R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to the APRN-NP in his family practice clinic. He presents with progressive difficulty getting his breath while doing simple tasks. He is having difficulty doing any manual work, but he has no symptoms when working behind his desk. He also reports a cough, fatigue, and weight loss. He has been treated for three respiratory infections a year for the past 3 years and feels like another one is developing now. On physical examination, you notice clubbing of his fingers, use of accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs. Pulmonary function studies show an FEV1 of 58%.
In a paper not to exceed six pages, excluding title and reference pages, please answer the following:
1. What is R. W.s likely diagnosis?
2. What stage of disease does RW have?
3. List specific pharmacotherapeutic treatment goals for R. W.
4. What drug therapy would the CNP likely prescribe? Why?
5. What are the parameters for monitoring the success of the therapy?
6. Describe specific patient education based on the prescribed therapy. Are there any possible side effects or adverse reactions from the medications prescribed? Differentiate side effects and adverse reactions.
7. Provide two adverse reactions for the selected agent that would cause the CNP to change therapy.
8. What would be the choice for second-line therapy?
9. What health promotion activities should be recommended for this patient?
10. If RW was currently taking metoprolol for headaches would a change be recommended?
|
Competency |
16 |
15 |
14 |
0 |
Points Earned |
|
Diagnosis & stage of disease |
Shows synthesis of patient data utilizing current evidence from the literature to determine diagnosis & stage of disease |
Discusses patient data, diagnosis, & stage of disease with use of current evidence from the literature |
Lists patient data without the connection shown between the data & diagnosis or stage of the disease. No use of current evidence from the literature. |
No discussion of a diagnosis & stage of disease |
/16 |
|
Pharmacotherapeutic treatment goals & choice of medication therapy |
Well-defined evidence of · critical thinking including treatment goals of medication therapy · therapeutic decision-making in drug selection and evaluation of patient care · pathophysiology and current pharmacological research · assessment of the effectiveness of drug therapy · formulation of clinical care and teaching plans for persons from diverse populations |
Evidence of critical thinking in prescriptive therapy, monitoring and adverse events. May have lacked a teaching plan or pathophysiologic discussion. |
Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology. |
Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking. |
/16 |
|
Patient monitoring & possible side effects |
Synthesizes knowledge of patient & disease to provide well-defined discussion of parameters to determine success of treatment and possible side effects specific to this patient |
Discusses parameters to determine success of treatment and possible side effects that are not specific to this patient |
Briefly lists parameters to determine success of treatment and side effects that are not specific to this patient |
|
0/16 |
|
Adverse reactions & second line therapy |
Synthesizes knowledge of patient, disease, & medication to provide discussion supported by current research & literature showing two adverse reactions to the original chosen regimen necessitating a change & choice of second line therapy specific to this patient |
Discusses two adverse medication reactions necessitating a change & choice of second line therapy that is not patient specific |
Briefly lists one adverse medication reaction necessitating a change &/or a choice of second line therapy that is not appropriate for this patient |
|
0/16 |
|
Health promotion & patient education |
Describes 3 health promotion activities & 3 patient education topics specific to the patient and related to the medication therapy. Includes a discussion of potential side effects with differentiation between side effects & adverse effects. |
Describes 2 health promotion activities & 2 patient education topics specific to the patient and related to the medication therapy |
Lists only one health promotion activity & one patient education topic specific to the patient and related to the medication therapy |
No discussion of health promotion and patient education or discussion is not specific to the patient & the medication therapy |
0/16 |
|
Competency |
10 |
8 |
7 |
0 |
|
|
Use of Metoprolol |
Integrates knowledge of the patient & medication to determine if a medication change is required |
Analyzes knowledge of the medication to determine if a medication change is required |
Briefly discusses if a medication change is required |
No discussion of metoprolol |
0/10 |
|
Competency |
5 |
4 |
3 |
0 |
|
|
Grammar, spelling, and punctuation |
There are no errors in grammar, spelling, and punctuation |
There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors) |
There are major errors in grammar, spelling, and punctuation .(4-5 errors) |
No content or more than 5 errors |
/5 |
|
APA Compliance |
The paper meets APA formatting guidelines |
There are a few minor errors (1-3 errors) |
There are significant errors in the format of the paper (4-5 errors) |
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