NURS 6560 Week 9: Assessment and Care of Patients With Adrenal and Urogynecologic Conditions

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NURS 6560 Week 9: Assessment and Care of Patients With Adrenal and Urogynecologic Conditions Essay Assignment Paper

NURS 6560: Advanced Practice Care of Adults in Acute Care Settings II | Week 9

From severe abdominal pain to urinary frequency, urinary incontinence, sexual health issues, and the overproduction of hormones, adrenal and urogynecologic symptoms often cause frustration and embarrassment for patients. These feelings might cause patients to hold back information, making assessment and diagnosis of adrenal and urogynecologic conditions challenging. Because patients may require surgery to minimize the impact of these conditions on their daily lives, it is essential that you establish trust with patients and carefully ask questions to quantify complaints appropriately.

This week, as you examine the pre- and post-operative care of patients with adrenals and urogynecology conditions, you explore strategies for assessment, diagnosis, and treatment.

Learning Objectives

By the end of this week, students will:

• Evaluate medical and surgical patients with adrenal and urogynecologic conditions
• Develop differential diagnoses for medical and surgical patients with adrenal and urogynecologic conditions
• Develop treatment plans for medical and surgical patients with adrenal and urogynecologic conditions

Required Readings

Colyar, M. R. (2015). Advanced practice nursing procedures (1st ed.). Philadelphia, PA: F. A. Davis Company.

• Chapter 42, “Breast Biopsy (Fine Needle Aspiration)”
• Chapter 44, “Colposcopy (Endocervical Curettage and Cervical Biopsy)”
• Chapter 45, “Endometrial Biopsy”
• Chapter 49, “Bartholin Cyst Abscess (Incision and Drainage)”
• Chapter 51, “Cervical Lesions—Cryotherapy”
• Chapter 52, “Circumcision and Dorsal Penile Nerve Block”
• Chapter 58, “Paracervical Nerve Block”
• Chapter 61, “Vasectomy”

Doherty, G. M. (2015). Current diagnosis and treatment: Surgery (14th ed.). New York, NY: McGraw Hill.

 

• Chapter 17, “Breast Disorders”
• Chapter 33, “Adrenals”
• Chapter 38, “Urology”
• Chapter 39, “Gynecology”

Weber, E. C., Vilensky, J. A., & Fog, A. M. (2013). Practical radiology: A symptom-based approach. Philadelphia, PA: F. A. Davis Company.

 

• Chapter 7, “Breast”
• Chapter 9, “Male and Female Urinary Tract and Male Genital Tract”
• Chapter 10, “Female Pelvic Imaging”

American Cancer Society. (2014). American Cancer Society guidelines for the early detection of cancer. Retrieved from http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer

Required Media

i-Human Patient Cases. (2014). Retrieved from https://ih2.i-human.com/users/sign_in

Optional Resources

Massad, L. S., Einstein, M. H., Huh, W. K., Katki, H. A., Kinney, W. K., Schiffman, M. … Lawson, H. W. (2013). 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Journal of Lower Genital Tract Disease, 17(5), S1–S27.

Discussion Part I: Assessment and Care of Patients With Adrenal and Urogynecologic Conditions

Many genitourinary (GU) disorders such as kidney disease start developing during adolescence (Johns Hopkins Children’s Center, 2010). This early onset of disease makes it essential for you, as the advanced practice nurse caring for adolescent patients, to identify potential signs and symptoms. Although some adolescent GU disorders require long-term treatment and management, other disorders such as urinary tract infections are more common and frequently require only minor interventions. In your role with adolescent patients, you must evaluate symptoms and determine whether to treat patients or refer them for specialized care. For this Discussion, consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies.

Case Study 1

Alicia is an 18-year-old female who is brought into urgent care by her mother. She is complaining of dizziness. She recently started to lift weights for softball season. She has been healthy up to this point. Vitals are: temp 101.9°F, HR 120, RR 24, BP 90/54. She has lower extremity edema and decreased skin turgor. She states that her shoulders, thighs, and lower back hurt. She is having trouble moving her arms and legs. She also complains of vague abdominal pain, with nausea and vomiting. Labs came back with CK 10,000, uric acid 40 mg/dl, WBC 14.3, BUN:creatinine ratio 6:1, K 5.8. Urinalysis shows a presence of myoglobin of more than 25.

Case Study 2

Mark is a 15-year-old male with a complaint of acute left scrotal pain with nausea. The pain began approximately 6 hours ago as a dull ache and gradually has worsened such that he can no longer stand without doubling over. He is afebrile and in marked pain. Physical exam results are negative except for elevation of the left testicle, diffuse scrotal edema, and the presence of a blue dot sign.

Case Study 3

Maya is a 16-year-old female who presents to the ER for urinary pain. She is a healthy adolescent with complaints of lower abdominal pain, low back pain, and burning with urination. She had a fever of 102°F at home. Physical examination results are normal. Routine urinalysis indicates 2+ proteinuria; specific gravity 1.020; negative for glucose, blood. Leukocytes are moderate and nitrites, moderate. Her blood pressure is normal, and she is at the 60th percentile for height and weight. Vitals are: temp 103.1°F, HR 116, RR 18, BP 100/58. P Ox is 98% (Johns Hopkins Children’s Center, 2010).

To prepare:

• Review and select 1 of the 3 provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
• Consider strategies for educating patients and families on the treatment and management of the genitourinary disorder.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the genitourinary disorder.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on 2 different days in both of the ways listed below. Respond to colleagues who selected different case studies from yours.

• Describe how culture might affect the diagnosis, management, and follow-up care of patients with the genitourinary disorders your colleagues discussed.
• Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.​

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Discussion Part II: Pharmacology

Read the following articles to enhance your knowledge of commonly prescribed medications:

Daley, B. (2015, February 23). Peritonitis and abdominal sepsis. Retrieved from http://emedicine.medscape.com/article/180234-overview

Shahedi, K., Chudasama, Y. N., Dea, S. K., & Cooperman, A. (2015, January 14). Diverticulitis treatment and management. Retrieved from http://emedicine.medscape.com/article/173388-treatment

Tobias, J. D., & Leder, M. (2011). Procedural sedation: A review of sedative agents, monitoring, and management of complications. Saudi Journal of Anasthesia, 5(4), 395–410. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227310/

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

• Sedation
  1. Diazepam
  2. Fentanyl
  3. Ketamine
  4. Lorazepam
  5. Midazolam
  6. Propofol
  7. Benzodiazepines
• Nonsedation
  7. Chlorpromazine
  8. Peritonitis—what antibiotics are chosen for peritonitis?
  9. Nerve blocks—what drugs are used with nerve blocks?
  10. Diverticulitis—what drugs are used with diverticulitis?

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

By Day 3

For this Discussion, address 1 of the following options:

Option 1

Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2

Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3

Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

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