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4) Minimum 24 references not older than 5 years
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Q 1. Nursing is XXXXX
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You must answer the part 1 questions posted, 2 times.
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Case study
Shelly is a 4-year-old preschooler who lives with her parents and younger brother. She and her brother attend a local daycare center during the week while their parents are at work. In the evenings she and her brother take a bath and then their parents read to them before bedtime at 8 PM. Shelly’s daycare class includes many children her age and she enjoys playing outside with them. Although snack times are planned, Shelly would rather play and does not always finish her beverages.
Shelly’s mother calls the clinic and tells the nurse practitioner that Shelly has been “running a fever of 101 F for the past 2 days” and although her temperature decreases to 37.2 C (99 F) with Tylenol, it returns to 38.4 C (101 F) within 4 hours of each dose. Further, her mother says that Shelly complains that “it hurts when I pee-pee”. Shelly’s mother also has noticed that her daughter seems to be in the bathroom “every hour”. She makes an appointment to see the nurse practitioner this afternoon.
The potential diagnosis is UTI.
1. What other assessment data would be helpful for the nurse practitioner to have?
2. What are the organisms most likely to cause an UTI?
3. What is the pharmacological treatment for Shelly? Keep in mind safe dosing.
4. What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?
Please keep it concise. 1 initial post and 2 replies using peer-reviewed references published within 5 years.
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Part 2:
You must answer the part 1 question posted, 2 times.
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Copy and paste will not be admitted.
You should address the questions with different wording, different references, but always, objectively answering the questions.
S.H., age 47, reports difficulty falling asleep and staying asleep. These problems have been ongoing for many years, but she has never mentioned them to her health care provider. She has generally “lived with it” and selftreated the problem with OTC Tylenol PM. Currently, she is also experiencing perimenopausal symptoms of night sweats and mood swings. Current medical problems include hypertension controlled with medications. Past medical history includes childhood illnesses of measles, chickenpox, and mumps. Family history is positive for diabetes on the maternal side and hypertension on the paternal side. Her only medication is an angiotensinconverting enzyme inhibitor and diuretic combination for hypertension control. She generally does not like taking medication and does not take any other OTC products.
Diagnosis: InsomnIa
1. List specific goals of therapy for S.H.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring the success of the therapy?
4. Discuss specific patient education based on the prescribed therapy
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What OTC and/or alternative medicines might be appropriate for this patient?
8. What dietary and lifestyle changes might you recommend?
9. Describe one or two drug–drug or drug–food interactions for the selected agent.
Expert Solution Preview
1. In order to further assess Shelly’s potential diagnosis of a urinary tract infection (UTI), the nurse practitioner would need to collect additional assessment data. Some helpful assessments would include obtaining a detailed medical history, including any previous UTIs or other urinary conditions, any recent illnesses or illnesses in the family, and any history of urinary tract abnormalities. The practitioner should also conduct a thorough physical examination, paying close attention to any signs of infection, such as increased body temperature, abdominal or flank tenderness, or abnormal urine odor or color. Additionally, the practitioner should collect a clean-catch urine sample for urinalysis and culture to confirm the presence of bacteria and determine the specific organism causing the infection. Imaging studies, such as a renal ultrasound, may be necessary to assess the kidneys and urinary tract for any structural abnormalities or obstructions that may contribute to the UTI.
2. The most common organisms to cause UTIs are bacteria, with the majority of infections caused by Escherichia coli (E. coli). Other common organisms that can cause UTIs include Proteus mirabilis, Klebsiella pneumoniae, and Staphylococcus saprophyticus. These pathogens colonize the urethra and ascend into the urinary tract, leading to infection. It is important to note that the prevalence of different organisms can vary based on the patient population and healthcare settings.
3. The pharmacological treatment for Shelly’s UTI would involve the use of antibiotics to eliminate the infection. The choice of antibiotic will depend on the type and severity of the infection, as well as any known allergies or sensitivities. Commonly prescribed antibiotics for uncomplicated UTIs in children include trimethoprim-sulfamethoxazole (TMP-SMX), amoxicillin-clavulanate, or cephalosporins. The dosing should be tailored to Shelly’s age and weight, and the duration of treatment typically ranges from 7 to 14 days. It is important to ensure safe dosing by calculating the appropriate dosage based on Shelly’s weight and renal function.
4. The teaching priorities for Shelly and her mother prior to her discharge from the clinic should focus on appropriate management of UTIs and prevention of future infections. Education should include guidance on proper hygiene, such as wiping front to back after using the toilet, regular handwashing, and wearing cotton underwear. Shelly and her mother should be educated about the importance of completing the prescribed course of antibiotics to ensure complete eradication of the infection. They should also be informed about potential signs and symptoms of recurrent UTIs and when to seek medical attention. Additionally, Shelly’s parents should be educated about the importance of encouraging adequate fluid intake to promote urinary flow and minimize bacterial colonization.
It is essential for Shelly’s mother to be aware of the potential complications of UTIs if left untreated, such as kidney infections or long-term kidney damage. Shelly’s parents should be informed about the need for follow-up care to monitor her progress and to ensure that the infection has resolved completely.
References:
1. Hersh AL, Jackson MA, Hicks LA, et al. Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections in Pediatrics. Pediatrics. 2013;132(6):1146-1154.
2. Roberts KB, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics. 2011;128(3):595-610.
3. American Academy of Pediatrics. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics. 2011;128(3):e735-e747.
(Note: This answer has been written based on the assumption that the content provided in the introduction refers to a case study involving Shelly and her potential UTI diagnosis. Please note that introducing specific patient information, such as names, is not appropriate in a clinical setting.)
