1. Describe the organization and its significance to nurses in the specialty area. Include its purpose, mission, and vision. Describe the overall benefits, or “perks,” of being a member.
  2. Explain why it is important for a nurse in this specialty field to network. Discuss how this organization creates networking opportunities for nurses.
  3. Discuss how the organization keeps its members informed of health care changes and changes to practice that affect the specialty area.
  4.  Discuss opportunities for continuing education and professional developmenStudent Success Center. An abstract is not required.

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 According to your worldview, what value does a human person have? How does your position affect your stance on controversial bioethical issues, such as abortion, designer babies, and stem cell research? 

Using 200-300 words APA format with at least two references within five years.

 What is the Christian concept of the imago Dei? How might it be important to health care, and why is it relevant? 

Using 200-300 words APA format with at least two references within five years.

 Explain how interprofessional collaboration will help reduce errors, provide higher-quality care, and increase safety. Provide an example of a current or emerging trend that will require more, or change the nature of, interprofessional collaboration. 

Using 200-300 words APA format with at least two references within five years.

Week 5 Discussion

For this assignment, you will review the latest evidence-based guidelines in the links provided below. Please make sure you are using scholarly references and they should not be older than 5 years. The posts/references must be in APA format. 

 Apply the information from the Aquifer case study to answer the following questions:

1 – How would you evaluate and manage a pediatric patient who has BP and BMI greater than what is expected for his/her age group? Which additional conditions would you want to screen for and why?

2 – What physical exam findings and diagnostic results would be concerning to you in this patient and why? What would be three differentials in this case?

3 – What are your final assessments (diagnoses) for this patient? What is your treatment recommendation and education for the patient and family? Why?

Discussion Question 1

For these questions, please read the following case study and then respond to the questions noted below.

Ms. BD is a 33-year-old G2P1 African-American female who presents to your clinic today complaining of unusual fatigue, nausea, and vomiting for the last five days. She has a medical history of chronic hypertension (HTN) that was diagnosed shortly after her first pregnancy two years ago and GERD. MS. BD’s blood pressure is controlled on Lisinopril-Hydrochlorothiazide 20/12.5mg by mouth twice a day, and GERD controlled on Bismuth Subsalicylate 262mg by mouth every 6 hours as needed. During the interview, you learn that she is single, sexually active, has one partner, and that her menses is ten days late. She performed a home pregnancy the three days after missing her menstrual cycle, and the results were inconclusive. She states she feels terrible and needs relief. She has no other medical problems, symptoms, or concerns.

Assessment: Physical examination is unremarkable. BP128/68, HR is 74, Urine human chorionic gonadotropin (HCG) positive, beta HCG sent, potassium 4.2, blood
urea nitrogen (BUN) 14, creatinine is 0.6, Alanine aminotransferase (ALT) 29, White blood cells (WBCs) 6.5, hemoglobin (Hgb) 12.8, hematocrit (Hct) 39, and platelets 330,000.

  1. List the additional questions you would need to ask this patient. Explain.

In the above case study, despite the fact that the patient noted that there were no other medical problems, I would ask questions relating to a past problem, whether related to hypertension or not. Also, I would ask the patient pertaining to the nature of the diet and whether she is involved in physical exercises. These questions are critical because they can help in assessing whether the patient has had an issue in the past that probably triggers high BP. Also, the questions on diets and physical activities are to or confirm the two as possible measures of alleviating the problem. 

  1. What is the safety profile of Lisinopril-hydrochlorothiazide and bismuth subsalicylate in pregnant women? What are the possible complications to the pregnant woman and her fetus?

Taking Lisinopril and bismuth can be a risk for pregnant women. According to Woo and Robinson (2015), possible complications related can be problematic during the second and third trimester of pregnancy. 

  1. What is the importance of assessing laboratory values when prescribing medications? How might the laboratory values, in this case, impact your treatment plan?

Laboratory monitoring ensure effective and safe medication therapy. This is more so for medication with increased risks of drug-induced toxicity (Woo & Robinson, 2015).

  1. Would you make any changes to Ms. BD’s blood pressure and GERD medications? Explain. If yes, what would you prescribe? Discuss the medications safety in pregnancy, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.

Yes, I would make changes to the BP medication to either nifedipine or labetalol. These are highly recommended for pregnant mothers. However, as argued by Ainuddin et al. (2019), labetalol cannot be used together with nifedipine because of possible additive effects, including dizziness, headache, and fainting. 

  1. How does ethnopharmacology apply to this patient if she were NOT pregnant? Explain.

In the case study, the patient was diagnosed with GERD and Hypertension and she has been compliant with medication. Thus, it is not necessary to have ethnopharmacology applied for the patient. 

  1. What health maintenance or preventive education do you provide in this client case based on your choice of medications/treatment?

To lower BP or to maintain a healthy BP level for a pregnant woman, it is critical to have her diet low in salt, consume food with potassium and whole grain, watch her weight, avoid drugs, and constant dehydration in case of diarrhea. 

  1. Would you treat this patient or refer her? Explain. If you prefer, where would you refer this patient?

Chronic hypertension in pregnant women can be treated. However, this would require constant monitoring, especially concerning her body intake. In case there are more complications, the patient can be referred to an obstetrician. 

References

Ainuddin, J., Javed, F. & Kazi, S. (2019). Oral labetalol versus oral nifedipine for the management of postpartum hypertension: A randomized control trial. Pakistan Journal of Medical Sciences, 35(5), 1428-1433. 

Woo, T. M., Robinson, M. V., & Woo, T. M. (2016). Pharmacotherapeutics for advanced practice nurse prescribers. F.A Davis Company

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Discussion Question 1

  1. List the additional questions you would need to ask this patient. Explain.

Assessment any other symptoms: Headache, check protein in urine, dizziness, Blurred vision, Swelling Hands and BLE. All above symptoms are signs of HTN crisis and Gestational HTN.  

  1. What is the safety profile of Lisinopril-hydrochlorothiazide and bismuth subsalicylate in pregnant women? What are the possible complications to the pregnant woman and her fetus?

Lisinopril-HCTZ are class D for pregnant women. This medication should be stopped immediately once pregnancy is confirmed. Lisinopril has shown to cause Fetal and neonatal morbidity and death in the second and third Trimester. 

Bismuth Subsalicylate should be stopped as it has shown to cause increased risk for bleeding in pregnant women in the second and third trimester. Class C in first and second trimester, D in third trimester due to closer to EDD. 

  1. What is the importance of assessing laboratory values when prescribing medications? How might the laboratory values, in this case, impact your treatment plan?

Due to the urine beta HCG test- confirmation of pregnancy was made. This Lab test alone will change the treatment plan. This patient must be stopped from Lisinopril- HCTZ and Bismuth Subsalicylate. She can no longer be managed by PCP due to PMH of HTN and current pregnancy. 

  1. Would you make any changes to Ms. BD’s blood pressure and GERD medications? Explain. If yes, what would you prescribe? Discuss the medications safety in pregnancy, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.

I would advise Ms. BD to stop both of the above medications and education her on risk for her and his pregnancy. As both medications are not recommended for pregnant women. I would also consult with Maternal fetal medicine on treatment plan until she is seen by them. Labetalol appears to be the HTN drug of choice for pregnancy with Metoprolol and atenolol appearing to be safe and effective in late pregnancy (Woo et al., 2020). Labetalol is common and safe in pregnancy. Mechanism of action: blocking alpha- and beta-adrenergic receptors, resulting in decreased peripheral vascular resistance without significant alteration of heart rate or cardiac output. Half-life: 3 to 8 hours. Metabolized from the lover and eliminated through the kidneys. In pregnancy there is no contraindications for Labetalol (Woo et al., 2020). 

  1. How does ethnopharmacology apply to this patient if she were NOT pregnant? Explain.

Ms. BD is an African American woman that has chronic HTN and developed gestation HTN with prior Pregnancy. Due to genetics and PMH she is at higher risk for developing complications causing poor BP management and poor outcome to her and her unborn child. 

  1. What health maintenance or preventive education do you provide in this client case based on your choice of medications/treatment?

I would educate patient on needing to f/u with Maternal Fetal Medicine, my telephone consultation with MFM physician and their recommendation to stop lisinopril-HCTZ and Bismuth Subsalicylate due to risk for her and fetus. Educate Ms. BD on Labetalol and the common and safe use in pregnancy. Diet management could be another possible alternative if patient wishes to stop all medication and not start anything new due to pregnancy. I woud advise patient to take labetalol until discussing further treatment plans with MFM physician. Appt with MFM would be made prior to patient leaving office.

  1. Would you treat this patient or refer her? Explain. If you refer, where would you refer this patient?

In my professional opinion, I believe Ms. BD should be sent to a Specialist for management of her Chronic HTN and pregnancy. Maternal fetus specialist. This is beyond the primary care specialty. Prior to patient leaving office, I would consult with a local Maternal fetus medicine physician for guidance on Treatment until Ms. BD is seen by him/her. 

Reference:

Woo, T. M., Wynne, A. L., & Robinson, M. V. (2020). Pharmacotherapeutics for Advanced Practice Nurse prescribers. F.A. Davis Company.