select a professional nursing organization of interest. analyze the organizational mission, vision/philosophy, theoretical framework, and political activism of the chosen organization. identify and discuss the organization's impact on current political issue(s) and nursing practice.
To Prepare:
PLEASE FOLLOW THE RUBRIC ATTACHED IN FILES!!!!
As a professional nurse, you are expected to apply your expertise to patient care. On occasion, you will also be expected to share that expertise.
With evolving technology and continuous changes to regulations designed to keep up these changes, there is usually a need to share information and expertise to inform colleagues, leadership, patients, and other stakeholders.
In this Assignment, you will study a recent nursing informatics-related healthcare policy, and you will share the relevant details via a fact sheet designed to inform and educate.
The Assignment: (1 p not including the title and reference page)
Create a 1-p fact sheet that your healthcare organization could hypothetically use to explain the health or nursing informatics policy/regulation you selected. Your fact sheet should address the following:
Required Readings:
Identify, analyze, and evaluate quantitative and qualitative healthcare data and information for effective decision making in various healthcare settings
The main idea of the assignment is to evaluate students' analytical skills. Students will need to use the same EXCEL Add-Ins we have used throughout this class.
Please note, that the questions and the analysis for the assignment are like those we have worked with in our exercises throughout this class. The data file for the this, however, is different from any of the data files we have used in this class (even though it may look familiar), and you should expect different results from what we found in our class practice exercises.
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Consider the scenario below, then follow the instructions underneath it to complete the discussion. If appropriate, support your position with credible resources/examples/evidence and provide APA references.
Mr. B, a 70-year-old male client, presented to his primary care physician with complaints of blurred vision and headaches over the last two months. On several visits, Mr. B's blood pressure was found to be elevated, so the physician started him on hydrochlorothiazide 25 mg by mouth daily. One month later, Mr. B began to have chest pains and shortness of breath, so his primary care provider referred Mr. B to a cardiologist for further evaluation.
The cardiologist ordered an echocardiogram and stress test which revealed heart enlargement and a reduced ejection fraction (volume of blood pumped out of the heart per minute). As a result, the cardiologist started Mr. B on a beta-blocker (metoprolol 25 mg by mouth daily).
A few days after taking the new medication (in addition to the hydrochlorothiazide ordered by the primary physician), Mr. B suffered a fall at home. Upon arrival at the emergency room, Mr. B's blood pressure was 80/50. The emergency room physician suspected the cause of Mr. B's fall was hypotension secondary to the medications he was taking. The ER physician recommended that Mr. B follow up with his primary care physician and cardiologist, but hold the medication until seen by them.
As recommended, Mr. B visits his primary care physician for a follow-up. During the visit, Mr. B's blood pressure is found to be elevated (160/90), so his physician tells Mr. B to restart taking his blood pressure medication.
Imagine that you are the nurse attending to Mr. B and that he indicates that he's afraid to restart the medication because of his recent fall.
Review the posts made by your classmates and reply to someone expanding on their idea or offering an alternative for consideration.
ALL INSTRUCTIONS ARE IN THE TEMPLATE ATTACHED. TWO SETS OF DRUG CARDS REQUIRED.
THE FIRST SET MUST BE SELECTED FROM Pha. 1,2,3,4 AND THE SECOND SET FROM Pha. 5,6,7,8,9 attached.
Prototypes
Drug Class Major Indication Prototypes Major Adverse Effects *Boxed Warning
Peripheral Nervous System Drugs
Muscarinic Agonist (Parasympathomimetic)
Treats urinary retention Bethanechol Mr. Pathetic (cholinergic)-hypotension, bradycardia, bronchoconstriction, miosis, sweating, urination, diarrhea
Muscarinic Antagonists (Anticholinergics, parsympatholytics)
Bradycardia (slow HR) Atropine Anticholinergic effects-BUDCATS- blurry vision (photophobia-increased IOP), urinary retention, dry mouth constipation, anhidrosis, tachycardia, sedation
Overactive bladder Oxybutynin Anticholinergic-BUDCATS Asthma, COPD Ipratropium Anticholinergic-BUDCATS COPD Tiotropium Anticholinergic-BUDCATS
Cholinesterase Inhibitors Myasthenia gravis Neostigmine Mr. Pathetic (cholinergic) Neuromuscular Blocker Surgery, intubation Pancuronium Respiratory arrest
Surgery Succinylcholine Prolonged apnea, malignant hyperthermia, muscle pain, ↑ K Adrenergic Agonists Shock, anaphylaxis Epinephrine Tachycardia, HTN, angina, necrosis, hyperglycemia Alpha1 Blocker BPH, HTN Prazosin Hypotension, reflex tachycardia, nasal congestion, anorgasmia Beta-Adrenergic Blockers Non-cardioselective
HTN, angina, migraines, dysrhythmias, MI, hyperthyroidism
Propranolol* *Abrupt cessation→MI or angina & dysrhythmias Bradycardia, AV heart block, heart failure, rebound tachycardia, hypotension, bronchoconstriction, depression, CNS effects, inhibition of glycogenolysis, masks sign of hypoglycemia-tachycardia
Cardioselective HTN, MI, Heart failure (HF)
Metoprolol* *Abrupt cessation→MI, angina & dysrhythmias Bradycardia, AV heart block, heart failure, rebound tachycardia hypotension, depression, CNS effects,
Alpha2 Agonists (indirect acting anti- adrenergic agents)
Clonidine* *Fetal injury Drowsiness, dry mouth, rebound hypertension, hypotension, bradycardia
Alpha2 Agonists HTN-preferred drug in pregnancy
Methyldopa + Coombs’ Test and hemolytic anemia, hepatotoxicity, hypotension
Drugs for Parkinson’s Disease
Dopaminergics Parkinson’s disease Levodopa/ carbidopa
Nausea and vomiting, dyskinesias, hypotension, dysrhythmias, psychosis, CNS effects, darkens body secretions, activates melanoma
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Dopamine receptor agonists
Parkinson’s disease Restless leg syndrome
Pramipexole Nausea, dizziness, sleep attacks, compulsive behavior, gambling
MAO-B Inhibitors Parkinson’s disease Selegiline Hypertensive crisis with tyramine containing foods Promotes dopamine release
Parkinson’s disease Amantadine CNS effects
Anticholinergic’s Parkinson’s disease to reduce tremor
Benztropine Anticholinergic-BUDCATS
Drugs for Alzheimer’s Disease (AD)
Cholinesterase Inhibitors AD Donepezil Mr. Pathetic (cholinergic) NMDA antagonists AD Memantine Dizziness, confusion, headache, constipation
Drugs for Epilepsy
Antiepileptic drugs (AEDS)
Seizures, cardiac dysrhythmias
Phenytoin* *CV risk (hypotension and bradycardia) with rapid infusion >50 mg/min CNS depression, nystagmus, diplopia, gingival hyperplasia, fatal rash (TEN, SJS), fetal risk, necrosis if infiltrated IV, induces metabolism of other drugs, withdrawal seizures, (mix only with saline)
Seizures, bipolar disorder (BPD)
Carbamazepine* *Aplastic anemia/ agranulocytosis, fatal rash (TEN, SJS) CNS effects, fetal harm, induces metabolism of other drugs, withdrawal seizures
Seizures, BPD, migraine prophylaxis
Valproic acid* *Hepatotoxicity, fetal risk, pancreatitis Elevated ammonia levels, weight gain, hair loss, tremor
Drugs for Migraines
Selective Serotonin Receptor Agonists
Migraines Sumatriptan Chest symptoms (transient pain, pressure, tightness) Coronary vasospasms
Ergot Alkaloids Migraines Ergotamine* *Peripheral ischemia, vasospasm, cerebral ischemia Ergotism, vasoconstriction
Opioid Analgesics and Antagonists
Pure Opioid Agonists Pain, MI Morphine* *Appropriate use by pain specialists *Addiction, abuse and misuse *Medication error with oral concentrated solution (20mg/mL) *Accidental exposure in children *Neonatal withdrawal syndrome
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*Respiratory depression *Risk of sedation, respiratory depression, coma and death if used with other CNS depressants Constipation, hypotension, urinary retention, cough suppression, biliary colic, emesis, ↑ ICP, euphoria/dysphoria, sedation, miosis, fetal injury, neurotoxicity
Codeine* *Medication error risk-confusion between mg and mL with different concentrations *Addiction, abuse and misuse *Respiratory depression *Accidental ingestion in children *Death related to ultra-rapid metabolism of codeine to morphine *Neonatal opioid withdrawal syndrome *use with other sedating agnets can cause death
Agonist-Antagonists Opioids
Pain Pentazocine* *Risk of sedation, respiratory depression, coma and death if used with other CNS depressants Withdrawal syndrome when given to opioid addicts, increases cardiac work, weird thoughts, nightmares, minimal respiratory depression, REMS required
Opioid Antagonists Reversal of opioids Naloxone No significant adverse effects Non-opioid Centrally Acting Analgesics
Pain, helpful with neuropathic pain
Tramadol* *Risk of sedation, respiratory depression, coma and death if used with other CNS depressants Seizures, minimal respiratory depression, sedation, headache, dry mouth, constipation, serotonin syndrome with other serotonergic agents
Antipsychotics
Traditional or 1st Generation Antipsychotics
Schizophrenia Chlorpromazine* (low potency)
*Not approved for dementia-related psychosis. Increased mortality risk in elderly dementia patients. Deaths due to CV events and infections Sedation, hypotension, anticholinergic effects, prolongs QT interval, EPS, neuroleptic malignant syndrome (NMS), neuroendocrine effects, sexual dysfunction, photosensitivity
Schizophrenia Haloperidol* *Not approved for dementia-related psychosis. Increased
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(high potency) mortality risk in elderly dementia patients. Deaths due to CV events and infections EPS, less NMS, sedation and anticholinergic effects, prolongs QT interval, neuroendocrine effects,
Atypical or 2nd Generation Antipsychotics
Schizophrenia Clozapine* *Restricted use-REMS required due to severe neutropenia *Orthostatic hypotension, bradycardia, syncope *Increase risk of seizures *Myocarditis/cardiomyopathy *Not approved for dementia-related psychosis. Increased mortality risk in elderly dementia patients. Deaths due to CV events and infections Agranulocytosis, weight gain, diabetes, dyslipidemia, EPS
Schizophrenia BPD Severe depression with aripiprazole
Aripiprazole* Olanzipine* Paliperidone* Quetiapine* Resperidone* Ziprasidone*
*Not approved for dementia-related psychosis. Increased mortality risk in elderly dementia patients. Deaths due to CV events and infections *Increased suicidal ideations (SI) in children, adolescents and young adults Weight gain, diabetes, dyslipidemia, EPS, sedation, anticholinergic-BUDCATS, rash, leukopenia, orthostatic hypotension, cataracts, QT prolongation, gynecomastia (adverse effects vary with each agent)
Antidepressants
SSRIs Depression Fluoxetine* *Increased suicidal ideations (SI) in children, adolescents and young adults Sexual dysfunction, weight gain, serotonin syndrome, withdrawal syndrome, neonatal withdrawal syndrome and pulmonary hypertension of the newborn, fetal harm, rare EPS, bruxism, bleeding, hyponatremia, glaucoma, QT prolongation
SNRIs Depression Venlafaxine* *Increased suicidal ideations (SI) in children, adolescents and young adults Serotonin syndrome, rare EPS, nausea, headache, nervousness, insomnia, HTN, withdrawal syndrome, hyponatremia, mydriasis (increased IOP)
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TCAs Depression Imipramine* *Increased suicidal ideations (SI) in children, adolescents and young adults Hypotension, anticholinergic-BUDCATS, diaphoresis, sedation, dysrhythmias, seizures, hypomania, serotonin syndrome
MAOIs Depression Phenelzine* *Increased suicidal ideations (SI) in children, adolescents and young adults Agitation, hypotension, HTN with tyramine foods
Atypical Antidepressants Depression Smoking cessation
Bupropion* *Increased suicidal ideations (SI) in children, adolescents and young adults *Neuropsychiatric symptoms-hostility, agitation, worsening of psychiatric illness Seizures, dry mouth, constipation, weight loss, GI upset, tachycardia, insomnia
Depression Insomnia
Mirtazapine* *Increased suicidal ideations (SI) in children, adolescents and young adults Somnolence, sedation, weight gain, anticholinergic effects
Depression Insomnia
Trazodone* *Increased suicidal ideations (SI) in children, adolescents and young adults Somnolence, sedation, prolongs QT interval, priapism
Drugs for Bipolar Disorder (BPD)
Mood Stabilizer Bipolar Disorder (BPD) Lithium* *Toxicity with ↑levels. Keep drug level below 1.5 mEq/L GI distress, tremor, polyuria, renal toxicity, goiter and hypothyroidism, fetal harm
Drugs for Anxiety and Insomnia and ADHD and Smoking Sensation
Benzodiazepines Anxiety and insomnia Diazepam* *Risk of sedation, respiratory depression, coma and death if used with other CNS depressants Sedation, physical dependence, withdrawal syndrome, fetal harm
BZD-like drugs Insomnia Zolpidem Sedation, weird nighttime behaviors Reversal agent BZD antidote Romazicon* *Seizure
Dysrhythmias Barbiturates Sedation Secobarbital Sedation, respiratory arrest, suicide, abuse Melatonin agonist Insomnia Ramelteon Sedation, dizziness
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Stimulants ADHD Methylphenidate* *Drug dependence, tolerance, psychotic episodes, Insomnia, weight loss, CNS stimulation, ↑ HR and ↑BP
Diuretics and Cardiovascular Drugs
Loop diuretics Heart failure Furosemide* * Fluid and electrolyte imbalance Hypotension, ototoxicity, hyperglycemia, hyperuricemia
Thiazide diuretic HTN HCTZ Hypoglycemia and other electrolyte imbalances Potassium sparing diuretics (aldosterone blockers)
Heart failure Spironolactone* *Tumor risk Hyperkalemia, endocrine effects (gynecomastia, menstrual irregularities, impotency, hirsutism, deepened voice)
ACE Inhibitors HTN, heart failure Lisinopril* *Fetal risk Angioedema, hypotension, cough, hyperkalemia, renal failure
ARBs HTN, heart failure Losartan* *Fetal risk Angioedema, hypotension, hyperkalemia, renal failure
Direct Renin Inhibitors HTN Aliskiren* *Fetal risk Angioedema, hypotension, cough, hyperkalemia, renal failure, diarrhea
Non-dihydropyridine CCBs
HTN, dysrhythmias, angina Verapamil and diltiazem
Constipation, bradycardia, peripheral edema, dizziness, headache
Dihydropyridine CCB HTN, angina Nifedipine and amlodipine
Hypotension and peripheral edema, flushing, dizziness, reflex tachycardia with nifedipine
Vasodialtors HTN, heart failure Hydralazine Hypotension, reflex tachycardia, increased blood volume, systemic lupus erythematosus-like syndrome
Cardiac Glycosides (Inotropic Agents)
Heart failure Digoxin Dysrhythmias, AV block, bradycardia, anorexia, nausea, vomiting, fatigue and visual disturbances (blurred vision, yellow tinge, and halos). Keep plasma level 0.5-0.8 ng/mL
Antidysrhythmic Drugs Class III
Dysrththmias AF off label (class III)
Amiodarone* *Appropriate use *Pulmonary toxicity *Hepatotoxicity *Proarrhythmic effects (sinus bradycardia, AV block) Thyroid toxicity, optic neuropathy, fetal harm, photosensitivity, CNS effects, hypotension, peripheral neuropathy
Statins (HMG-CoA Hyperlipidemia Atorvastatin Myopathy, rhabdomyolysis, hepatotoxicity, diabetes, fetal
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reductase inhibitors) harm, cognitive impairment Bile-acid sequestrants Hyperlipidemia Colesevelam Constipation, decreased uptake of fat-soluble vitamins Fibrates Hypertriglyceridemia Fenofibrate GI distress, gallstones, myopathy, liver injury Organic Nitrates Angina Nitroglycerin Headache, orthostatic hypotension, reflex tachycardia Anticoagulants Deep vein thrombosis
(DVT) pulmonary embolism (PE)
Heparin Hemorrhage, heparin–induced thrombocytopenia (HIT), hypersensitivity reaction
Vitamin K Antagonists Prevention of thrombosis, atrial fibrillation (AF)
Warfarin* *Hemorrhage Fetal harm
Direct Thrombin Inhibitors
DVT, AF Dabigatran* *Treatment discontinuation→increased thrombosis *Epidural/spinal hematoma risk Bleeding, GI distress
Factor Xa Inhibitors DVT, AF Rivaroxaban* *Treatment discontinuation→increased thrombosis * Epidural/spinal hematoma risk Bleeding
Antiplatelets AF, MI Aspirin Bleeding, GI bleed Antiplatelet AF, MI Clopidogrel* *Diminished antiplatelet effect in CYP2C19 poor metabolizers Thrombolytics Embolism Alteplase Bleeding
RBC Builders Renal disease, anemia Epoetin alpha* *Increased mortality and serious CV events in CKD patients when Hgb is >11 g/dL. REMS required *Increased mortality and/or tumor progression in cancer patients *Increased thromboembolic events in surgery patients HTN
WBC Builder Bone marrow disease Filgrastim Bone pain, leukocytosis, hyperuricemia Platelet Builder Thrombocytopenia Oprelvekin Fluid retention, dysrhythmias, anaphylaxis
Drugs for Diabetes
Biguanides Diabetes Mellitus (DM) Metformin* *Lactic acidosis GI distress, diarrhea, decrease B12
Sulfonylureas DM Glyburide Hypoglycemia, weight gain Thiazolidinediones (Glitazones or TZDs)
DM Pioglitazone* *Heart failure Fluid retention, edema, hepatotoxicity, possible bladder cancer
Meglitinides DM Repaglinide Hypoglycemia, weight gain Alpha-glucosidase inhib DM Acarbose Flatulence, cramps, and diarrhea, hypoglycemia, liver
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dysfunction DPP-4 Inhibitors DM Sitagliptin Rare pancreatitis GLP-1 Agonist DM Exenatide GI distress, pancreatitis
DM and weight loss Liraglutide* *Thyroid C-cell tumor risk. Contraindicated in patients with medullary thyroid cancer or family history of multiple endocrine neoplasia syndrome type 2
SGLT-2 Inhibitors DM Canagliflozin Genital mycotic infections, orthostasis Amylin Mimetic DM Pramlintide* *Hypoglycemia
Drugs for Thyroid Disorders
Thyroid hormones Hypothyroidism Levothyroxine* *Not to be used for weight loss, toxicity in ↑ doses Tachycardia, angina, tremor, nervousness, insomnia, hyperthermia with excess dosages
Antithyroid drugs Hyperthyroidism Methimazole Agranulocytosis, hypothyroidism, fetal harm Hyperthyroidism Used in pregnancy and in thyroid storm
Propylthiouracil (PTU)*
*Appropriate use *Hepatotoxicity *Treatment of choice during or just prior to 1st trimester Agranulocytosis, hypersensitivity
Drugs for Disorders of the Adrenal Cortex
Glucocorticoids Adrenal insufficiency (Addison’s disease)
Hydrocortisone Cushions syndrome, hyperglycemia, glaucoma, hypokalemia
Mineralocorticoids Adrenal insufficiency Fludrocortisone Cushing’s syndrome, HTN edema, cardiac enlargement, hypokalemia
Drugs for Erectile Dysfunction and BPH
PDE-5 Inhibitors Erectile dysfunction (ED) Sildenafil Hypotension, priapism, non-arteritic ischemic optic neuropathy, sudden hearing loss, headache, flushing, may worsen sleep apnea. Prolonged QT interval with vardenafil
5-alpha Reductase Inhibitors
BPH Finasteride Decrease libido, gynecomastia. Pregnant women should not handle tabs
Alpha Blockers BPH Tamsulosin Hypotension, somnolence, nasal congestion, retrograde ejaculation, floppy iris syndrome
COX Inhibitors, Anti-inflammatory, Anti-allergic, Immunologic Drugs
1st Generation H1 Blockers Allergies, insomnia, common cold
Diphenhydramine Sedation, anticholinergic-BUDCATS Respiratory depression in child
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Nausea/vomiting Allergic reactions sedation, motion sickness
Promethazine* *Respiratory depression in children less than 2 years of age *Severe tissue injury-gangrene with injection
2nd Generation H1 Blockers
Allergic rhinitis Fexofenadine No sedation
1st Generation NSAIDs Pain, inflammation Fever
ASA Reyes syndrome in child, GI ulceration, bleeding, renal impairment, salicylism, fetal harm, hypersensitivity
Ibuprofen* *Increase risk of CV thrombotic events MI and stroke *Contraindicated after CABG-CV risk *GI risk, bleeding, ulcer, stomach or intestine perforation
2nd Generation NSAIDS Pain, inflammation Celecoxib* *Increase risk of CV thrombotic events MI and stroke *Contraindicated after CABG-CV risk *GI risk, bleeding, ulcer, stomach or intestine perforation
Central COX Inhibitor Pain, fever Acetaminophen Liver damage with ETOH, anaphylaxis, SJS and TEN Glucocorticoids Asthma, RA, SLE,
allergies Prednisone Adrenal insufficiency, osteoporosis, infection, hyperglycemia,
PUD Drugs for Rheumatoid Arthritis, Gout, and Osteoporosis
Disease Modifying Anti- rheumatic Drugs (DMARDs)
Rheumatoid arthritis (RA) Methotrexate* *Appropriate use *Fetal injury *Hepatotoxicity *Impaired drug elimination in CKD *Pulmonary toxicity *GI toxicity *Malignant lymphoma *Tumor lysis syndrome *Skin reactions *Opportunistic infections *Concomitant Radiotherapy *Aplastic anemia if used with NSAIDs
RA, lupus Hydroxychloroquine sulfate (Plaquenil)*
*Prescribers should be familiar with prescribing information Agranulocytosis, seizures, hypersensitivity reaction, hepatotoxicity, retinopathy, dizziness, headache, GI distress
TNF Antagonists RA Etanercept* *Infection, reactivation of TB *Malignancy Severe allergic reaction, heart failure, cancer, hematological disorders, liver injury, CNS demyelinating disorders
Urate Lowering Drugs Gout Allopurinol Hypersensitivity syndrome, rash, may elicit an acute gouty attack, GI distress, neurologic effects, cataracts with prolonged use
Anti-inflammatory Gout Colchicine Nausea, vomiting, diarrhea, bone marrow suppression, muscle injury
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Bisphosphonates Osteoporosis Alendronate Esophagitis, atypical fractures, osteonecrosis of the jaw, ocular problems
Selective Estrogen Receptor Modulators (SERMS)
Breast cancer Osteoporosis
Raloxifene* *Venous thromboembolism DVT, PE, stroke Fetal harm, hot flashes
Respiratory Drugs
Inhaled Glucocorticoids Asthma Beclomethasone Oral candidiasis, dysphonia, slowed growth in children, bone loss, cataracts
Oral Glucocorticoids Asthma Prednisone Adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, growth suppression in children, increased risk of infection, insomnia, increased risk of cataracts
Leukotriene Inhibitors Asthma, allergic rhinitis Zileuton Liver injury Montelukast Possible neuropsychiatric events such as mood changes
Beta2 Agonists SABA Asthma, COPD Albuterol Tachycardia, angina, tremor, seizures, cardiac arrest-use more than 2/week is an indication of poor asthma control
Beta2 Agonists LABA Asthma, COPD Salmeterol* *Asthma related death *Pediatric & adolescents-increase risk of death-use fixed combo Tachycardia, angina, tremor, seizures
Anticholinergic SAMA Asthma, COPD Ipratropium Anticholinergic-BUDCATS Anticholinergic LAMA COPD Tiotropium Anticholinergic-BUDCATS IgE Antagonists Severe asthma
Allergic rhinitis Omalizumab* *Anaphylaxis
Injection site reaction, URI Methylxanthines Severe asthma Theophylline GI distress, toxicity, dysrhythmias, keep serum level less than 20
mcg/mL Nasal Steroids Allergic rhinitis Beclomethasone Dry nose, burning, itching, sore throat, epistaxis Nasal Decongestants Common cold Phenylephrine Rebound congestion with topical agents, hypertension,
dysrhythmias Antitussives Cough Dextromethorphan Euphoria in high doses Opioid Antitussives Cough Codeine* *Death in children related to ultra-rapid metabolism of codeine
to morphine leading to respiratory depression *Risk from concomitant use with other CNS depressants
Gastrointestinal Drugs
H2 Receptor Blockers GERD, ulcer Cimetidine Anti-androgenic effects (gynecomastia, reduced libido, impotence, CNS effects in older adults, increased risk of
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pneumonia Proton Pump Inhibitors GERD, ulcer Omeprazole Headache, GI distress, increased risk of pneumonia, fractures,
rebound acid secretion, hypomagnesemia, C. difficile infection (CDI)
Mucosal Protectant Antiulcer Sucralfate Constipation Prostaglandin Analogs Antiulcer Misoprostol* *Abortion, premature birth, or birth defects
*Don’t use in women of child bearing age Diarrhea, fetal expulsion
Serotonin antagonist Antiemetic Ondansetron HA, diarrhea, dizziness, QT interval prolonged Substance P Antiemetic Aprepitant Fatigue, asthenia, hiccups, dizziness, diarrhea Dopamine antagonist Antiemetic, anxiety,
schizophrenia Prochlorperazine* *Not used for dementia related psychosis-↑ infections and CV
events Tardive dyskinesia (TD), NMS, blood dyscrasias Respiratory depression in child, anticholinergic effects, hypotension
Nausea/vomiting Allergic reactions sedation, motion sickness
Promethazine* *Respiratory depression in children < 2 years old *Severe tissue injury, gangrene with injection
GERD, diabetic gastroparesis, nausea/vomiting
Metoclopramide* *Tardive dyskinesia (TD)
Cannabinoids Antiemetic Dronabinol QT prolongation Antibiotics and Antifungals, Antivirals
PCN Infections PCN Allergic reaction Cephalosporins Infections (gram +) Cephalexin Allergic reactions, c. diff infection (CDI) Carbapenems Infections Imipenem GI effects Other antibiotic Infections Vancomycin Renal failure, ototoxicity, red man syndrome, thrombophlebitis,
immune-mediated thrombocytopenia Tetracyclines Infections
MRSA Tetracycline Minocycline Doxycycline
GI distress, staining of teeth, suppress bone growth not for children less than 8 years or pregnant women), sunburn, CDI, hepatotoxicity, renal toxicity
Macrolides Infections Erythromycin Azithromycin Clarithromycin
GI distress QT prolongation and sudden cardiac death
Clindamycin Infections, MRSA Clindamycin* *CDI
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Aminoglycosides Gram (-) infections Gentamycin* *Neurotoxicity (vertigo, numbness, tingling, seizures *Ototoxic, *Nephrotoxicity *Neuromuscular blockade (flaccid paralysis causing respiratory depression) Hypersensitivity reactions, rash, blood dyscrasias
Sulfonamides UTI MRSA
Trimethoprim/ sulfamethoxazole
Hypersensitivity reactions, rash, SJS, TEN, hemolytic anemia in patients with G6PD deficiency, kernicterus in newborns (don’t use in infants younger than 2 years or in late pregnancy), renal damage, photosensitivity, CDI
Nitrofurantoin UTI Nitrofurantoin GI effects, pulmonary reactions, hematologic effects, peripheral neuropathy, hepatotoxicity, birth defects (don’t give near end of pregnancy-or in 1st trimester), CNS effects
Fluoroquinolones Infections Ciprofloxacin* Levofloxacin* Moxifloxacin*
*Tendon rupture *Peripheral neuropathy and CNS effects *Avoid in myasthenia gravis *Don’t use for sinusitis, bronchitis or uncomplicated UTI GI effects, fetal harm, photosensitivity, QT prolongation, CDI
Antiprotozoal Drugs Protozoal infections and anaerobic bacterial infections
Metronidazole* *Carcinogenic in rats and mice, avoid unnecessary use GI effects, headache, dry mouth, metallic taste, darkening urine, hypersensitivity reactions, SJS, neurologic injuries, disulfiram if used with alcohol (wait 24-72 hours before consuming ETOH)
Antifungals Fungal infections Amphotericin* *Use only in life threatening fungal infections *Overdose prevention Infusion reaction (delirium, hypotension, hypertension, wheezing, hypoxia), nephrotoxicity, hypokalemia, anemia
Azole antifungals Fungal infections Itraconazole* *Don’t use in patients with CHF *Many interactions GI effects, liver toxicity, cardiac suppression, rash, headache
Anti-tuberculosis drugs TB Isoniazid* Rifampin Pyrazinamide Ethambutol
*Hepatotoxicity Change in color body fluids, peripheral neuropathy
Anti-viral Herpes simplex Acyclovir Phlebitis, renal toxicity (IV) GI distress NRTIs HIV Zidovudine* *Severe anemia
*Myopathy
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*Lactic acidosis and severe hepatomegaly with fatty liver GI effects, diabetes, hyperlipidemia, lipoatrophy
NNRTIs HIV Efavirenz CNS symptoms, rash, fetal harm, liver damage Protease Inhibitors HIV Lopinavir/ritonivir GI distress, AV block, QT prolongation,
Hyperglycemia/diabetes, reduced bone density, elevation of liver transaminases, fat redistribution, hyperlipidemia
Integrase Inhibitors HIV Ralgetavir Insomnia, headache, myopathy, hypersensitivity reactions (SJS and TEN), liver injury
Infusion Inhibitor HIV Enfuvirtide Injection site reaction, pneumonia, hypersensitivity reaction
CCR5 antagonists HIV Maraviroc* *Hepatotoxicity Cough, dizziness, rash
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Student Name: ________________________________________ Date: _________________________
Drug Classification: ________________________________________________
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Actions |
Uses |
Give 2 examples of each classification of drug (include trade and generic name for each drug example) |
Give at least 3 Common adverse effects |
Give at least 2 Serious adverse effects |
Patient Teaching- must include if applicable, dietary restrictions, activity restrictions, vital signs monitoring, and, drug interactions, lab monitoring |
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For each of the nine NONPF competencies, write one paragraph explaining how the program has prepared you to meet the competency (for a total of at least nine paragraphs). Then, propose how you plan to engage in social change in your community as a nurse practitioner. Finally, describe 1–2 legislative and/or advocacy activities in which your state nurse practitioner organization(s) are involved. Be specific and provide examples. The nine areas of competency are: Nurse Practitioner Core Competencies Content A delineation of suggested content specific to the NP core competencies 2014 Updated May 2017* NP Core Competencies Content Work Group Anne Thomas (Chair), PhD, ANP-BC, GNP, FAANP M. Katherine Crabtree, DNSc, APN-BC, FAAN Kathleen Delaney, PhD, PMH-NP, FAAN Mary Anne Dumas, PhD, RN, FNP-BC, GNP-BC, FAANP, FAAN Ruth Kleinpell, PhD, RN, FAAN, FCCM Julie Marfell, DNP, APRN, FNP-BC, FAANP Donna Nativio, PhD, CRNP, FAAN, FAANP Kimberly Udlis, PhD, FNP-BC, APNP Andrea Wolf, DNP, CRNP Acknowledgments: NONPF also wishes to recognize members of the Curricular Leadership Committee who provided review and comment on the draft document. The comments from the following people shaped the final document: Susan Buchholz, Holly Dileo, Kathy Dontje, Judith Haber, Ann Marie Hart, Kathleen Reeve, Susan Ruppert, Susan Schaffer, and Courtney Young. * The updates made to the 2014 Nurse Practitioner Core Competencies Content publication updates the competencies to align with the 2016 Adult-Gerontology Acute Care And Primary Care NP Competencies. NONPF – 1 Nurse Practitioner Core Competencies with Suggested Curriculum Content In the development of the nurse practitioner (NP) population-focused competencies, a task force had extensive discussions of competencies vs. content. The task force concluded that it would be beneficial to programs if some content could be included as exemplars of how to support curriculum development for addressing a competency. Within the 2013 edition of the NP population-focused competencies, the final column in each population’s competency table presents the respective competency work group’s ideas of relevant content. In 2014, NONPF convened a work group to identify the suggested curriculum content for the NP Core Competencies. This work group consisted of members of the task force that prepared the 2011 edition of the NP Core Competencies, as well as additional representation from the NONPF Board and Curricular Leadership Committee. A sub-group of the NONPF Curricular Leadership Committee completed a review of the draft content, and the work group incorporated the review feedback into the final document presented herein. Please see the cover page for a list of work group members and an acknowledgment of the reviewers. In 2016 the Adult-Gerontology Acute Care And Primary Care NP Competencies document was completed. This document was updated in May 2017 to align with the 2016 Adult-Gerontology Acute Care And Primary Care NP Competencies. The table that follows includes the NP Core Competencies and a list of suggested curriculum content. NONPF does not intend for the requirement of all of this content, nor is the content list comprehensive for all that a program would cover with population-focused competencies. The content column reflects only suggestions for content relative to the core competencies. This document should be used in combination with the population- focused competencies. Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies Scientific Foundation Competencies 1. Critically analyzes data and evidence for improving advanced nursing practice. 2. Integrates knowledge from the humanities and sciences within the context of nursing science. Comparison of patient data sets with evidence-based standards to improve care NONPF – 2 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies 3. Translates research and other forms of knowledge to improve practice processes and outcomes. 4. Develops new practice approaches based on the integration of research, theory, and practice knowledge. Scientific foundations to practice, including, but not limited to, knowledge of advanced pathophysiology, pharmacology, physiology, genetics, and communication skills Science from other disciplines relevant to health care Theories/conceptual frameworks/principles for practice: • Translational research that guides practice • Critical evaluation of research findings • Mid-range nursing theories and concepts to guide nursing practice • Evidence-based care • Physiologic • Communication • Developmental • Genetic • Behavior change • Population health Critical thinking development: • Evidence appraisal • Formulating a practice problem • Use of science-based theories and concepts to assess, enhance, and ameliorate health care delivery phenomena • Use of PICO questions to initiate research and quality improvement projects Qualitative and quantitative research and quality improvement methods Ethical and legal protection of human subjects NONPF – 3 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies Inquiry processes and practices related to health literacy, vulnerable populations, and culture Monitoring of health outcomes Leadership Competencies 1. Assumes complex and advanced leadership roles to initiate and guide change. 2. Provides leadership to foster collaboration with multiple stakeholders (e.g. patients, community, integrated health care teams, and policy makers) to improve health care. 3. Demonstrates leadership that uses critical and reflective thinking. 4. Advocates for improved access, quality and cost effective health care. 5. Advances practice through the development and implementation of innovations incorporating principles of change. 6. Communicates practice knowledge effectively, both orally and in writing. 7. Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus. Content related to: • Crisis management and leadership • Stress management (for staff and patient/family) • Teams and teamwork, including team leadership, building effective teams, and nurturing team Leadership, change, and management theories with application to practice Political processes, political decision making processes, and health care advocacy Problem solving: • Influencing and negotiation • Conflict management • Strategic thinking • Managing change Business development: • High reliability organization principles • Building and maintaining effective teams • Project management concepts • Principles of effective decision making • Principles of change management • Civility • Principles of innovation Communications: • Scholarly writing, manuscript, and abstract preparation • Structuring and presenting persuasive arguments NONPF – 4 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies Peer review: • Publications • Presentations • Research • Practice. Leadership development: • Skills to influence decision-making bodies at the system, state, or national level • Interprofessional leadership • Assuming leadership positions in professional, political, or regulatory organizations • Structure and functions of editorial/board roles • Ethical and critical decision making, effective working relationships, and a systems-perspective Concepts of strategic planning process Leadership styles How to lead change in practice, manage practice changes • Monitoring implementation and fidelity • Adaptation of change to patients, providers and organizational needs and resources • Interim feedback on achievements and efficiencies • Interpretation of data and articulating evidence Self-reflection of leadership style e.g., personal leadership strengths and weaknesses; working with diverse skills sets and diverse teams Quality Competencies 1. Uses best available evidence to continuously improve quality of clinical practice. Quality Safety Education in Nursing (QSEN) principles and content Evaluation of outcomes of care such as quality improvement projects with an evaluation component NONPF – 5 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies 2. Evaluates the relationships among access, cost, quality, and safety and their influence on health care. 3. Evaluates how organizational structure, care processes, financing, marketing, and policy decisions impact the quality of health care. 4. Applies skills in peer review to promote a culture of excellence. 5. Anticipates variations in practice and is proactive in implementing interventions to ensure quality Reflective practice Culture of safety Quality improvement processes and practices Knowledge of quality improvement methods such as: • Plan-Do-Study Act • Six Sigma Cost benefit analysis Peer review process • Reviewer • Reviewee Collaborative team processes and practices Leadership skills for leading change for quality clinical practice Methods and measures of quality assurance during transitions of care Laws and rules to enhance quality such as • Meaningful use • Federal, state, and local quality data sources and indicators Practice Inquiry Competencies 1. Provides leadership in the translation of new knowledge into practice. 2. Generates knowledge from clinical practice to improve practice and patient outcomes. 3. Applies clinical investigative skills to improve health outcomes. 4. Leads practice inquiry, individually or in partnership with Leadership for role in practice improvement Clinical investigation strategies: • Identifying clinical practice problems • Appraising evidence for application to practice (e.g., design, methods, tools, analysis) • Literature search methods, including, but not limited to, the PICO Model to define a clinical questions and search for the best clinical evidence NONPF – 6 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies others. 5. Disseminates evidence from inquiry to diverse audiences using multiple modalities. 6. Analyzes clinical guidelines for individualized application into practice Use of electronic databases, such as electronic health records: • Assessing clinical practice • Reviewing patient technology • Exploring behaviors and risk factors • Using data to support evidence based changes in clinical management • Template development Patient management, including, but not limited to, discerning gaps in care and barriers to care needing resolution during patient encounters Project development and management: • Synthesis and translation/extrapolation of research to selected populations • Frameworks to guide projects • Quality improvement methods • Assessment of resources needed and available for projects • Competing priorities of patients, payers, providers, and suppliers • Data-based, needs assessment for project • Processes used in conducting projects based on current and best evidence, including evaluation of the application of evidence or inquiry to the population of concern • Evaluation of outcomes (for health status of patient and population as well as system outcomes) • Evaluation of why expected results were or were not attained and lessons learned • Making recommendations for further work • Addressing issues of sustainability of project findings NONPF – 7 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies Dissemination of work and findings: • Abstract and manuscript writing to support the dissemination of project/research outcomes • Discussion of clinically meaningful results that may or may not be statistically significant • Presentation skill development with modification for different audiences Integration of findings: • Results, methods, and tools, as appropriate, into care delivery • Identification of best practices • Opportunities for multidisciplinary team/inter-professional collaboration for patient care • Development and use of clinical guidelines • Use of clinical judgment to improve practice • Application of evidence to validate or change policy Evaluation of alternative care delivery models and treatments, including costs, cost benefits, and return on investment Institutional review board policies and processes Interprofessional research and scholarship exemplars and opportunities Technology and Information Literacy Competencies 1. Integrates appropriate technologies for knowledge management to improve health care. 2. Translates technical and scientific health information appropriate for various users’ needs. Technology available in clinical practice: • Electronic resources that identify current evidenced-based care • Electronic resources that enhance patient safety • Technological care delivery systems • Telehealth • Information databases used by health care systems • Electronic communication with other professionals and patients • Encrypted and unencrypted technology NONPF – 8 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies 2.a Assesses the patient’s and caregiver’s educational needs to provide effective, personalized health care. 2.b Coaches the patient and caregiver for positive behavioral change. 3. Demonstrates information literacy skills in complex decision making. 4. Contributes to the design of clinical information systems that promote safe, quality and cost effective care. 5. Uses technology systems that capture data on variables for the evaluation of nursing care. • Electronic resources to support differential diagnosis, algorithmic thinking, and medical record review • Templates for documentation in nursing care • Use of electronic datasets to evaluate practice and improve quality, cost, and efficiency of care Technology available to support education: • Standardized patient encounters • Electronic/computer based learning modules based on characteristics such as cultural literacy, educational level, and home assessment • Coaching/teaching resources adapted to population, health literacy, and age of patient learning styles, • Age-appropriate concepts and development of educational tools • Use of applications for references at point of care Using telehealth to provide care for the adult population, considering benefits, methods, differences, and regulatory issues. IT resources such as: • Informatics competencies from Technology Informatics Guiding Education Reform (TIGER) initiative • American Medical Informatics Association (AMIA) Use of electronic communication methods, including social media, with healthcare professionals, patients, families, and caregivers Compliance issues related to patient privacy with use of technology Population-appropriate clinical indicators for incorporation into information systems, such as electronic health records Use of technologies to monitor and evaluate clinical problems, e.g. • Blood pressure • Vital signs • Glucose • Weight NONPF – 9 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies Policy Competencies 1. Demonstrates an understanding of the interdependence of policy and practice. 2. Advocates for ethical policies that promote access, equity, quality, and cost. 3. Analyzes ethical, legal, and social factors influencing policy development. 4. Contributes in the development of health policy. 5. Analyzes the implications of health policy across disciplines. 6. Evaluates the impact of globalization on health care policy development. 7. Advocates for policies for safe and healthy practice environments. Policy analysis process: • Political environment • Political feasibility • Economic feasibility • Implementation strategy and planning • Outcomes evaluation at local, state, national, and international levels • Specific NP role for influencing health care agenda and patient advocacy Health policy and health care reform: • Federal budget • National health priorities • Methods for appropriation of funding • Vulnerable populations and needs • The relationship between the USPSTF guidelines and Affordable Care Act implementation Legislative and regulatory processes: • Origin of laws • Regulatory process • How to influence/impact passage of laws and their translation into regulation • Health care financing and third party reimbursement Population health model and its impact on policy planning Introduction of global issues: • Infections • Travel • Immigration • Disasters/terrorism • Access to health care NONPF – 10 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies Ethical issues in health care planning: • Fairness • Equity and health disparities • Access and resource allocation • Health behavior • Social determinants of health Comparative health systems Proactive and responsive use of media Barriers to NP practice Legislative process and resources, e.g., Congress.gov Policy theories Examples of policy making at multiple levels and individual and collective contributions to shape policy Health Delivery System Competencies 1. Applies knowledge of organizational practices and complex systems to improve health care delivery. 2. Effects health care change using broad based skills including negotiating, consensus-building, and partnering. 3. Minimizes risk to patients and providers at the individual and systems level. 4. Facilitates the development of health care systems that address the needs of culturally diverse populations, providers, and other stakeholders. 5. Evaluates the impact of health care delivery on patients, Organizational practices: • Organizational structure, tables of organization • Organizational decision making • Organizational theory • Principles of management Interprofessional collaborative partnerships Informatics/information systems: • Interpreting variations in outcomes • Use of data to improve practice • Use of collateral information • Organizational delivery subsystems, (e.g. electronic prescription writing-pharmacy software) NONPF – 11 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies providers, other stakeholders, and the environment. 6. Analyzes organizational structure, functions and resources to improve the delivery of care. 7. Collaborates in planning for transitions across the continuum of care. Needs assessment of populations served: • Socioeconomic and cultural factors • Unique population needs • System resources to meet population needs (e.g. use interpreters to facilitate communication) • Community resources/system outreach to community • Diversity among providers Financial issues: • Financial business principles • Health care system financing • Reimbursement systems • Resource management • Billing and coding principles Interprofessional/team competencies: • Communication (theory) • Collaboration • Conflict resolution • Consultations/referrals • Team building • Values and ethics • Roles and responsibilities Safety and quality: • Cost-effective care • Legal/ethical issues • Research and quality improvement • Continuous quality improvement • Quality and Safety Education in Nursing Transitional care: NONPF – 12 Competency Area NP Core Competencies Curriculum Content to Support Competencies Neither required nor comprehensive, this list reflects only suggested content specific to the core competencies • Navigating transitions across health care s
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