel fearful angry, frustrated or helpless, they may also avoid patients or situations that may trigger all of these feelings. Nurses lose cognitive focus after a violent event. (Gillespie et al, 2010). Workplace violence is very costly. It is estimated that it costs billions of dollars a year. (Higazee and Rayan, 2017). Not to mention loss of work for the professional due to injury. Some nurses choose to leave the profession all together.  Busby,G. ( Jan, 2017). Incidence and Costs of Workplace Violence. Journal of Emergency Nursing. Vol. 41. Issue 1.  Gillespie,G.L., Gates, D.M., Miller, M. & Howard, P.K. (2010). Violence Against Healthcare workers in the Pediatric Emergency Department. Advanced Journal Emergency Nursing Journal. 32 (1), p.68-82  Higazee, M.Z.A., Rayan, A. (2017). Consequences and Control Measures of Workplace Violence among Nurses. Journal of Nursing and Health Studies.Vol.2 No.3:22.  OSHA (2015). Caring for our Caregivers. Preventing Violence a Roadmap for Healthcare Facilities. Retrieved o https://www.osha.gov/Publications/OSHA3827.pdfn October 20, 2019 from  Wolfe, E., (3 Oct. 2018). Violence Against Emergency Staffers Seen as Increasing. Fairwarning reports. Retrieved on October 20, 2019, from https://www.fairwarning.org/2018/10/violence-emergency-rooms-workplace-physicians-nurses/

 

"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "Newclient"

Case 3: Volume 1, Case #29: The depressed man who thought he was out of options Review this week’s Learning Resources and reflect on the insights they provide. Go to the Stahl Online website and examine the case study you were assigned. Take the pretest for the case study. Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office. Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.). Consider whether any additional physical exams or diagnostic testing may be necessary for the patient. Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.  Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient. Review the posttest for the case study.

Post a response to the following: Provide the case number in the subject line of the Discussion thread. List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions. Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used. List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why. List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities? If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided. Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations

Rubric:

Thoroughly responds to the discussion question(s)

is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.  

supported by at least 3 current, credible sources

Written clearly and concisely

Contains no grammatical or spelling errors

Fully adheres to current APA manual writing rules and style

 

"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "Newclient"

 

Perform an internet search for a current health care organization of your choice (preferably publicly traded for-profit organizations because these organizations must report all financial data and make it available to the public). In your search, select and evaluate the report of the financial information from the past 4 quarters or more. Complete the following for this assignment: Predict the effect of changes in all financial metrics to changes in a proposed strategic plan in your chosen organization for the following 3 scenarios: Payer mix changes from 50% Medicare and 5% Medicaid patients to 70% Medicare and 10% Medicaid patients in 1 year. Professional turnover goes from 5% annually to 10% annually. Demand for services increases 20% in 1 year Search course materials including your text and the Internet for assistance in completing applicable financial calculations for this assignment. Using the statements that you located, provide a financial plan that will do the following: Create projected financial statements to analyze effects of alternate operating assumptions on the firm’s financial condition Determine the projected financial requirements that will be needed to support each of the 3 sets of alternate operating instructions Forecast the financial sources that might be needed to support your alternative assumptions Assess the projected results using a financial condition analysis to the forecasted data Provide appropriate spreadsheets such as Projected Income Statement and Projected Balance Sheets to validate your projected assumptions. Consider the effect of the following factors to justify the changes that may be needed to the strategic plan as a result of your analysis: Validity of data in the decision-making process Revenue growth rate Capacity Rate of turnover

The body of the resultant paper should be 6 pages and should include at least 5 relevant academic or professional references published in the past 5 years.

For a resource guide on using the online library to search for references, click here.

Please submit your assignment.

Your assignment will be graded in accordance with the following criteria. Click here to view the grading rubric.

 

"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "Newclient"