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. NURS 6521N Week 9: Women’s and Men’s Health/ Infections

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 – NURS 6521N Week 9: Women’s and Men’s Health/ Infections

Required Readings (click to expand/reduce)

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

• Chapter 44, “Anticoagulant and Antiplatelet Drugs” (pp. 451–472)
• Chapter 45, “Drugs for Deficiency Anemias” (pp. 473–483)
• Chapter 48, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 521–533)
• Chapter 49, “Birth Control” (pp. 535–547)
• Chapter 50, “Androgens” (pp. 549–556)
• Chapter 51, “Drugs for Erectile Dysfunction and Benign Prostatic Hyperplasia” (pp. 557–569)
• Chapter 68, “Basic Principles of Antimicrobial Therapy” (pp. 769–781)
• Chapter 69, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 783–790)
• Chapter 73, “Sulfonamides and Trimethoprim” (pp. 619–826)
• Chapter 74, “Drug Therapy of Urinary Tract Infections” (pp. 827–831)
• Chapter 75, “Antimycobacterial Agents” (pp. 833–847)
• Chapter 76, “Miscellaneous Antibacterial Drugs” (pp. 849–853)
• Chapter 77, “Antifungal Agents” (pp. 855–866)
• Chapter 78, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 867–886)
• Chapter 80, “Drug Therapy of Sexually Transmitted Diseases” (pp. 905–911)

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.

Required Media (click to expand/reduce)

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.

Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript

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.
• 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.

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!

Example Discussion

Chronic Obstructive Pulmonary Disease (COPD) is a common, incurable illness that is associated with a high incidence of morbidity and mortality.  It is the third leading cause of death in the United States and is one of the most frequently comorbid conditions in patients with pneumonia Restrepo, Sibila, & Anzueto, 2018). 

The patient in this case study is a 68 year old male who has presented with community acquired pneumonia for the past 3 days. His past medical history includes COPD, HTN, HLD and DM. He is taking ceftriaxone 1g IV daily and azithromycin 500 mg IV daily. The gentleman is improving and requiring less oxygen; however, he is not tolerating his diet and complains of nausea and vomiting.

Since this patient is already on antibiotics I would continue their prescribed course. This patient would also require respiratory treatments. I would have the patient on a regimen of Albuterol, Arformoterol, and Budesonide. Albuterol provides quick relief for the bronchospasms caused by COPD. Since Albuterol is a short acting medication, I would prescribe 2.5 mg inhaled, 4 times a day. The Arformoterol is a long acting bronchodilator.  I would have the patient on 15 mcg q12 hours. Finally, Budesonide is an inhaled corticosteroid that will aid in the reduction of lung inflammation. I would prescribe 0.5 mg of this drug twice a day (Rosenthal & Burchum, 2018). I would also order IV Methylprednisolone 125 mg for the first 3 days of his hospitalization and then taper to oral prednisone (Li, 2004). Methylprednisolone works by reducing shortness of breath by decreasing inflammation in the bronchial tubes (Bishop, 2010).  Patients with COPD who are suffering from an exacerbation or pneumonia, have been shown to have shorter hospital stays and better treatment outcomes when given corticosteroids. Although, Methylprednisolone has many benefits, it does cause hyperglycemia. Since this patient is already a diabetic, it will be important for him to have his blood glucose monitored before meals and at bed time; and be prescribed sliding scale insulin for glucose control (Li, 2004).  NURS 6521N Week 9: Women’s and Men’s Health/ Infections

Often patients with pneumonia need assistance with coughing up mucus from the lungs. It may be beneficial for the patient to be prescribed an expectorant, such as Guaifenesin, 200mg q12 hours.  It is unclear why the patient has nausea and vomiting. It could be from his course of antibiotics or a side effect from corticosteroids. Therefore, I would provide supportive care with ondansetron 4 mg IV q6 PRN (Rosenthal & Burchum, 2018). 

This gentleman will need education on managing his health care needs. The first thing I would offer this patient is smoking cessation. Chronic Obstructive Pulmonary Disease is typically caused by smoking; and people with COPD are at a much higher risk of acquiring  pneumonia (Gotter, 2018).  If this patient is smoking, it would be imperative that he quits. If this patient is to be discharged with an oral steroid, it will be important that he carefully monitors his blood sugar, as steroids cause hyperglycemia (Li, 2004). Chronic Obstructive Pulmonary Disease  and pneumonia are both in the top ten leading causes of death in the United States. The lungs of patients with COPD are exposed to more pathogens and are thereby at an increased risk for pneumonia (Restrepo, Sibila, & Anzueto, 2018). This patient will need to be educated on the signs and symptoms of hypoxia and be informed on the importance of receiving their flu shot and pneumonia vaccine to assist in preventing further cases of pneumonia (Bishop, 2010).

As Advanced Practice Nurses, we will be responsible for caring for patients with a variety of comorbid conditions. It will be important that we consider all of our patients illnesses before prescribing a course of treatment. It will be vital for us to empower our patients with the education they need to better manage their health care and disease processes. 

Bishop, S. (2010). Methylprednisolone may relieve shortness of breath, but won’t treat     Emphysema.https://newsnetwork.mayoclinic.org/discussion/methylprednisolone-may   relieve-shortness-of-breath-but-wont-treat-emphysema/

Gotter, A. (2018). What at the risks of having COPD and pneumonia? https://www.healthline.com/health/copd/copd-and-pneumonia-understanding-your-risk

Li, J. (2004). Recommended dose of IV corticosteroids for COPD exacerbation?   https://www.medscape.com/viewarticle/468134

Restrepo, M.I., Sibila, O., Anzueto, A. (2018). Pneumonia in patients with Chronic Obstructive   Pulmonary Disease. Tuberculosis & Respiratory Diseases, 81(3), 187-197. doi: 10.4046/trd/2018/0030.

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

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 9 Discussion Rubric

Post by Day 3 of Week 9 and Respond by Day 6 of Week 10

To Participate in this Discussion:

Week 9 Discussion