NUR2356 Module 10 Written Assignment – Pharmacological Treatments for Arthritis,100% CORRECT

NUR2356 Module 10 Written Assignment – Pharmacological Treatments for Arthritis MEDICATION generic and trade name drug classification Medication Mechanism of Action Common Side Effects Pertinent Nursing Impli ...

NUR2356 Module 10 Written Assignment – Pharmacological Treatments for Arthritis MEDICATION generic and trade name drug classification Medication Mechanism of Action Common Side Effects Pertinent Nursing Implications & Patient Teaching Purpose of the Assignment 1. Identify the common pharmacologic treatments for inflammatory diseases of the human body 2. Review potential effects medication have on the clients’ basic care and comfort needs 3. Identify nursing interventions meeting to basic care of comfort needs of clients’ receiving these pharmacological agents Course Competencies • Describe strategies for safe, effective multidimensional nursing practice when providing care for clients experiencing immunologic, infectious and inflammatory disorders. • Explain components of multidimensional nursing care for clients with musculoskeletal disorders. • Select appropriate nursing interventions when providing multidimensional care to clients experiencing alterations in mobility. Instructions Complete the table directly below these instructions in your own words for each of the following medications: • Ibuprofen • Methotrexate • Leflunomide • Hydroxychloroquine • Infliximab • Anakinra • Abatacept • Rituximab • Golimumab • Tocilizumab Use at least two scholarly sources to support your findings. Be sure to cite your sources in-text and on a reference page using APA format. You can find useful reference materials for this assignment in the School of Nursing guide: https://guides.rasmussen.edu/nursing/referenceebooks Have questions about APA? Visit the online APA guide: https://guides.rasmussen.edu/apa . 1.) Generic: Ibuprofen Trade: Advil, Motrin Classification: NSAIDs (Vallerand, Sanoski, & Deglin, 2017, pgs. 662-665) &(Leek, 2009) • Action: Inhibits prostaglandin synthesis • Therapeutic effect: decreased pain & inflammation; reduction of fever. • CNS: headaches, dizziness, drowsiness • EENT: blurred vision, tinnitus, amblyopia • GI: GI bleeding, hepatitis, constipation, nausea, vomiting, abdominal discomfort • CV: arrhythmias, edema, MI, CVA • GU: renal failure, hematuria, cystitis • Hemat: prolonged bleeding time • Monitor vital signs & pain level • Monitor BUN, serum creatine, CBC w/differential, electrolytes, bleeding time, & liver function tests periodically • Advise clients to take with food or water & remain in an upright position for 15-30 mins after administration to decrease irritation of the lower esophagus • Report abdominal/stomach pain, black-red odorous stools, & rash or sore throat immediately Avoid use of alcohol 2.) Generic: Methotrexate Trade: Rheumatrex, Trexall Classification: Antimetabolite; DMARD (Vallerand, Sanoski, & Deglin, 2017, pgs. 824-827) &(Leek, 2009) • Action: Interferes with folic acid metabolism; result in inhibition of DNA synthesis & cell reproduction; also has immunosuppressive activity. • Therapeutic effect: Death of rapidly replicating cells, particularly malignant ones, & immunosuppression. • CNS: dizziness, drowsiness, headaches, malaise • EENT: blurred vision, dysarthria, transient blindness • GI: anorexia, nausea, vomiting, stomatitis • Derm: alopecia, pruritus, rashes, skin ulceration • GU: infertility • Hemat: bone marrow suppression Resp: pulmonary fibrosis, intestinal pneumonitis • Auscultate lungs & monitor character of respirations & presence of cough (pulmonary fibrosis) • Monitor vital signs periodically • Monitor CBC w/differential, liver & renal function, & uric acid levels prior to & frequently during therapy • Advise clients to report SOB, bruising, or sore throat • Avoid use of alcohol & NSAIDs Avoid vaccinations w/o advice of HCP 3.) Generic: Leflunomide Trade: Arava Classification: DMARD (Vallerand, Sanoski, & Deglin, 2017, pgs. 751-752) • Action: Inhibits an enzyme required for pyrimidine synthesis; has antiproliferative & anti-inflammatory effects • Therapeutic effect: Decreased pain & inflammation, slowed structural progression & improved physical function • CNS: headache, dizziness, weakness • Resp: interstitial lung disease, bronchitis, cough, pharyngitis, pneumonia, respiratory infection, rhinitis, sinusitis • GI: hepatoxicity, diarrhea, nausea, abdominal pain, increased liver enzymes, vomiting, mouth ulcers • Derm: erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, pruritis, alopecia, rashes, dry skin, eczema • GU: UTI • Neuro: paresthesia, peripheral neuropathy • Assess ROM & degree of swelling & pain in affected joints before & periodically during therapy • Monitor liver function tests, ALT, AST, & CBC w/platelets periodically • Assess for rash periodically • Monitor for signs & symptoms of interstitial lung disease • Instruct patient to avoid vaccinations w/live vaccines during therapy • Inform client that medication may cause dizziness & hair loss; avoid driving 4.) Generic: Hydroxychloroquine Trade: Plaquenil Classification: DMARD (Vallerand, Sanoski, & Deglin, 2017, pgs. 655-656) • Action: Inhibits protein synthesis in susceptible organisms by inhibiting DNA & RNA polymerase • Therapeutic effect: Death of plasmodia responsible for causing malaria; also has anti-inflammatory properties • CNS: seizures, aggressiveness, anxiety, apathy, confusion, fatigue, headache, irritability, personality changes, psychoses • EENT: keratopathy, ototoxicity, retinopathy, tinnitus, visual disturbances • GI: abdominal cramps, anorexia, diarrhea, nausea, vomiting, hepatic failure • CV: ECG changes, hypotension • Derm: bleaching of hair, alopecia, hyperpigmentation, Steven-Johnson syndrome • Hemat: agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia • Neuro:neuromyopathy, peripheral neuritis • Assess patient monthly for pain, swelling, & ROM • Monitor CBC w/platelet count periodically throughout therapy • Assess deep tendon reflexes periodically to determine muscle weakness • Instruct patient to contact HCP if no improvement of RA is noticed within a few days & may require up to 6 months for full benefit • Avoid use of alcohol Report sore throat, fever, unusual bleeding or bruising, blurred vision, ringing in the ears, difficulty hearing, muscle weakness, or vision changes 5.) Generic: Infliximab Trade: Remicade Classification: antirheumatics/ DMARD, tumor necrosis factor (TNF) blocker (Vallerand, Sanoski, & Deglin, 2017, pgs. 681-683) &(Leek, 2009) • Action: Neutralizes & prevents the activity of TNF-alpha, resulting in anti-inflammatory & antiproliferative activity • Therapeutic effect: decreased pain & swelling, decreased rate of joint destruction & improved physical function in ankylosing spondylitis, rheumatoid or psoriatic arthritis • CNS: headache, dizziness, weakness, fatigue, depression, insomnia • EENT: rhinitis, pharyngitis, sinusitis • Resp: upper respiratory tract infection, cough, respiratory disorder, bronchitis, dyspnea, laryngitis • GI: abdominal pain, dyspepsia • Derm: rash, acne, ecchymosis, hematoma, sweating, hot flashes • Hemat: bone marrow suppression Misc: infections, increased risk of malignancies • Assess pain & ROM prior to & periodically during therapy • Monitor clients who develop a new infection while taking medication • Assess for signs & symptoms of systemic infections • Monitor liver function tests & CBC w/differential periodically during therapy • Instruct client to not receive live vaccinations during therapy & to avoid exposure to ill people or those showing signs of an illness. • Notify HCP is upper respiratory or other infections occur. • Inform client that medication may cause dizziness Advise patient to examine skin periodically during therapy 6.) Generic: Anakinra Trade: Kineret Classification: Interleukin antagonists (Vallerand, Sanoski, & Deglin, 2017, pgs. 662-665) • Action: Blocks the destructive effects of interleukin-1 on cartilage & bone resorption by inhibiting its binding at specific tissue receptor sites • Therapeutic effect: Slowed progression of RA, reduction in neonatal onset multisystem inflammatory disease (NOMID) symptoms • CNS: headache • GI: diarrhea, nausea • Hemat: neutropenia • Misc: infections, hypersensitivity reactions including anaphylaxis • Assess patient’s ROM & degree of swelling & pain in affected joints before & periodically during therapy • Assess for signs & symptoms of infection prior to & during therapy • Monitor neutrophil count prior to & during therapy • Inform patient if the signs & symptoms of hypersensitivity reactions & injection site reactions. Advise patient to not receive live vaccines during therapy 7.) Generic: Abatacept Trade: Orencia Classification: DMARD/Antirheumatics, fusion protein (Leek, 2009) • Action: Inhibits T-cell activation & the inflammatory process by binding to specific receptors • Therapeutic effect: Decreased progression of rheumatoid arthritis • CNS: headache, dizziness • Misc: hypersensitivity reactions including anaphylaxis, infections • Assess ROM, degree of swelling, & pain in affected joints before & periodically during therapy • Assess infusion-related reaction & signs of allergic reaction • Assess & monitor health status at each session • Advise patient to not receive live vaccines during therapy • Advise patient that TNF antagonists should not be taken with this medication & may increase risk for infections. Report any signs of upper respiratory infections or other infections occur 8.) Generic: Rituximab Trade: Rituxan Classification: monoclonal antibodies, antineoplatics (Vallerand, Sanoski, & Deglin, 2017, pgs. 1098-1101) • Action: Binds to the CD20 antigen on the surface of lymphoma cells, preventing the activation process for cell cycle initiation & differentiation Therapeutic effect: Death of lymphoma cells; prolonged progression-free survival in chronic lymphocytic leukemia; reduced signs & symptoms of RA. • CNS: progressive multifocal leukoencephalopathy, headache • Resp: bronchospasm, cough, dyspnea • GI: abdominal pain, altered taste, dyspepsia • CV: arrhythmias, hypotension, peripheral edema • GU: renal failure • Hemat: anemia, neutropenia, thrombocytopenia • Derm: flushing, urticaria • Monitor CBC & platelet count regularly during therapy • Monitor patient for fever, chills/rigor, nausea, urticaria, fatigue, headache, pruritus, bronchospasm, dyspnea, sensation of tongue or throat swelling, rhinitis, vomiting, hypotension, flushing, & pain at disease sites • Assess patient for hypersensitivity reactions during administration Assess for infection during & for 1 year after therapy MEDICATION generic and trade name drug classification Medication Mechanism of Action Common Side Effects Pertinent Nursing Implications & Patient Teaching 9.) Generic: Golimumab Trade: Simponi, Simponi Aria Classification: antirheumatics, DMARD, anti-TNF agent (Vallerand, Sanoski, & Deglin, 2017, pgs. 616-618) • Action: Inhibits binding of TNFα to receptors inhibiting activity & resulting in anti-inflammatory & antiproliferative activity • Therapeutic effect: decreased pain & swelling with decreased joint destruction in patients with RA, psoriatic arthritis, & ankylosing spondylitis • CNS: CNS demyelinating disorders, Guillain-Barre syndrome, MS • EENT: nasopharyngitis, optic neuritis • GI: increased liver enzymes • CV: heart failure, hypertension • Resp: upper respiratory tract infection • Hemat: aplastic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia • Neuro: paresthesia • Misc: anaphylaxis, hypersensitivity reactions, infections • Assess for signs & symptoms of infection • Assess for exacerbations & new onset psoriasis • Assess for signs & symptoms of systemic fungal infections • Assess pain & ROM prior to & periodically during therapy • Monitor CBC w/differential periodically during therapy • Caution patient not to share this medication with others • Instruct patient to notify HCP if any signs of infection occur • Instruct patient to examine skin periodically during therapy • Avoid patient from receiving live vaccines Inform patient the increased risk of cancer 10.) Generic: Tocilizumab Trade: Actemra Classification: antirheumatics, immunosuppressants, interleukin antagonists (Vallerand, Sanoski, & Deglin, 2017, pgs. 1205-1207) &(Leek, 2009) • Action: Acts as an inhibitor of interleukin-6 (IL-6) receptors by binding to them; IL-6 is a mediator of various inflammatory responses • Therapeutic effect: Slowed progression of rheumatoid arthritis or systemic/polyarticular juvenile idiopathic arthritis • CNS: headache, dizziness • EENT: nasopharyngitis • GI: gastrointestinal perforation, increased liver enzymes • CV: hypertension • Resp: upper respiratory tract infections • Hemat: neutropenia, thrombocytopenia • Misc: anaphylaxis, hypersensitivity reactions • Assess pain & ROM before & periodically during therapy • Assess for signs of infection • Monitor patient for signs of anaphylaxis following injection • Assess CBC with platelet count and liver function Notify HCP if signs of infection occur Nursing Interventions for a Client with Arthritis Relieving Pain and Discomfort(Gulanick & Myers, 2014) • Provide a variety of comfort measures (eg, application of heat or cold; massage, position changes, rest; foam mattress, supportive pillow, splints; relaxation techniques, diversional activities). • Administer anti-inflammatory, analgesic, and slow-acting antirheumatic medications as prescribed. • Individualize medication schedule to meet patient’s need for pain management. • Encourage verbalization of feelings about pain and chronicity of disease. • Teach pathophysiology of pain and rheumatic disease and assist patient to recognize that pain often leads to unproven treatment methods. • Assist in identification of pain that leads to use of unproven methods of treatment. • Assess for subjective changes in pain. Reducing Fatigue(Gulanick & Myers, 2014) • Provide instruction about fatigue: Describe relationship of disease activity to fatigue; describe comfort measures while providing them; develop and encourage a sleep routine (warm bath and relaxation techniques that promote sleep); explain importance of rest for relieving systematic, articular, • and emotional stress. • Explain how to use energy conservation techniques (pacing, delegating, setting priorities). • Identify physical and emotional factors that can cause fatigue. • Facilitate development of appropriate activity/rest schedule. • Encourage adherence to the treatment program. • Refer to and encourage a conditioning program. • Encourage adequate nutrition, including source of iron from food and supplements. Increasing Mobility(Gulanick & Myers, 2014) • Encourage verbalization regarding limitations in mobility. • Assess need for occupational or physical therapy consultation: Emphasize range of motion of affected joints; promote use of assistive ambulatory devices; explain use of safe footwear; use individual appropriate positioning/posture. • Assist to identify environmental barriers. • Encourage independence in mobility and assist as needed: Allow ample time for activity; provide rest period after activity; reinforce principles of joint protection and work simplification. • Initiate referral to community health agency. Facilitating Self Care(Gulanick & Myers, 2014) • Assist patient to identify self-care deficits and factors that interfere with ability to perform self-care activities. • Develop a plan based on the patient’s perceptions and priorities on how to establish and achieve goals to meet self-care needs, incorporating joint protection, energy conservation, and work simplification concepts: Provide appropriate assistive devices; reinforce correct and safe use of assistive devices; allow patient to control timing of self-care activities; explore with the patient different ways to perform difficult tasks or ways to enlist the help of someone else. • Consult with community health care agencies when individuals have attained a maximum level of self-care yet still have some deficits, especially regarding safety. Improving Body Image and Coping Skills(Gulanick & Myers, 2014) • Help patient identify elements of control over disease symptoms and treatment. • Encourage patient’s verbalization of feelings, perceptions, and fears. • Identify areas of life affected by disease. Answer questions and dispel possible myths. • Develop plan for managing symptoms and enlisting support of family and friends to promote daily function. References Gulanick, M., & Myers, J. L. (2014). Nursing care plans: diagnoses, interventions, and outcomes. (8th ed.). Philadelphia, PA: Elsevier/Mosby. Leek, V. I. (2009). Pharm Phlash!: Pharmacology flash cards. (2nd ed.). Philadelphia, PA: F.A. Davis Co. Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2017). Davis’s drug guide for nurses (15th ed.). Philadelphia, PA: F.A. Davis Company. Module 10 Written Assignment – Pharmacological Treatments for Arthritis Rubric Total Assessment Points: 35 Levels of Achievement Criteria Emerging Limited or developing demonstration of criteria. Competence Adequate or basic demonstration of criteria. Proficiency Clear or effective demonstration of criteria. Mastery Advanced or exceeds demonstration of criteria. Drug Names, Classification, Mechanism of Action (5 Pts) Information is accurate and complete. Information is accurate, complete and is paraphrased. Information is accurate, complete, and written in own words and relates to disease process. Information is accurate, complete, written in own words, and relates medication to disease process, and applies to improving diseases. Points: 0-2 Points:3 Points:4 Points:5 Common Side Effects (10 Pts) Common side effects listed. Identifies common side effects and relates to. Explains common side effects. Prioritizes common side effects. Points:0-7 Points:8 Points:9 Points:10 Pertinent Nursing Implications and Patient Teaching (10 Pts) Implications or patient teaching listed. Identifies implications and patient teaching Explains implications and patient teaching. Prioritizes implications and patient teaching Points:0-7 Points:8 Points:9 Points:10 APA Citation (5 Pts) Description: APA in-text citations and references are missing. Description: Attempted to use APA in-text citations and references. Description: APA in-text citations and references are used with few errors. Description: APA in-text citations and references are used correctly. Points:0-2 Points:3 Points:4 Points:5 Spelling and Grammar (5 Pts) Description: Numerous spelling and grammar errors, which detract from the audience's ability to comprehend material. Description: Some spelling and grammar errors, which detract from the audience's ability to comprehend material. Description: Few spelling and grammar errors. Description: Minimal to no spelling and grammar errors. Points: 0-2 Points:3 Points:4 Points:5