Answer the following questions for A and B in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources to include clinical practice guidelines. As an Advanced Nurse Practitioner (ANP), you are working in an acute care setting. Jason Tyler is a 65-year-old male admitted to the hospital with a history of chronic cancer pain using Morphine SR 60 mg PO q8h. On admission, morphine 2 mg IV q4h was ordered. The patient reports his pain only went from a 9 to an 8 after the morphine dose and is asking for more pain medication. The staff begins to question the motivation of the patient and if addiction is present. The resident decides to start a PCA for his pain. In a few hours, the patient is comfortable, resting in bed. A: Answer the following questions and provide your rationales for your choices. J.T.’s behavior is best described as: (Please provide the definition for your choice and your rationales) Tolerance Addiction Pseudo addiction Dependence During his hospital stay, J.T. went into acute renal failure. He is increasingly lethargic and is experiencing confusion and some hallucinations. The physician believes the morphine metabolites may be responsible and would like to convert to an alternative regimen. What would be your recommendation? Change opioid to fentanyl patch 50 mcg q72h. Decrease morphine SR dose to 60 mg PO q8h. Switch to hydromorphone 8 mg orally q4h as needed. Add haloperidol 1 mg PO q6h. Tolerance will not develop to which adverse opioid effect? Respiratory depression Sedation Constipation Nausea B: What pieces of the holistic assessment are missing from this scenario: (Answer the following questions and provide your rationales) As a healthcare provider, what else do you need to understand about this patient related to pain management? In your response please provide the teaching you would provide to JT. What is meant by the DEA Drug Classification Schedule? Explain each category/classification.
(PICOT question): Is Paxlovid an effective treatment for covid-19 infections in adult patients to improve quality of life and covid symptoms as compared to adult patients with no treatment?
Please check the uploaded file for instructions.
Joshua George is a 42-year-old white man presenting with a 2-month history of intermittent mid-epigastric pain. The pain sometimes wakes him up at night and seems to get better after he eats a meal. J.G. informs you that his doctor told him that he had an infection in his stomach 6 months ago. He never followed up and has been taking over-the-counter antacids and histamine receptor antagonists (H2Ras) for 2 weeks without relief. He takes no other medications. He is concerned because the pain is continuing. He has no other significant history except he is a 20-pack-year smoker and he drinks 5 cups of coffee a day. He eats late at night and goes to bed about 30 minutes after dinner. He is allergic to penicillin. Diagnosis: Peptic Ulcer Disease List specific goals for treatment for J.G. What drug therapy would you prescribe for J.G.? Please provide your rationale. What are the parameters for monitoring the success of the therapy? Discuss specific patient education based on the prescribed therapy. List one or two adverse reactions for the selected agent that would cause you to change therapy. What would be the choice for second-line therapy? What over-the-counter and/or alternative medications would be appropriate for J.G.? What lifestyle changes would you recommend to J.G.? Describe one or two drug-drug or drug-food interactions for the selected agent.
Answer the following questions in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources. Topic: Heart Failure Michael, age 62, is a male who is new to your practice. He is reporting shortness of breath on exertion, especially after climbing steps or walking three to four blocks. His symptoms clear with rest. He also has difficulty sleeping at night (he tells you he needs two pillows to be comfortable). He tells you that 2 years ago, he suddenly became short of breath after hurrying for an airplane. He was admitted to a hospital and treated for acute pulmonary edema. Three days before the episode of pulmonary edema, he had an upper respiratory tract infection with fever and mild cough. After the episode of pulmonary edema, his blood pressure has been consistently elevated. His previous physician started him on a sustained-release preparation of diltiazem 180 mg/d. Medical History: His medical history includes moderate prostatic hypertrophy for 5 years, adult-onset diabetes mellitus for 10 years, hypertension for 10 years, and degenerative joint disease for 5 years. Medications: His medication history includes hydrochlorothiazide (HydroDIURIL) 50 mg/d, atenolol (Tenormin) 100 mg/d, controlled-delivery diltiazem 180 mg/d, glyburide (DiaBeta) 5 mg/d, and indomethacin (Indocin) 25 to 50 mg three times a day as needed for pain. While reviewing his medical records, you see that his last physical examination revealed a blood pressure of 160/95 mm Hg, a pulse of 95 bpm, a respiratory rate of 18, normal peripheral pulses, mild edema bilaterally in his feet, a prominent S3 and S4, neck vein distention, and an enlarged liver. Diagnosis: Heart Failure Class II 1 List specific goals of treatment for Michael. 2 What drug(s) would you prescribe? Please provide rationales. 3 What are the parameters for monitoring the success of your selected therapy? 4 Discuss specific patient education based on the prescribed therapy. 5 Describe one or two drug–drug or drug–food interactions for the selected agent(s). 6 List one or two adverse reactions for the selected agent(s) that would cause you to change therapy. 7 What would be the choice for the second-line therapy? 8 What over-the-counter or alternative medications would be appropriate for Michael? 9 What dietary and lifestyle changes should be recommended for Michael
Select the Week 2 Discussion link above and create thread to post the initial substantive response to the Discussion Question. Initial response must address all aspects of the Discussion Question and contain at least two citations with corresponding references. You must post one response each, to at least two classmates, in a topic focused discussion, following the instructions in the Discussion Questions by Sunday night, or Saturday night of the last week of the course. Respond to any direct comments or questions initiated by the instructor or a classmate. Please follow the grading rubric for Discussions
For week 2 discussion, select ONE of the two cases below. After you have read it thoroughly, respond to the questions. Responses should be substantive and meet the requirements of the weekly discussion board.
A 47-year-old female patient is in for a follow-up visit to monitor her treatment for type 2 diabetes. You added regular insulin to her treatment regimen last month. She tells you that she has not had any symptoms of hypoglycemia with the new plan and her glucose levels have been between 60 and 80. She tells you that her visit to her cardiologist went well and she was prescribed a new medication, atenolol.
Discuss the problems and/or complications that might result when a patient with diabetes is treated with a beta blocker.
Would there be a difference if the beta blocker was not atenolol?
Is there something about the rest of her treatment plan that needs to be addressed?
Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees cardiology, pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetes mellitus, postcoronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructive pulmonary disease issues from a 30 pack year history of smoking. His last visit with you was over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill of his Crestor prescription, which was ordered by cardiology soon after his CABG. Per the electronic links to the cardiology service within your facility, the medication was due to be renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last recorded HgA1C was 9.0 from a visit to endocrine 4 months ago. Review of records include a prescription for his hypertension (Lisinopril 20 mg daily), metformin 1,000 mg twice a day for his diabetes, and no known medications for his pulmonary issues. The Crestor prescription appears to have multiple dosing levels over the past few refills. His last vital signs were blood pressure (BP) 170/110 mm Hg, pulse 88, and respirations 22. His body mass index is 30 and he indicates a pain level of four out of five. His pulse oximetry was 92% on room air.
How do you respond to this telephonic request?
What steps are required to get Jack’s therapeutic plan under control?
What is the role of the primary care provider (PCP) in this scenario?
Case Study – Dislipidemia Jeremy, age 55 white male, has come in for his annual physical. He has hypertension and type 2 diabetes mellitus. His blood pressure is controlled with lisinopril 20 mg daily and amlodipine 5 mg daily, NKA, and denied any hx of smoking. His most recent HbA1c was 7.2% while taking metformin 500 mg twice a day. His father died at age 55 of a myocardial infarction, and his brother, age 57, just underwent angioplasty. Jeremy eats fast food at least five times a week because of his work schedule. He weighs 245 lb and stands 5-foot-11. His fasting blood sugar is 213. His blood pressure is 134/80. His total cholesterol is 237 (LDL, 162; HDL, 35; triglycerides, 200). 1. Does Jeremy fall into any of the statin risk categories? If so, which one? 2. What drug therapy and dose would you prescribe, and why? 3. What are the parameters for monitoring the success of the therapy? 4. List one or two adverse reactions for the drug therapy that you prescribed for Jeremy that would cause you to change therapy. Provide rationale for your answer. 5. When rechecked, Jeremy’s total cholesterol is 174 (LDL, 100; HDL, 38), but he is complaining of muscle pain. How would you manage Jeremy’s treatment? Provide rationale for your answer. 6. When would you have patient follow up? 7. What labs would you order and why?
please make ppp of the attached article and focus on the results of increase and decrease proteins in amygdala and piriform cortex with the methods
I have a reviewer comment on this manuscriipt, the comment is “Similar articles are published. only students differ. No novelty of the study ”
I would like to distinguish my study from the similarly published papers.
Just give a paragraph of about 60 words to substantiate that my paper is unique than other published paper in the introdcution and in the abstract. (Please highlight your edit).
Please do this work with highest specialist writer, because this work needs study of the published papers and understanding of this work findings- you can use the following paper to compare and find the substantiate:
Pick a medication that addresses urinary incontinence or erectile dysfunction. Pick an evidenced based article describing the indication for this medication. Describe the mechanism of action of the medication that you chose.
Provide link to evidenced based article.