NURS 6521 week 9 Assignment Case Studies

Case Studies

Scenario 1

Treatment Plan

Sara Johnson, is 32 years old and 24 weeks pregnant she has a history of high blood pressure and needs a comprehensive treatment approach that attends to the well-being of both mother and baby. Recommendations in dealing with hypertension should be things like monitoring schedules and keeping blood pressure logs. If a pregnant woman stops taking lisinopril, she is advised to discontinue the drug and use a safer option such as labetalol. The starting dose is half a tablet, adjusted as a patient responds to the medication (Malha et al., 2024). Lifestyle changes, like a low-sodium diet, as well as decreasing coffee intake from three cups a day to one or two a day, are also important for her condition.

Medication Order

Patient: Sara Johnson

Drug: Labetalol

Dose: 100 mg
Route: Oral
Frequency: Twice daily
Special instructions: It is optional to take with food. Regularly check blood pressure and notify of any notable changes or adverse effects like faintness, tiredness, or heart palpitations. Prevent sudden cessation of the medication.
Quantity prescribed: 60 tablets
Refills: 2

Labs/Monitoring

There are many aspects to Sara Johnson’s hypertension drug therapy. The first step is to get into the routine of checking blood pressure at home, as well as when seeing your gynaecologist, preferably at the same time each day. At the same time, it is established by studies that patients should be logical to be able to grasp the right method of self-monitoring for accuracy (Kennedy et al., 2020). Also, you’ll want to watch for possible side effects like dizziness, fatigue or bradycardia (slow heart rate) while you’re monitoring your blood pressure and assessing the effectiveness of the treatment. Also, by checking some indicator of elevated blood pressure and preeclampsia deterioration, you can realize if the treatment is effective. The blood pressure pregnancy target value for Sara is less than 140/90mmHg (Wendel et al., 2022). This objective will cut down on risks to both the mother and the growing baby, and so lead to better pregnancy results. Finally, it highlights the importance of ongoing communication even more so in consultations that allow the plan of treatment to be adjusted.

Scenario 2

Treatment Plan

One possible choice for Lydia, a 24-year-old woman with a confirmed gonorrhea infection and a sulfonamide allergy, is to utilize a combination treatment to eliminate the infection and prevent serious outcomes. The recommended treatment for sexually active teenagers involves a single intramuscular injection of ceftriaxone 500mg, which effectively eliminates Neisseria gonorrhoeae and is suitable for individuals with sulfa allergies. Additionally, all individuals diagnosed with gonorrhea should also undergo testing and receive treatment for Chlamydia trachomatis since it is a common cause of dual infection. Usually, this is managed using a single oral dose of 1g azithromycin. The utilization of this combined treatment aligns with recommended guidelines to provide the best care and prevent the rise of antibiotic resistance (Scurtu et al., 2022). There must also be thorough monitoring and guidance on additional safety measures to prevent future infections.

Consideration of Covering

Research indicates that screening for Chlamydia trachomatis might become more common soon, as it was discovered that fifty seven percent of individuals with gonorrhea also had this infection (Scurtu et al., 2022). Due to Lydia’s positive gonorrhea culture and recent sexual activity with a new partner, there is a high likelihood of Chlamydia because the two infections are linked. Screening and treating Chlamydia is essential due to Lydia’s allergy to sulpha products, thus requiring careful treatment for this infection.

Medication Order

Patient: Lydia

Drug 1: Ceftriaxone

Dose: 500 mg
Route: Intramuscular (IM)
Frequency: Single dose
Special instructions: Inject into the deltoid or gluteal muscle. Watch for allergies following the administration.
Quantity prescribed: 1 vial
Refills: 0

Drug 2: Azithromycin

Dose: 1 g
Route: Oral
Frequency: Single dose
Special instructions: You can take it with or without a meal. Advise the patient to notify about any gastrointestinal side effects like feeling sick or having diarrhea.
Quantity prescribed: 1 tablet
Refills: 0

Prevention from Reinfection

Lydia must avoid having sex for a minimum of seven days following treatment for gonorrhea and any possible co-infection with Chlamydia. This timeframe enables the medicine to fully work and lowers the chances of getting infected again. It is also recommended for her partner(s) to undergo testing and treatment if needed in order to avoid further spreading of the infection.

Patient Education

Lydia’s patient education should include multiple key points. Initially, it involves educating the patient on the significance of sticking to prescribed guidelines and adhering to all specified regulations. Lydia should refrain from engaging in any sexual activity with a partner for a minimum of 7 days post treatment completion, with the added precaution of partners getting tested and treated if needed. Another crucial step is to educate her about possible indicators of complications or recurrent infections such as continuous or worsening discharge, pelvic discomfort, or other symptoms (Chan et al., 2022). Encouraging the use of condoms or dental dams is crucial in reducing the risk of acquiring sexually transmitted infections (STIs) later on. Lydia needs to inform her recent sexual partners of her diagnosis in order for them to be tested and treated.

Scenario 3

Treatment Plan

For a 6-year-old named Edgar who has bacterial conjunctivitis and is allergic to sulfa, amoxicillin, and penicillin, the suggested treatment would be ciprofloxacin 0.3%. Put one drop in the eye that is affected every 2 hours during wakefulness for the initial 48 hours, then switch to one drop every 4 hours for the following 5 days. After the treatment is given to the patient, schedule a follow-up appointment in 5-7 business days to assess its effectiveness. Moreover, the mother should be informed that bacterial conjunctivitis is frequently referred to as pink eye and she should be educated on what indicators to watch for in case symptoms deteriorate and when it is necessary for the child to visit a physician.

Medication Order

Patient: Edgar

Drug 1: Ciprofloxacin 0.3% Eye Drops

Dose: 1 drop in the right eye
Route: Ophthalmic
Frequency: Every two hours during the first two days when awake, followed by one drop four times daily for the next five days
Special instructions: Advise the patient not to touch the dropper’s tip to any surface, such as the eye, to avoid contamination. Keep in a cool, dry area and make sure to shake before using.
Quantity prescribed: 1 bottle (typically 5 mL)
Refills: 0

Education

Multiple factors need to be included in the education provided to Edgar’s mother about his treatment. It is necessary to instruct her on the correct way to use the ciprofloxacin eye drops, stress the significance of washing hands before and after putting in the eye drops, and remind her to avoid touching the dropper tip (Desu et al., 2024). Nevertheless, suggesting warm compresses for the affected eye and implementing other precautions like washing hands and avoiding touching the eyes, such as advising Edgar to stop rubbing his eyes, can also help stop infections from spreading. Encouraging her to monitor any worsening symptoms like increased redness, swelling, or unusual discharge is crucial. If these events occur, she should seek medical evaluation immediately without hesitation. Additionally, it is important to schedule Edgar’s follow-up appointment within 5-7 days to monitor his improvement.

Scenario 4

Medication Order

Patient: JT

Drug 1: Amoxicillin Oral Suspension

Strength: 400 mg/5 mL
Dose: 300 mg (20 mg/kg/day)
Route: Oral
Frequency: Every 12 hours (BID) for the next 10 days
Special instructions: Please ensure to shake before using. Use a suitable measuring tool for accurate dosing. Advise caregivers to make sure JT finishes the entire antibiotic treatment, even if he begins to feel improvement. Watch out for any allergic responses or digestive system side effects.
Quantity prescribed: 150 mL
Refills: 0

Alternative Treatments

If JT is allergic to amoxicillin or needs a different antibiotic for acute otitis media, Cefdinir would be a good choice.

Alternative Medication Order for JT

Patient: JT
Drug: Cefdinir Oral Suspension

Strength: 250 mg/5 mL
Dose: 14 mg/kg/day
Route: Oral
Frequency: Every 12 hours (BID)
Duration: 10 days
Special instructions: Please ensure to shake before using. Use a suitable measuring tool for accurate dosing. Advise caregivers to make sure JT finishes the entire antibiotic treatment, even if he begins to feel improvement. Watch out for any allergic responses or digestive system side effects.
Quantity prescribed: 105 mL
Refills: 0

Education

It is crucial to talk about the new antibiotic therapy option of JT for acute otitis media during this visit. Shaking the suspension before use and appropriate dosing cup, cefdinir dosage is 14 mg/kg/day split into two doses, twelve hours apart for ten days (Molloy et al., 2020). Finishing the entire course of antibiotics is important to stop the spread of antibiotic resistance and even if JT’s symptoms subside before the treatment is finished. She also has to be on the lookout for unpleasant side effects like gut troubles or harmful reactions that may make her stop the treatment, and should see the doctor if JT’s condition gets worse, for instance if he experiences pain, suffers a fever, or just downplays anything. For this reason, we will discuss what kinds of things might serve as warning signs, as well as the importance of regular appointments.

References

Chan, G., Lum, L., & Tong, P. (2022). Pelvic inflammatory disease with obstructive complications: Two cases and a literature review. Singapore Medical Journal. https://doi.org/10.11622/smedj.2022021

Desu, H. R., Narang, A. S., Kumar, V., Thoma, L. A., & Mahato, R. I. (2024, January 1). Chapter 10 – Liquid Dosage Forms (A. K. Dash & S. Singh, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/pii/B9780323997966000072

Kennedy, F., Shearsmith, L., Ayres, M., Lindner, O. C., Marston, L., Pass, A., Danson, S., & Velikova, G. (2020). Online monitoring of patient self-reported adverse events in early phase clinical trials: Views from patients, clinicians, and trial staff. Clinical Trials, 174077452097212. https://doi.org/10.1177/1740774520972125

Line Malha, Tiina Podymow, & August, P. (2024). Hypertension in Pregnancy. Elsevier EBooks, 501–517. https://doi.org/10.1016/b978-0-323-88369-6.00044-x

Molloy, L., Barron, S., Khan, N., Abrass, E., Ang, J., & Abdel-Haq, N. (2020). Oral β-lactam antibiotics for pediatric otitis media, rhinosinusitis, and pneumonia. Journal of Pediatric Health Care, 34(3), 291–300. https://doi.org/10.1016/j.pedhc.2019.11.001

Scurtu, L. G., Jinga, V., & Simionescu, O. (2022). Fascinating molecular and immune escape mechanisms in the treatment of STIs (syphilis, gonorrhea, chlamydia, and herpes simplex). International Journal of Molecular Sciences, 23(7), 3550. https://doi.org/10.3390/ijms23073550

Wendel, M. P., Bane, H., Frankowski, S., & Magann, E. F. (2022). Elevated blood pressure and stage 1 hypertension in pregnancy: A review of the literature. Obstetrical & Gynecological Survey, 77(7), 415–422. https://doi.org/10.1097/OGX.0000000000001040

World Health Organization. (2020, January 20). Antimicrobial resistance: Does stopping a course of antibiotics early lead to antibiotic resistance? Www.who.int. https://www.who.int/news-room/questions-and-answers/item/antimicrobial-resistance-does-stopping-a-course-of-antibiotics-early-lead-to-antibiotic-resistance