DUE AUG 11

https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_02/index.html

 

 

Write a 1-page narrative in APA format that addresses the following:

  • Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
  • Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

DUE 7/28

Respond to your peer

 

Community-acquired pneumonia (CAP) is an infectious disease that although common could become deadly when combined with the patients’ comorbidities: COPD, Hypertension and Diabetes. Treatment includes antimicrobial medications and sufficient oxygenation. It can be caused by bacteria, viruses, or fungi and can be prevented through vaccination with pneumococcal, influenza, and COVID-19 vaccines (Rothberg, M.B., 2022). The CAP causing pathogen will be the deciding factor for the pharmacological approach, but allergies to empiric drug therapies such as penicillin further complicate treatment options. Treatment should include: rapid diagnosis, microbiological investigation, prevention and management of complications (eg, respiratory failure, sepsis, and multiorgan failure), empirical antibiotic therapy (Aliberti, S., et al. 2021).

 Commonly used pharmacological treatment of CAP include:

Macrolides: Such as azithromycin, clarithromycin, and erythromycin. These medications are considered first-line therapy for mild to moderate CAP (Metlay, J. P., 2019). Macrolides is a broad-spectrum antibiotic and can treat both Gram-positive and some Gram-negative organisms. The mechanism of action of macrolides is the disruption of the bacterial protein synthesis, specifically targeting the ribosomes.

 Fluoroquinolones: Include levofloxacin and moxifloxacin and are reserved to treat severe cases of CAP or patients with co-morbidities not allowing for the use of Macrolides. The mechanism of action of this class of medication includes targeting the bacteria’s DNA process itself through the interference of DNA gyrase and topoisomerase IV which is responsible for DNA repair and replication.

 Penicillin and their derivatives: Penicillin and their derivatives are prescribed for CAP caused by the Streptococcus pneumoniae.  The mechanism of action of this drug includes inhibiting the bacterial wall synthesis which leads to cell death.

 Third generation cephalosporins like ceftriaxone as well as Doxycycline are antibiotic options for patients who cannot take macrolides or fluoroquinolones. The mechanism of action of this treatment is like Penicillin in which they target the cell wall but also go a step further and cause osmotic lysis.

The patient in this case study was treated with empiric antibiotics which included ceftriaxone and azithromycin due to the causative agent of the community acquired pneumonia currently being unknown. The patient will require blood and sputum cultures to be able to prescribe a more specific pharmacological treatment. The antibiotic regimen will need to continue for 7-10 days taking care not to exceed the recommended time to avoid the development of antibiotic resistance.

Due to the patient’s current issues with diet an infusion of D5 ½ NS would be necessary for the replenishment of electrolytes. Accu-checks would also be required to establish blood sugar levels. The patient’s COPD condition should be managed through the administration of a short acting beta agonist (Albuterol) for exacerbation as well as their long-acting bronchodilators for sustained bronchodilation.

Patient education should include the emphasize of the importance of completing the full course of antibiotics even if symptoms subside. If being discharged the patient’s need for in home oxygen should be assessed and monitoring of oxygen levels should be reiterated. The use of the spirometer should be demonstrated as a tool for lung expansion. 

 

References:

Aliberti, S., Dela Cruz, C. S., Amati, F., Sotgiu, G., & Restrepo, M. I. (2021). Community-acquired pneumonia. Lancet (London, England), 398(10303), 906–919. https://doi.org/10.1016/S0140-6736(21)00630-9

Liapikou, A., Cilloniz, C., Palomeque, A., & Torres, T. (2019). Emerging antibiotics for community-acquired pneumonia. Expert opinion on emerging drugs, 24(4), 221–231. https://doi.org/10.1080/14728214.2019.1685494

Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. American journal of respiratory and critical care medicine, 200(7), e45–e67. https://doi.org/10.1164/rccm.201908-1581ST

Rothberg M. B. (2022). Community-Acquired Pneumonia. Annals of internal medicine, 175(4), ITC49–ITC64. https://doi.org/10.7326/AITC202204190

Williams, D. J., Creech, C. B., Walter, E. B., Martin, J. M., Gerber, J. S., Newland, J. G., Howard, L., Hofto, M. E., Staat, M. A., Oler, R. E., Tuyishimire, B., Conrad, T. M., Lee, M. S., Ghazaryan, V., Pettigrew, M. M., Fowler, V. G., Jr, Chambers, H. F., Zaoutis, T. E., Evans, S., Huskins, W. C., … The DMID 14-0079 Study Team (2022). Short- vs Standard-Course Outpatient Antibiotic Therapy for Community-Acquired Pneumonia in Children: The SCOUT-CAP Randomized Clinical Trial. JAMA pediatrics, 176(3), 253–261. https://doi.org/10.1001/jamapediatrics.2021.5547

Case Study DUE 7/26

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.

 

Case Study

HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes.

He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3).

Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.

Ht: 5’8”  Wt: 89 kg (196 pounds)

Allergies: Penicillin (delayed, rash)

 

Facilitator/Faculty Tips to do well: 

 

NEED SUBSTANTIVE DISCUSSION.

Discuss very briefly any pharmacological intervention patient is presently on for COPD, HTN, hyperlipidemia & diabetes. Just one or two lines each on what would be drugs used, pharmacological relevance on treating these diseases.

Thoroughly discuss the anti-infective drugs used for treating the infection Community Acquired Pneumonia (pharmacology to include mechanism of action, therapeutic effects, adverse effects, kinetics etc.).

Is the current empiric therapy based on any guidelines?

If allergic to penicillin, why was ceftriaxone given, which is another beta-lactam antibiotic (a cephalosporin which is also a beta lactam antibiotic)?

If penicillin allergy was immediate type, what are the alternate options for treating CAP? (tips: Doxycycline? Levofloxacin?)

 

Need a thorough discussion on a case like this on ADVANCED PHARMACOLOGY, AT CLINICIAN LEVEL.

USE PEER REVIEWED SCHOLARLY, US BASED, CURRENT, PRIMARY SOURCE, CLINICIAN BASED (NOT PATIENT BASED) REFERENCES.

/Alzheimer’s Disease DUE SUNDAY AM 7/23

http://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html 

 

To Prepare:

  • Review the interactive media piece assigned by your Instructor.
  • Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
  • Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
  • You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

Write a 1- to 2-page summary paper that addresses the following:

  • Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
  • Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
  • What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
  • Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

Pharm due 7/19

Respond to your peer’s post

 

 

 

Anxiety is an unpleasant feeling that includes both psychological and physical aspects (Rosenthal & Burchum, 2020). This discussion aims to use pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD. In this discussion, I will highlight, compare, and contrast different treatment options that can be used to treat these patients.

Generalized anxiety disorder (GAD) can be treated with nonpharmacological and pharmacological therapy (Gottschalk & Domschke, 2017). The first-line pharmacotherapies for GAD have often included the medication classes known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Strawn et al., 2018). Four antidepressants are now licensed for GAD: venlafaxine (Effexor XR), duloxetine (Cymbalta), paroxetine (Paxil), and escitalopram (Lexapro, Cipralex) (Rosenthal & Burchum, 2020). Paroxetine and escitalopram are SSRIs, while venlafaxine and duloxetine are SNRIs (Rosenthal & Burchum, 2020). Initial drug reactions can be observed after a week, but optimal responses take several more weeks to develop. This is because anxiolytic effects take time (Rosenthal & Burchum, 2020). Antidepressants are more effective at reducing cognitive and psychic symptoms of anxiety than benzodiazepines are in reducing physical symptoms. Antidepressants also have a lower risk of addiction. However, a sudden stop may result in withdrawal symptoms.

Before SSRIs and SNRIs were developed, benzodiazepines were the primary form of GAD treatment (Strawn et al., 2018). The duration of action, abuse potential, lipophilicity, and metabolism of these drugs differ (Strawn et al., 2018). Although, unlike antidepressant drugs, the therapeutic effects linked to benzodiazepines occur soon after administration. Alprazolam is the only benzodiazepine the FDA has officially approved for treating GAD (Strawn et al., 2018). However, GAD is frequently treated with clonazepam, lorazepam, and diazepam. Although long-acting benzodiazepines like clonazepam and diazepam may be effective in treating GAD, many clinicians restrict their usage out of concern for the potential for abuse and dependence (Strawn et al., 2018). Benzodiazepine therapy for adults is recommended to be short-term (3-6 months), according to current prescribing guidelines (Strawn et al., 2018). It is noteworthy that many medical professionals have expressed the belief that benzodiazepines can be a viable alternative for some patients, such as those with a low risk of substance abuse, when other treatments are contraindicated or are ineffective, provided they are administered with consistent, close monitoring (Strawn et al., 2018). Although SSRIs and SNRIs are the most popular medications for treating GAD, a recent meta-analysis encompassing 12,655 patients found that the Hedges’ g for SSRIs and SNRIs was 0.33 and 0.36, respectively (Strawn et al., 2018). In contrast, the Hedges g for benzodiazepines was 0.5(Strawn et al., 2018). According to these results, benzodiazepines are more successful at treating adults with GAD than SSRIs or SNRIs (Strawn et al., 2018).

While GAD can make patients feel uncomfortable both psychologically and physically, practitioners knowing GAD and the proper medications to treat this disorder is essential. Drugs of SSRIs, SNRIs, and benzodiazepines (or combination), along with therapy, can help these patients overcome this uncomfortable state.

References

Gottschalk, M. B., & Domschke, K. (2017). Genetics of generalized anxiety disorder and related traits. Dialogues in Clinical Neuroscience, 19(2), 159–168. https://doi.org/10.31887/dcns.2017.19.2/kdomschkeLinks to an external site.

Rosenthal, L., & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed). St. Louis, MO: Elsevier.

Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070.

 

 

 

adv pharm

Post a discussion of pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD. In your discussion, utilizing the discussion highlights, compare and contrast different treatment options that can be used.

Discount on Bonds Payable Definition, Example Journal Entries

In other words, a discount on bond payable means that the bond was sold for less than the amount the issuer will have to pay back in the future. This means the issuer receives $47,000 in cash, even though the bond’s face value is $50,000. The $3,000 difference is the discount, which will be amortized over the bond’s life. A zero coupon bond is a bond which does not have coupons and therefore does not make interest payments. So issuing bonds is a way of raising larger amounts of finance from multiple investors.

Such bonds were known as bearer bonds and the bonds had coupons attached that the bearer would “clip” and deposit at the bearer’s bank. Bonds allow corporations to use financial leverage or to trade on equity. The reason is that a corporation issuing bonds can control larger amounts of assets without increasing its common stock. The bond’s total present value of $96,149 is approximately the bond’s market value and issue price. The following T-account shows how the balance in the account Premium on Bonds Payable will decrease over the 5-year life of the bonds under the straight-line method of amortization. Keep in mind that a bond’s stated cash amounts—the ones shown in our timeline—will not change during the life of the bond.

Over the life of the bonds the bond issue costs are amortized to interest expense. Over the life of the bond, the balance in the account Discount on Bonds Payable must be reduced to $0. Reducing this account balance in a logical manner is known as amortizing or amortization. Since a bond’s discount is caused by the difference between a bond’s stated interest rate and the market interest rate, the journal entry for amortizing the discount will involve the account Interest Expense. discount on bonds payable on balance sheet Let’s assume that on January 1, 2024 a corporation issues a 9% $100,000 bond at its face amount.

Calculating the Present Value of a 9% Bond in an 8% Market

The bond payable will stipulate the interest rate and the term, known as the maturity date. At the maturity date the investor will receive repayment of the principal amount invested and interest. Bonds are transferable, and an investor can sell their bond before the maturity date.

  • The journal entries for the years 2025 through 2028 will be similar if all of the bonds remain outstanding.
  • Take time to verify the factors by reference to the appropriate tables, spreadsheet, or calculator routine.
  • Because we’re actually going to make that payment and that’s going to be in the amount of $2,250, getting rid of the liability for interest payable.
  • Mathematically, to calculate bond yield to maturity, we need to find the internal rate of return (IRR) of the bond if held to its maturity date.
  • As a result, interest expense each year is not exactly equal to the effective rate of interest (6%) that was implicit in the pricing of the bonds.
  • An organization with a bond payable will commonly make periodic payments to its bondholders towards the interest owed on the bonds.

Present Value of a Bond’s Interest Payments

Each yearly income statement would include $9,544.40 of interest expense ($4,772.20 X 2). The straight-line approach suffers from the same limitations discussed earlier, and is acceptable only if the results are not materially different from those resulting with the effective-interest technique. Accountants have devised a more precise approach to account for bond issues called the effective-interest method. Be aware that the more theoretically correct effective-interest method is actually the required method, except in those cases where the straight-line results do not differ materially. Effective-interest techniques are introduced in a following section of this chapter.

Over the life of the bonds, the initial debit balance in Discount on Bonds Payable will decrease as it is amortized to Bond Interest Expense. As the company decides to buyback bonds before maturity, so the carrying amount is different from par value. We need to calculate the carrying amount and compare it with the purchase price to calculate gain or lose. Bond price is the present value of future cash flow discount at market interest rate.

  • The bond will pay interest of $4,500 (9% x $100,000 x 6/12 of a year) on each June 30 and December 31.
  • They will use the present value of future cash flow with market rate to calculate the bond selling price.
  • This article will cover accounting for bonds payable and how bonds payable are accounted for in the normal course of the business.
  • On maturity, due to amortization of premium/discount, the carrying value will become same as face value on the debt instrument.
  • We will use present value tables with factors rounded to three decimal places and will round some dollar amounts to the nearest dollar.
  • Now, the only difference is that actually, when I say cash, we’re not paying it in cash on December 31st, right?

Journal Entry of Discount on Bond Payable

When the bonds issue at premium or discount, there will be a different balance between par value and cash received. The difference is premium/discount on bonds payable, which will impact the bonds carrying value presented in the balance sheet. The situation of bonds payable arises when a company issues bonds to the prospective investors in the financial market to raise funds to meet the business expenditures. In this case the company becomes the borrower and the investors become the lender. Since there is a borrower-lender relationship, it naturally creates a liability for the issuer in the balance sheet, in this form of debt. Now, the only difference is that actually, when I say cash, we’re not paying it in cash on December 31st, right?

The corporation issuing the bond is borrowing money from an investor who becomes a lender and bondholder. By the end of third years, the discounted bonds payable balance will be zero, and bonds carry value will be $ 100,000. Thus, in case the bond is issued at a premium, the carrying amount will be face value plus premium(unamortised). In case it is issued at a discount, varying amount will be face value minus discount (unamortised). In case the bond is issued at par, then the carrying value or book value will be same as the face value of the bond since there is no discount or premium.

📆 Date: May 3-4, 2025🕛 Time: 8:30-11:30 AM EST📍 Venue: OnlineInstructor: Dheeraj Vaidya, CFA, FRM

Some valuable items that cannot be measured and expressed in dollars include the company’s outstanding reputation, its customer base, the value of successful consumer brands, and its management team. As a result these items are not reported among the assets appearing on the balance sheet. The accounting term that means an entry will be made on the left side of an account. Liabilities also include amounts received in advance for a future sale or for a future service to be performed. (Some corporations have preferred stock in addition to their common stock.) Shares of common stock provide evidence of ownership in a corporation.

Bonds Issued At A Discount

So, this is technically our interest payable that we have as of December 31st is the $2,250. Our journal entry is going to look very similar, except instead of cash, we’re going to have interest payable in this one. So, we know that we’re going to be paying interest tomorrow on January 1st. So, we have this liability to pay $2,250, for the 6 months that have passed.

Holders of common stock elect the corporation’s directors and share in the distribution of profits of the company via dividends. If the corporation were to liquidate, the secured lenders would be paid first, followed by unsecured lenders, preferred stockholders (if any), and lastly the common stockholders. Bonds that do not have specific collateral and instead rely on the corporation’s general financial position are referred to as unsecured bonds or debentures. Bonds that mature on a single maturity date are known as term bonds.

A business will issue bonds payable if it wants to obtain funding from long term investors by way of loans. The accounting process carried out when working with bonds payable is illustrated in the following example. Notice that under both methods of amortization, the book value at the time the bonds were issued ($104,100) moves toward the bond’s maturity value of $100,000. The reason is that the bond premium of $4,100 is being amortized to interest expense over the life of the bond. When a bond is sold at a premium, the amount of the bond premium must be amortized to interest expense over the life of the bond. In our example, there will be a $100,000 principal payment on the bond’s maturity date at the end of the 10th semiannual period.

The market interest rate is used to discount both the bond’s future interest payments and the principal payment occurring on the maturity date. The market value of an existing bond will fluctuate with changes in the market interest rates and with changes in the financial condition of the corporation that issued the bond. For example, an existing bond that promises to pay 9% interest for the next 20 years will become less valuable if market interest rates rise to 10%. Likewise, a 9% bond will become more valuable if market interest rates decrease to 8%.

Journal Entries for Interest Expense – Annual Financial Statements

The recorded interest expense is less than the statement amount as a result of the premium amortization. The appropriate accounting treatment for issuance costs is to capitalize them upon original issuance and then expense them over the remaining life of the bond until maturity. Additionally, if bonds are paid off before their maturity date, the remaining unamortized issuance costs will be expensed as of the payoff date. We calculate these two present values by discounting the future cash amounts by the market interest rate per semiannual period. Notice that the first column of the PV of 1 Table has the heading of “n“. This column represents the number of identical periods that interest will be compounded.

Week 6 Due 5/8

You have an assignment which is to analyze the SOAP note given to you. Submit your assignment in a Word document. This should be written in a narrative format and not a SOAP note. Focus on answering the questions given to you in the assignment instructions area. Review the grading rubric prior to submission.

 

ABDOMINAL ASSESSMENT

Subjective:

CC: “My stomach has been hurting for the past two days.”

HPI: LZ, 65 y/o AA male, presents to the emergency department with a two days history of intermittent epigastric abdominal pain that radiates into his back. He went to the local Urgent Care where was given PPI’s with no relief. At this time, the patient reports that the pain has been increasing in severity over the past few hours; he vomited after lunch, which led his to go to the ED at this time. He has not experienced fever, diarrhea, or other symptoms associated with his abdominal pain. 

PMH: HTN

Medications: Metoprolol 50mg

Allergies: NKDA

FH: HTN, Gerd,  Hyperlipidemia

Social Hx: ETOH, smoking for 20 years but quit both 2 years ago, divorced for 5 years, 3 children, 2 males, 1 female 

Objective:

·        VS: Temp 98.2; BP 91/60; RR 16; P 76; HT 6’10”; WT 262lbs

·        Heart: RRR, no murmurs

·        Lungs: CTA, chest wall symmetrical

·        Skin: Intact without lesions, no urticaria

·        Abd: abdomen is tender in the epigastric area with guarding but without mass or rebound.Diagnostics: US and CTA 

Assessment:

1.     Abdominal Aortic Aneurysm (AAA)

2.     Perforated Ulcer

3.     Pancreatitis

 

 

  1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.
  2. Analyze the objective portion of the note. List additional information that should be included in the documentation.
  3. Is the assessment supported by the subjective and objective information? Why or why not?
  4. What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
  5. Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.