EBP Assignment NUR 2005 concept

Complete a literature search for a journal article relating to a NUR 2005 concept. Find an article about evidence-based practice or best practices in nursing. Complete a one-page (double spaced, APA format) paper about suicide prevention how the results of the research would impact your nursing practice. Include the name and title of the article in APA format

Directions: With your small group, complete this worksheet utilizing information from your Module Worksheet, the Active Medication Templates, and class lecture.

Clinical Scenario: Jennifer P, 37-year-old female, and her 37-year-old husband, David, present with the complaint of a possible fertility problem. The couple has been married for 2 years. The patient has a 4-year-old daughter from a previous relationship. The patient used birth control pills until one-and-a- half-years-ago. The couple has been trying to conceive since then and report a high degree of stress related to their lack of success. Jennifer reports good health and no problems in conceiving her previous pregnancy or in the vaginal delivery of her daughter. She reports that her periods were regular on the birth control pill, but have been irregular since she discontinued taking them. She reports having periods every 5-7 weeks. Past history is remarkable only for mild depression. Imipramine 150 mg qhs for the last 8 months is her only medication. Jennifer works as a cashier, runs 12-24 miles each week for the last 2 years, and has no history of STDs, abnormal Paps, smoking, alcohol or other drugs. She has had no surgery.

David also reports good health and reports no problems with erection, ejaculation or pain with intercourse. He has had no prior urogenital infections or exposure to STDs. He has had unprotected sex prior to his current relationship, but has not knowingly conceived. He has no medical problems or past surgery. David works as a long-distance truck driver and is on the road 2-3 weeks each month. He smokes a pack of cigarettes a day since age 18 and drinks 2-3 cans of beer 3-4 times a week when he’s not driving. He occasionally uses amphetamines to stay awake while driving at night. The couple has vaginal intercourse 3-5 times per week when he is at home.

1. What is the definition of infertility?

2. What are some etiologies of infertility?

EBP Assignment NUR 2005 concept

3. Complete the menstrual cycle process, filling in the correct endocrine glands and the target tissues – estrogen/progesterone, hypothalamus, ovary, pituitary, and uterus.

Noticing:

4. Evaluation of client’s medical history: Describe any abnormal findings/potential issues related to Jennifer/David’s infertility etiology and describe your thoughts about these findings.

5. Interpreting: What is the initial work-up for infertile couples and what tests would you add for this couple?

Patient

Partner

EBP Assignment NUR 2005 concept

Interpreting:

6. What contraindications should healthcare personnel screen for prior to the use of clomiphene?

Clinical Scenario Progression: It has been found that Jennifer has primary ovarian insufficiency. She is prescribed clomiphene 50 mg PO every day for five days, starting on day 3 of menstrual period.

Interpret:

7. When discussing administration of clomiphene with the couple, what information should be included?

Responding:

8. When starting fertility treatment with clomiphene, it is important to discuss possible adverse reactions with Jennifer and David. Complete the following chart with information related to interventions and which reactions should be reported to the provider.

Adverse drug reactions to clomiphene	Patient and/or Nursing interventions	Report to provider (yes/no)
Breast engorgement
Nausea, abdominal discomfort
Vasomotor instability (hot flashes)
Ovarian hyperstimulation
Multiple gestation
Blurred vision, flashes of light, dizzyness

Reflecting:

9. Couples who are experiencing infertility issues often require other specific interventions and/or nursing considerations. In relation to Jennifer and David’s situation, what particular nursing care topics should be addressed?

Problem Based Scenario – BPH

Client’s Chief Complaint:

“It is getting more and more difficult to urinate. When I do urinate it seems like I can’t empty my bladder and it gets painful. I am always waking up at night to urinate too.”

Clinical Scenario:

Mr. B.H. is a 52 year old white male who was referred to the urology clinic by his primary care physician after complaining of his inability to urinate, painful urination and incomplete bladder emptying. Mr. B.H. symptoms have been getting increasingly worse over the past 3 months. Most recently Mr. B.H. has noticed an increase in pain and unequal stream flow of urine while urinating. He indicates that his problems seem to be worse at night and that the pain is greater during urination after waking from sleep.

Past Medical History:

· Hernia operation at birth

· Left forearm break, age 14

· Right knee ACL repair, age 19

· Right shoulder rotator cuff repair, age 20

· Hypertension diagnosis, age 41

· UTI x 2, age 50 and 52

Pertinent Family History:

· Father alive, age 76 years, Smoker, CAD, HTN, COPD, BPH, prostate CA

· Mother alive, age 76 years, Smoker, CAD, HTN, MI with cardiac stents at age 64

· Brother alive, age 46, HTN

· Sister alive and well at age 39 years

· Father diagnosed with BPH at age of 57

Pertinent Social History:

· Marine Corps Veteran with 2 tours in Iraq, 1991-1998

· Has worked full-time as a real-estate agent for 15 years

· Hobbies include woodwork, weight lifting, surfing and boating

· Frequently spends time in the Pacific Ocean surfing, at least 3 times a week

· Smoker x 20 years

· Drinks approximately 3 beers 2-3 times a week

· Diet high in cholesterol

Allergies:

· NKA

Current Medications:

· Atenolol 25 mg PO BID

Focused Physical Assessment:

Vital Signs:

T: (oral) 98.2˚F

P: (regular) 82 /min

R: (regular) 18 /min

BP: 155/88 (sitting)

02 sat: 98% (room air)

Abdomen/Scrotum/Rectum

· Bladder distended

· Abdomen tender to palpation at lower quadrants

· Digital rectal examination reveals enlarged, asymmetrical prostate gland; no tenderness; no masses; no nodules

EBP Assignment NUR 2005 concept

Testing/Lab Results:

Basic Metabolic Panel (BMP)	Result	Complete Blood Count (CBC)	Result
Sodium (135-145 mEq/L)	140	WBC (3.4-9.6 K/uL)	7.6
Potassium (3.5-5.0 mEq/L)	3.9	RBC (4.35-5.65 M/uL)	5.22
Chloride (95-105 mEq/L)	97	Hematocrit (38.3-48.6 %)	46.8
Glucose (70-110 mg/dL)	106	Hemoglobin (13.2-16.6 g/dL)	14.7
Calcium (8.4-10.2 mg/dL)	8.9	Platelets (135-317 K/uL)	290
BUN (7-25 mg/dL)	24
Creatinine (0.6-1.2 mg/dL)	1.0

Urinalysis	Result	Other Testing	Result
Color (yellow)	Yellow	Prostate Specific Antigen	5.2 ng/mL
Clarity (clear)	Clear	Void with post void residual u/s	350mL
Specific Gravity (1.015-1.030)	1.026
Protein (neg)	Neg
Glucose (neg)	Neg
Ketones (neg)	Neg
Bilirubin (neg)	Neg
Blood (neg)	Trace
Nitrite (neg)	Neg