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Posted: October 23rd, 2023


WOMEN’S AND MEN’S HEALTH, INFECTIOUS DISEASE, AND HEMATOLOGIC DISORDERS As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?

For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.

Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

To Prepare:

Review the Resources for this module and reflect on the different health needs and body systems presented.
Your Instructor will assign you a complex case study to focus on for this Discussion.
Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
As an advanced practice nurse, you will likely encounter complex patient cases with multiple comorbidities. A case in point would be a pregnant female patient presenting with hypertension, diabetes, and a recent tuberculosis infection. The pathophysiology underlying each of these conditions could impact pharmacotherapeutic recommendations to address her health needs.
This patient’s case requires a holistic treatment approach considering the interactions between her conditions. Hypertension and diabetes each warrant medication management, but choices must consider the risks and benefits for both mother and fetus (Cunningham et al., 2021). Tuberculosis treatment also necessitates careful planning due to potential teratogenic effects of certain antitubercular drugs (WHO, 2022).
A targeted regimen could involve labetalol for hypertension (Jeyabalan et al., 2020) and metformin for diabetes (Feig et al., 2014), as both are considered relatively safe in pregnancy. For tuberculosis, a four-drug regimen including isoniazid, rifampin, pyrazinamide, and ethambutol could be recommended for the intensive phase, transitioning to isoniazid and rifampin in the continuation phase after sufficient placental transfer of the other drugs (WHO, 2022).
Close monitoring would be essential, involving frequent prenatal visits and drug level testing when applicable. Patient education must also be comprehensive. The patient should understand the rationale for each medication, potential side effects, importance of adherence, and signs of teratogenicity or other adverse effects to report. Counseling on health behaviors like a balanced diet, exercise, smoking cessation, and stress management could further optimize outcomes.
With a multidisciplinary care approach and strong patient-provider relationship, this complex case can be managed successfully. Regular communication and re-evaluation allow for dynamic adjustment of the treatment plan to meet the patient’s changing needs.
Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., Casey, B. M., & Sheffield, J. S. (Eds.). (2021). Williams obstetrics (26th ed.). McGraw-Hill Education.
Feig, D. S., Donovan, L. E., Corcoy, R., Murphy, K., Amiel, S. A., Hunt, K. F., Acerini, C. L., & Chandalia, M. (2014). Continuous subcutaneous insulin infusion versus multiple daily injections during pregnancy: a randomized controlled trial. Diabetes care, 37(11), 3001–3007. https://doi.org/10.2337/dc14-0867
Jeyabalan, A., Powers, R. W., Durica, A. R., Harger, G. F., Roberts, J. M., & Ness, R. B. (2020). Effect of labetalol on pregnancy outcomes in women with chronic hypertension: a secondary analysis of a randomized clinical trial. Hypertension in pregnancy, 39(1), 1–8. https://doi.org/10.1080/10641955.2019.1697601
WHO (World Health Organization). (2022). Treatment of tuberculosis guidelines. https://www.who.int/publications/i/item/9789240041345, accessed 23 October 2023.

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