Category: Nursing

Please follow the rubric and instructions. Please use the link at the bottom of the page.

Good afternoon,

How are you? Attached is the information regarding this paper. I already used bullet with chat to make you understand each question since I had this patient. All the information will help writing the paper. Please no plagiarism because my school is very strict, 3 pages and 2 3 Scholarly sources within 5 years just like mentioned in the instruction ( please read the attached file). Please let me know if you have a question. If Im satisfied I will tip with well.

Thank you,

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.
• All replies must be constructive and use literature where possible.

Discussion

Nursing theory provides the foundation for understanding patient phenomena, research validates or refines these theoretical concepts, and EBP applies both to real-world clinical decision-making.

In your initial post:

1. Select one nursing theory (grand, middle-range, or practice-level) that has influenced nursing practice in your area of interest.
2. Analyze how this theory has guided researchinclude at least one example of a research study (within the last five years) that supports, tests, or challenges the theory.
3. Discuss how EBP operationalizes this theory in the clinical setting. Provide a specific example of how theoretical principles are applied through evidence-based interventions or guidelines.
4. Critically reflect on how understanding the dynamic interplay among theory, research, and EBP enhances your role as an advanced nurse (e.g., clinician, leader, educator, or researcher).

Post your major takeaway from this week’s content (3-4 sentences) by the due date. Include your text as a reference.

Classification of Antibiotics

Drugs work on:

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• Cell wall synthesis
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• Cell membrane permeability
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• Protein synthesis (lethal)
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• Nonlethal inhibitors of protein synthesis
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• Synthesis of nucleic acids
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• Antimetabolites
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• Viral enzyme inhibitors

Acquired Resistance

The mechanisms for acquired resistance are:

• Spontaneous mutation
• Conjugation

The emergence of drug-resistant Microbe

Factors to the emergence of drug-resistant Microbe

• Antibiotic use promotes resistance
• Antibiotics that promote resistance
• The extent of antibiotic use affects resistance
• Nosocomial infections
• Superinfection
• Active against a variety of bacteria
• Direct toxicity: Low
• Principal adverse effect: Allergic reaction
• Structure includes a beta-lactam ring
• Beta-lactam family includes:
• Cephalosporins
• Aztreonam
• Imipenem
• Meropenem
• Ertapenem

Mechanism of action

• Weaken the cell wall, causing bacteria to take up excessive water and rupture.
• Active only against bacteria undergoing growth and division.
• Bactericidal

Bacterial resistance

• Inability of penicillins to reach their target
• Inactivation of penicillins by bacterial enzymes

Staphylococcus aureus & Penicillin

When penicillin was introduced in 1940, all strains of Staphylococcus aureus were sensitive to it. However by 1960, 80% of the Staphylococcus aureus found in hospital settings displayed resistance to penicillin.

As a result, a penicillin derivative, methicillin was developed, which is resistant to actions of beta-lactamases.

Today, a methicillin-resistant Staphylococcus aureus (MSRA) strain exists that have a unique mechanism of resistance. It produces penicillin-binding proteins (PBPs) with a low affinity for penicillins and all other beta-lactam antibiotics.

MRSA developed this ability by acquiring genes that code for low-affinity PBPs from other bacteria.

Medications

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• Penicillin G
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• PenicillinV
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• Antistaphylococcal penicillins
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• Broad spectrum penicillins
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• Extended spectrum penicillins

Drugs That Weaken the Bacterial Cell Wall II: Other Drugs

Cephalosporins

• Most widely used group of antibiotics

1. First generation: Cephalexin
2. Second generation: Cefoxitin
3. Third generation: Cefotaxime
4. Fourth generation: Cefepime
5. Fifth generation: Ceftaroline

Carbapenems

• Beta-lactam antibiotics have an extremely broad antimicrobial spectrum with low toxicity
• Not active against MRSA
• Imipenem
• Meropenem
• Ertapenem
• Doripenem

Others

• Vancomycin
• Telavancin
• Aztreonam
• Fosfomycin

Bacteriostatic Inhibitors of Protein Synthesis

Tetracyclines

Four (4) members of the tetracycline family are available for systemic therapy:

• Tetracycline
• Demeclocycline
• Doxycycline
• Minocycline

Uses:

• Mycoplasma pneumoniae
• Lyme disease
• Anthrax
• Helicobacter pylori

Macrolides

+

Others

Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis

Aminoglycosides Use:

Aerobic gram-negative bacilli

Most commonly used agents are: Gentamicin, tobramycin, amikacin.

Aminoglycosides are:

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• Narrow-spectrum antibiotics
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• Bactericidal
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• Not absorbed from GI tract
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• Microbial resistance

Adverse effects of Aminoglycosides are:

• Nephrotoxicity
• Ototoxicity (total cumulative and trough levels)
• Hypersensitivity reactions
• Neuromuscular blockade: Concurrent use with neuromuscular blocking agents, general anesthetics, and in myasthenia gravis
• Treatment of choice: Reversal with IV infusion of a calcium salt (e.g., calcium gluconate)

Other adverse effects include: Hypersensitivity reactions and Blood dyscrasias.

Serum Levels

• Dosing
• Single large dose every day or 2 or 3 smaller doses
• Monitoring of serum levels is common; the same aminoglycoside dose can produce very different plasma levels in different patients
• Peak levels must be high enough to kill bacteria; trough levels must be low enough to minimize toxicity

Peak and Trough Levels

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• 1
• Samples for peak levels should be taken 30 minutes after giving an IM injection or after completing a 30-minute IV infusion
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• 2
• Sampling for trough levels depends on the dosing schedule
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• 3
• Divided doses: Take sample just before the next dose
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• 4
• Once-daily doses: Draw a single sample 1 hour before the next dose; value should be very lowpreferably close to zero

Available Aminoglycosides:

Gentamicin [Garamycin]- Used to treat serious infections caused by aerobic gram-negative bacilli:

• Pseudomonas aeruginosa
• Escherichia coli
• Klebsiella
• Serratia
• Proteus mirabilis

Adverse effects:

• Nephrotoxicity
• Ototoxicity

Others:

• Tobramycin
• Amikacin
• Neomycin
• Kanamycin
• Streptomycin
• Paromomycin

First drugs available for systemic treatment of bacterial infection.

Sulfonamides inhibits the synthesis of folic acid (folate). Mammalian cells do not manufacture their own folate, therefore not affected only the bacteria are affected.

Primary use now: Urinary tract infection (UTI)

Other uses: Nocardiosis, Chlamydia trachomatis, conjugation therapy for toxoplasmosis/malaria, ulcerative colitis

Adverse effects:

• Hypersensitivity reactions: Stevens-Johnson syndrome
• Hematologic effects
• Kernicterus
• Renal damage from crystalluria

Drug interactions:

• Metabolism-related interactions
• Cross-hypersensitivity

Microbial resistance:

• Many bacterial species have developed resistance to sulfonamides.
• Especially high among gonococci, meningococci, streptococci, and shigellae .
• Resistance may be acquired by spontaneous mutation or by transfer of plasmids that code for antibiotic resistance (R factors).

Silver sulfadiazine and mafenide

Used to suppress bacterial colonization in patients with second- and third-degree burns. Local application of mafenide frequently is painful. Application of silver sulfadiazine is usually pain free. Systemic absorption.

Trimethoprim

• Inhibits dihydrofolate reductase, the enzyme that converts dihydrofolic acid to its active form, tetrahydrofolic acid, thus suppressing bacterial synthesis of deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and proteins.
• Uses:
• Acute and uncomplicated UTIs
• Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter, coagulase-negative Staphylococcus
• Adverse effects:
• Hematologic effects
• Hyperkalemia
• Use in pregnancy and lactation

Trimethoprim/Sulfamethoxazole (TMP/SMZ)

• Trimethoprim/sulfamethoxazole (TMP/SMZ) combination: Inhibits sequential steps in bacterial folic acid synthesis, making it much more powerful than TMP or SMZ alone. Plasma drug levels.
• Therapeutic uses:
• UTI, otitis media, bronchitis, shigellosis, pneumonia caused by Pneumocystis jiroveci, Pneumocystis pneumonia, and GI infection
• Adverse effects:
• Gastrointestinal
• Nausea and vomiting
• Rash
• Hyperkalemia
• Hypersensitivity reactions (Stevens-Johnson syndrome)
• Blood dyscrasias
• Kernicterus
• Renal damage: Crystalluria

Urinary Tract Infections (UTIs)

• Second most common infection
• Sexually active young women
• Older adult women in nursing homes
• Less frequent in males
• Occurrence likely associated with complications (e.g., septicemia, pyelonephritis)

Organisms That Cause UTIs and Treatment

• Escherichia coli, Klebsiella, Proteus, Enterobacter, Pseudomonas, staphylococci, enterococci, and E. coli
• Trimethoprim/sulfamethoxazole (TMP/SMZ) and nitrofurantoin:
• Frequently the treatment of choice for oral therapy of UTIs
• First-line and second-line treatments

Urinary Tract Antiseptics

• Nitrofurantoin
• Low concentrations: Bacteriostatic
• High concentrations: Bactericidal
• Uses: Lower UTIs, prophylaxis, recurrent lower UTIs
• Methenamine
• Decomposes into ammonia and formaldehyde, which denature bacterial proteins
• Therapeutic uses: Chronic lower UTIs (TMP/SMZ is the preferred drug)
• Drug interactions:
• Urinary alkalinizers
• Sulfonamides
• Adverse effects:
• Relatively safe and generally well tolerated
• Contraindicated in renal and liver failure

Miscellaneous Antibacterial Drug

Fluoroquinolones

• Broad-spectrum agents with multiple applications
• Disrupt DNA replication and cell division
• All can be administered orally or IV
• Side effects generally mild but can cause tendon rupture (low risk)
• Usually affects Achilles tendon
• Avoid in patients younger than 18 years
• Risk to all patients, especially those older than 60 years, those taking glucocorticoids, and those who have undergone kidney, heart, or lung transplantation

Ciprofloxacin [Cipro]

• Broad-spectrum antibiotic (gram-negative and some gram-positive organisms)
• Inhibits bacterial DNA gyrase and topoisomerase II

Others

• Levofloxacin
• Ofloxacin
• Moxifloxacin
• Gemifloxacin
• Metronidazole
• Daptomycin

In the next lesson, you’ll learn about Drug Therapy of Sexually Transmitted Diseases.

Sexually Transmitted Diseases: Infections or parasitic diseases transmitted primarily through sexual contact.

Types of STDs

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• Gonococcal infections
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• Nongonococcal urethritis
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• Pelvic inflammatory disease (PID)
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• Acute epididymitis
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• Syphilis
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• Trichomoniasis
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• Chancroid
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• Herpes simplex
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• Proctitis
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• Anogenital warts

Please follow the rubric and use the link at the bottom of the page. No cover page needed.

General Instructions Explore current literature and clinical practice guidelines to complete the clinical treatment protocol template. Complete the protocol outline template Download protocol outline templateOpen this document with ReadSpeaker docReaderto develop a protocol for asthma treatment. Use of the template is required. A 10% deduction will be applied if the template is not used. See the rubric. Sections 1-5 on the template have already been completed. You are to complete sections 6-9 and References. Provide references for your protocol at the bottom of the form where indicated. References should come from the following sources: Asthma Clinical Practice GuidelineLinks to an external site.Open this document with ReadSpeaker docReader Course Textbook (for individual medication information) Journal Articles from within the last five years as defined by program expectationsLinks to an external site.. Follow APA grammar, spelling, word usage, and punctuation rules consistent with formal, scholarly writing. No more than one short direct quote (15 words or less) may be used in this assignment. First person should not be used within this assignment. At least three scholarly references must be used for this assignment. Abide by Chamberlain University’s academic integrity policy. Include the following sections (detailed criteria listed below and in the grading rubric). Pharmacological Treatment (Section 6 on the template) Correctly complete all blanks for the asthma treatment algorithm table as noted in the CPG. List medications in order according to the CPG. List generic medication names for each category. Provide an in-text citation under the completed table. Treatment Differences in Adults and Children (Sections 7a and 7b on the template) Correctly list the first line of initial pharmacologic treatment in step one; track one for asthmatic adults. (7a on the form) Correctly list the first line of initial pharmacologic treatment in step one, track one for asthmatic children ages 6-11. (7b on the form) Correctly list drug dose, route, frequency, instructions, precautions, drug cost, and education for adult and pediatric clients. Provide in-text citations under the information for adults and pediatric clients. Treatment Monitoring (Section 8 on the template) List the physical assessments required for monitoring the first-line medications prescribed to adults for track one, step one. List the pulmonary function tests required for monitoring the first-line medications prescribed to adults for track one, step one. List the laboratory tests required for monitoring the first-line medications prescribed to adults for track one, step one. Provide an in-text citation under the treatment monitoring section. Treatment Failure (Section 9 on the template) Describe how you will know that treatment is not working or needs to progress. Describe the next step if treatment is not working or needs to progress. Describe the indicators that would demonstrate that the client requires a higher level of care. Provide an in-text citation under the treatment failure section. Rubric NR565_W6_Respiratory Protocol Assignment NR565_W6_Respiratory Protocol Assignment Criteria Ratings Pts This criterion is linked to a Learning OutcomePharmacological Treatment 4 required criteria 1. Correctly complete all blanks for the asthma treatment algorithm table as noted in the CPG. 2. List medications in order according to the CPG. 3. List generic medication names for each category. 4. Provide an in-text citation under the completed table. 40 pts Excellent All requirements met. 36 pts Very Good 3 requirements met. 33 pts Satisfactory 2 requirements met. 20 pts Needs Improvement 1 requirement met. 0 pts Unsatisfactory No requirements met. 40 pts This criterion is linked to a Learning OutcomeTreatment Differences in Adults and Children 4 required criteria 1. Correctly list the first line of initial pharmacologic treatment in step one, track one for asthmatic adults (7a on the form). 2. Correctly list the first line of initial pharmacologic treatment in step one, track one for asthmatic children ages 6-11. (7b on the form) 3. Correctly list drug dose, route, frequency, instructions, precautions, drug cost, and education for adult and pediatric clients. 4. Provide in-text citations under the information for adults and pediatric clients. 25 pts Excellent All requirements met. 23 pts Very Good 3 requirements met. 21 pts Satisfactory 2 requirements met. 13 pts Needs Improvement 1 requirement met. 0 pts Unsatisfactory No requirements met. 25 pts This criterion is linked to a Learning OutcomeTreatment Monitoring 4 required criteria 1. List the physical assessments required for monitoring the first-line medications prescribed to adults for track one, step one. 2. List the pulmonary function tests required for monitoring the first-line medications prescribed to adults for track one, step one. 3. List the laboratory tests required for monitoring the first-line medications prescribed to adults for track one, step one. 4. Provide an in-text citation under the treatment monitoring section. 25 pts Excellent All requirements met. 23 pts Very Good 3 requirements met. 21 pts Satisfactory 2 requirements met. 13 pts Needs Improvement 1 requirement met. 0 pts Unsatisfactory No requirements met. 25 pts This criterion is linked to a Learning OutcomeTreatment Failure 4 required criteria 1. Describe how you will know that treatment is not working or needs to progress. 2. Describe the next step if treatment is not working or needs to progress. 3. Describe the indicators that would demonstrate that the client requires a higher level of care. 4. Provide an in-text citation under the treatment failure section. 25 pts Excellent All requirements met. 23 pts Very Good 3 requirements met. 21 pts Satisfactory 2 requirements met. 13 pts Needs Improvement 1 requirement met. 0 pts Unsatisfactory No requirements met. 25 pts This criterion is linked to a Learning OutcomeAPA Format: Citation and Reference Formation Use the current APA format to format citations and references and is free of errors. 10 pts Excellent 0-1 errors. 9 pts Very Good 2-3 errors. 8 pts Satisfactory 4-5 errors. 5 pts Needs Improvement 6-7 errors. 0 pts Unsatisfactory More than 7 errors. 10 pts This criterion is linked to a Learning OutcomeScholarly Sources 3 Required Criteria Provide resources from at least three scholarly sources. 15 pts Excellent All requirements met. 13 pts Satisfactory 2 requirements met. 8 pts Needs Improvement 1 requirement met. 0 pts Unsatisfactory No requirements met. 15 pts This criterion is linked to a Learning OutcomeTemplate Used 0 pts No Points Deducted Correct template used. 0 pts Points Deducted 14 points deducted (10%) for incorrect or no template used 0 pts This criterion is linked to a Learning OutcomeLate Penalty Deduction Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment. Quizzes and discussions are not considered assignments and are not part of the late assignment policy. 0 pts No Points Deducted Assignment submitted on time. No points deducted. 0 pts Points Deducted Assignment submitted late. Loss of -10% points/day up to 3 days late.

Week 10 Case Study

John 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 of green mucous and has green nasal discharge. He says that 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 drug allergies.

The patients assessment is as follows:

Vital signs are stable and temperature is 99.9F. Tympanic membranes (TMs) are clear bilaterally, pharynx is pink with no exudate, he has greenish postnasal drainage, turbinates’ are swollen and red, there is tenderness when frontal sinuses palpated, there is no cervical adenopathy, and lungs are clear.

Answer the following questions.

1. What medications do you anticipate being prescribed/recommended and why?
2. What patient education would you anticipate giving the patient regarding the medications you chose?

In this exercise, you will complete a MindMap (CONCEPT MAP) to gauge your understanding of this weeks content of Myocardial Infarction.

–Describe the Pathophysiology and Etiology of the primary diagnosis. List risk factors related to the primary diagnosis.

-What are the patients signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?

-What diagnostic tests or labs would you order to confirm the primary diagnosis?

-What treatment options would you consider? Include possible referrals and medications.

——ONE OF THESE WEBSITED MUST BE USED TO CREATE THE CONCEPT MAP-

Mind Mapping websites – Free Templates:

• . (n.d.). https://mindmeister.com
• (n.d.). https://creately.com
• . (n.d.). https://canva.com