NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders

Walden University NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders                     

Whether one passes or fails an academic assignment such as the Walden University NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders                     

The introduction for the Walden University NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders                     

After the introduction, move into the main part of the NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders                     

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders                     

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders Included After Question

NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders

NURS 6501 Knowledge Check Women’s and Men’s Health, Infections, and Hematologic Disorders

The case study concerns a 60-year-old man with complaints of urinary frequency and incontinence that started after having chemo and radiotherapy three years ago to treat prostate cancer. The patient is more worried about his low back and hip pain that started roughly one month ago, which he thought was caused by lifting heavy boxes. Lab results show a normal urinalysis and CBC, and PSA of 7.2. The prostate is enlarged and nodular on DRE. The purpose of this assignment is to discuss prostatitis as it relates to the patient case.

Why prostatitis and infection happen and causes of a systemic reaction.

Prostatitis occurs due to inflammation of the prostate gland. Bacterial prostatitis mainly occurs with urethritis or a lower urinary tract infection (UTI). It is commonly caused by Enterobacter, Escherichia coli, Group D streptococci, and Proteus (Pirola et al., 2019). The microbes reach the prostate through the urethra or bloodstream. The patient presents with symptoms of chronic bacterial prostatitis like urinary frequency and incontinence. This could have been caused by the inoculation of bacteria during therapy or microorganisms from a lower UTI spreading to the prostate (Pirola et al., 2019).

Furthermore, chronic prostatitis manifests with pain in and around the penis, testicles, anal area, lower abdomen, and lower back. It also presents with an enlarged or tender prostate on digital rectal examination (DRE). Therefore, the patient’s low back and hip pain, as well as findings of an enlarged, nodular prostate, can be pointed to chronic prostatitis. 

Benign prostatic hyperplasia (BPH) is a risk factor for prostatitis. The patient’s history of prostate cancer can be attributed to chronic bacterial prostatitis. The bacteria may have been inoculated to the prostate during the chemotherapy and radiotherapy. The patient has an elevated PSA level of 7.2 and an enlarged nodular prostate, which can be attributed to prostate cancer (McCance & Huether, 2019). Local clinical manifestations of prostate cancer include lower urinary tract symptoms, hematuria, hematospermia, erectile dysfunction, and urinary retention. The patient’s urinary frequency and incontinence can further be attributed to the current prostate cancer.

The patient’s mild degenerative changes in the spine and cystic mass near the spine can be due to metastatic spinal cord compression (MSCC). MSCC occurs when cancer cells spread from the prostate and grow in or near the spine, pressing on the spinal cord (Patnaik et al., 2020). A systemic reaction occurs in a patient with prostatitis when the causative organisms enter the circulation through the lymphatic or blood system and cause infection to other body organs. This results in systemic symptoms like fever, chills, malaise, tachycardia, tachypnea, and myalgia.

Conclusion

The patient has symptoms consistent with chronic bacterial prostatitis, like urinary frequency and incontinence. Chemotherapy may have caused prostatitis when pathogens are inoculated into the bladder. Besides, the patient has symptoms consistent with prostate cancer, like an enlarged, nodular prostate and elevated PSA levels. The degenerative changes and cystic mass near the spine are likely due to the spread of cancer cells from the prostate. A systemic reaction can occur when causative organisms migrate from the prostate to the circulation. 

References

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier

Patnaik, S., Turner, J., Inaparthy, P., & Kieffer, W. K. (2020). Metastatic spinal cord compression. British journal of hospital medicine (London, England : 2005), 81(4), 1–10. https://doi.org/10.12968/hmed.2019.0399

Pirola, G. M., Verdacchi, T., Rosadi, S., Annino, F., & De Angelis, M. (2019). Chronic prostatitis: current treatment options. Research and reports in urology, 11, 165–174. https://doi.org/10.2147/RRU.S194679

• Question 2

  4 out of 4 points     Scenario 1: Polycystic Ovarian Syndrome (PCOS) A 29-year-old female presents to the clinic with a complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 11 years of age. She began to develop dark, coarse facial hair when she was 13 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m². Moderate hirsutism without virilization noted. 
•  Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management. Question How does PCOS affect a woman’s fertility or infertility?  Selected Answer: PCOS is the leading cause of infertility in women (McCance & Huether, 2019). Infertility results from alterations in androgen production, follicular disturbances, and an absence of ovulation. In other words, PCOS  negatively impacts fertility because women with the condition do not ovulate or release an egg each month due to an overproduction of estrogen by the ovaries. Correct Answer:   Ovulation problems are usually the primary cause of infertility in women with PCOS. Ovulation may not occur due to an increase in testosterone production or © 2020 Walden University 2 because follicles on the ovaries do not mature. Due to unbalanced hormones, ovulation and menstruation can be irregular. A hyperandrogenic state is a cardinal feature in the pathogenesis of PCOS. Excessive androgens affect follicular growth, and insulin affects follicular decline by suppressing apoptosis and enabling follicle to persist. There is dysfunction in ovarian follicle development. Inappropriate gonadotropin secretion triggers the beginning of a vicious cycle that perpetuates anovulation Response Feedback: [None Given]
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Question 3

4 out of 4 points

	Scenario 2: Pelvic Inflammatory Disease (PID) A 30-year-old female comes to the clinic with a complaint of abdominal pain, foul smelling vaginal discharge, and fever and chills for the past 5 days. She denies nausea, vomiting, or difficulties with bowels. Last bowel movement this morning and was normal for her. Nothing has helped with the pain despite taking ibuprofen 200 mg orally several times a day. She describes the pain as sharp and localizes the pain to her lower abdomen. Past medical history noncontributory. GYN/Social history + for having had unprotected sex while at a fraternity party. Physical exam: thin, Ill appearing anxious looking white female who is moving around on the exam table and unable to find a comfortable position. Temperature 101.6F orally, pulse 120, respirations 22 and regular. Review of systems negative except for chief complaint. Focused assessment of abdomen demonstrated moderate pain to palpation left and right lower quadrants. Upper quadrants soft and non-tender. Bowel sounds diminished in bilateral lower quadrants. Pelvic exam demonstrated + adnexal tenderness, + cervical motion tenderness and copious amounts of greenish thick secretions. The APRN diagnoses the patient as having pelvic inflammatory disease (PID). Question: 1.     What is the pathophysiology of PID?
	Selected Answer: Pelvic inflammatory disease (PID) is a condition of inflammation related to infections and involves the uterus, fallopian tubes, ovaries, and the peritoneal cavity in severe cases. Infections combined with the normal vaginal microbiome’s failure allow the infecting microorganism to spread into the upper genital tract causing PID (McCance & Huether, 2019). Although often caused by gonorrhea or chlamydia, PID’s etiology can be caused by multiple bacteria when the pH of the vagina changes and alter the integrity of the mucus of the cervix (McCance & Huether, 2019). Altering the cervix’s integrity allows an inflammatory process to begin in the uterus and fallopian tubes with edema, obstruction, or necrosis. Gonorrhea pathogens secrete toxins increasing the inflammation and damage, and chlamydia replicates in the cells rupturing the cell membrane, with both pathogens capable of spreading into the abdominal cavity (McCance & Huether, 2019). Correct Answer:   Pelvic inflammatory disease (PID) is an infectious and inflammatory disorder of the upper female genital tract, including the uterus, fallopian tubes, and adjacent pelvic structures. Infection and inflammation may spread to the abdomen, including perihepatic structures. PID is initiated by infection that ascends from the vagina and cervix into the upper genital tract. Chlamydia trachomatis is the predominant sexually transmitted organism associated with PID. Of all acute PID cases, less than 50% test positive for the sexually transmitted organisms such as Chlamydia trachomatis and Neisseria gonorrhea. Other organisms implicated in the pathogenesis of PID include, Gardnerella vaginalis (which causes bacterial vaginosis (BV), Haemophilus influenzae, and anaerobes such as Peptococcus and Bacteroides species. Inflammatory responses in the fallopian tubes and uterus causes swelling and sometimes necrosis of the area. This inflammation leads to scarring of the fallopian tubes and causes infertility. N gonorrhoeae is no longer the primary organism associated with PID, but gonorrhea remains the second most frequently reported sexually transmitted disease, after chlamydial infection. Response Feedback: [None Given]

 

Question 4

8 out of 8 points

	Scenario 3: Syphilis A 37-year-old male comes to the clinic with a complaint of a “sore on my penis” that has been there for 5 days. He says it burns and leaked a little fluid. He denies any other symptoms. Past medical history noncontributory. SH: Bartender and he states he often “hooks up” with some of the patrons, both male and female after work. He does not always use condoms. PE: WNL except for a lesion on the lateral side of the penis adjacent to the glans. The area is indurated with a small round raised lesion. The APRN orders laboratory tests, but feels the patient has syphilis. Question: 1.     What are the 4 stages of syphilis
	Selected Answer: When syphilis goes untreated, it advances through four stages identified through clinical manifestations. The first stage is the primary stage and consists of bacterial pathogens replicating in the epithelium, producing chancre, and draining into lymph nodes, which stimulates the adaptive immune response (McCance & Huether, 2019). The secondary stage involves a systemic invasion of pathogens with the immune system fighting the infection and clearing the chancres. The latent phase follows the secondary stage. There are no clinical manifestations in this period, although the individual infected transmit the disease if sexually active. In the final phase, the tertiary period, the disease’s systemic manifestations are severe and lead to death. These manifestations include destructive lesions in the skin, bone, and soft tissue and cardiovascular complications such as aneurysm, heart valve malfunctions, and heart failure (McCance & Huether, 2019). Additionally, neurological lesions are possible. Correct Answer:   4-5 . What are the 4 stages of syphilis? Answer: Syphilis is an infectious venereal disease caused by the spirochete Treponema pallidum. Syphilis is transmissible by sexual contact with infectious lesions, from mother to fetus in utero, via blood product transfusion, and occasionally through breaks in the skin that come into contact with infectious lesions. If untreated, it progresses through 4 stages: primary, secondary, latent, and tertiary. Primary: A chancre, or hard lesion develops at the site of the treponemal entry after exposure. In acquired syphilis, T pallidum rapidly penetrates intact mucous membranes or microscopic dermal abrasions and, within a few hours, enters the lymphatics and blood to produce systemic infection. Incubation time from exposure to development of primary lesions, which occur at the primary site of inoculation, averages 3 weeks but can range from 10-90 days. Secondary syphilis develops about 4-10 weeks after the appearance of the primary lesion. During this stage, the spirochetes multiply and spread throughout the body. Secondary syphilis lesions are quite variable in their manifestations. Systemic manifestations include malaise, fever, myalgias, arthralgias, lymphadenopathy, and  rash. Even if untreated, the immune system is usually able to suppress the infection and spontaneous resolution of skin lesions occurs. Latent syphilis is a stage at which the features of secondary syphilis have resolved, though patients remain seroreactive. Some patients experience recurrence of the infectious skin lesions of secondary syphilis during this period. About one third of untreated latent syphilis patients go on to develop tertiary syphilis, whereas the rest remain asymptomatic. Tertiary syphilis disease is rare. When it does occur, it mainly affects the cardiovascular system (80-85%) and the CNS (5-10%), developing over months to years and involving slow inflammatory damage to tissues. The 3 general categories of tertiary syphilis are gummatous syphilis (also called late benign), cardiovascular syphilis, and neurosyphilis. Response Feedback: [None Given]

A Sample Answer For the Assignment: NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders

Title: NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders

Week 10: Concepts of Women’s and Men’s Health, Infections, and Hematologic Disorders: Knowledge Check

Concepts of Women’s and Men’s Health, Infections, and Hematologic Disorders: Knowledge Check

Scenario 1: Polycystic Ovarian Syndrome (PCOS)

What is the pathogenesis of PCOS? 

PCOS is a complex heterogeneous familial disorder characterized by anovulation, menstrual dysfunction, and signs of hyperandrogenism. Despite the exact pathophysiology of this disorder being unknown, studies show that PCOS can develop because of abnormal functioning of the hypothalamic-pituitary-ovarian (HPO) axis (Zeng et al., 2020). Inappropriate secretion of gonadotropin hormone due to ovarian dysfunction has been reported among PCOS patients. General the pathogenesis of PCOS is associated with neuroendocrine alterations, primary ovarian abnormalities, interactions of epigenetic and genetic changes, and endocrine and metabolic modifiers like insulin resistance, hyperinsulinemia, anti-Müllerian hormone, and adiposity.

How does PCOS affect a woman’s fertility or infertility? 

Infertility is mostly caused by chronic anovulation among women with PCOS. However, subfertility may be associated with the increase of plasma levels of luteinizing hormone in the follicular phase of the menstrual cycle leading to a resumption of the second meiotic oocyte division and the release of premature oocytes (Khmil et al., 2020). The increased LH levels reported in PCOS are associated with the increased frequency of spontaneous abortions. The main factors contributing to spontaneous abortion among women with PCOS are related to the factors associated with steroidogenesis, maturation of the oocyte, reduced endometrial receptivity, and folliculogenesis. Consequently, PCOS is associated with an increased risk of miscarriages in pregnant women.

Scenario 2: Pelvic Inflammatory Disease (PID)

What is the pathophysiology of PID? 

The pelvic inflammatory disease normally results from ascending infection of the cervicovaginal microorganisms such as Chlamydia trachomatis and Neisseria gonorrhoeae (Hillier et al., 2021). The mechanism by which these microorganisms ascend from the lower genital tract is not clear. However, studies report that several factors may be involved. Despite cervical mucous serving as a form of functional barrier against the upward spread, hormonal changes and vaginal inflammation which normally occur during menstruation and ovulation can decrease the efficacy of this barrier. Additionally, the treatment of STIs with antibiotics can compromise endogenous flora balance in the lower genital tract leading to overgrowth of non-pathogenic microorganisms. Ascending of the infection can be promoted during intercourse through the rhythmic uterine contractions during orgasm. The bacteria can also move into the uterus and fallopian tubes through the sperm.

Scenario 3: Syphilis

What are the 4 stages of syphilis? 

Syphilis can be divided into 4 main stages such as primary, secondary, latent, and tertiary based on the patients presenting symptoms (Trivedi et al., 2019). A patient is normally diagnosed with primary syphilis when they present with a sore or several sores at the original infection site. These sources are normally seen in or around the genitals, anus, rectum, and mouth. Most of the time, the sores will be painless, firm, and round. Secondary syphilis is characterized by swollen lymph nodes, skin rash, and fever. The signs and symptoms presented in primary and secondary syphilis may be mild and unnoticed. In latent syphilis, the patient displays no signs and symptoms. Tertiary syphilis on the other hand is associated with severe health complications such as psychiatric manifestations, cardiovascular syphilis, or late neurosyphilis.

References

Trivedi, S., Williams, C., Torrone, E., & Kidd, S. (2019). National trends and reported risk factors among pregnant women with syphilis in the United States, 2012–2016. Obstetrics and gynecology, 133(1), 27. https://doi.org/10.1097/AOG.0000000000003000

Hillier, S. L., Bernstein, K. T., & Aral, S. (2021). A Review of the Challenges and Complexities in the Diagnosis, Etiology, Epidemiology, and Pathogenesis of Pelvic Inflammatory Disease. The Journal of Infectious Diseases, 224(Supplement_2), S23-S28. https://doi.org/10.1093/infdis/jiab116

Khmil, M., Khmil, S., & Marushchak, M. (2020). Hormone Imbalance in Women with Infertility Caused by Polycystic Ovary Syndrome: Is There a Connection with Body Mass Index?. Open Access Macedonian Journal of Medical Sciences, 8(B), 731-737. https://doi.org/10.3889/oamjms.2020.4569

Zeng, X., Xie, Y. J., Liu, Y. T., Long, S. L., & Mo, Z. C. (2020). Polycystic ovarian syndrome: correlation between hyperandrogenism, insulin resistance, and obesity. Clinica Chimica Acta, 502, 214-221. https://doi.org/10.1016/j.cca.2019.11.003

Week 9 Discussion Response to My Discussion Post

First of all, Thank you for your insightful and informative response. To answer your question I would start him on a hydrochlorothiazide for his hypertension (HTN) managment unless he is actually on something else. Along with lifestyle modifications. Again, Thank you for your response, best of luck on the remainder of this course and your future endeavors!

Case Study

• HH is a 68-year-old male who has been admitted to the medical ward with community-acquired pneumonia (CAP) for the past 3 days.
• His past medical history PMH is significant for:
• Chronic obstructive pulmonary disease (COPD)
• Hypertension (HTN)
• Hyperlipidemia
• Diabetes.
• He remains on empiric antibiotics, which include:
• Ceftriaxone 1 g IV everyday (day 3)
• Azithromycin 500 mg IV everyday (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.
• Height: 5’8” Weight: 89 kg (196 pounds)
• Allergies: Penicillin (delayed, rash)

Addressing Patient’s PMH

First, due to risk of bronchoconstriction resulting in chronic obstructive pulmonary disease (COPD) exacerbation, prescribing a thiazide diuretic or a potassium-sparing diuretic would be an appropriate first step in treating hypertension in the patient.  For the same reason, beta-blockers should be used with caution and reserved for patients diagnosed with cardiovascular disease (Finks et at., 2020).  Addressing hyperlipidemia, statins have been proven to be effective in preventing cardiac complications in patients also diagnosed with COPD (Lu et al., 2019).  Lastly, metformin (biguanide) has been proven to be the best treatment option in treating diabetes for patients who have also been diagnosed with COPD (Zhu et al., 2019).

CAP

Community acquired pneumonia (CAP), can be classified as either viral or bacterial.  Biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) have been demonstrated to be beneficial in differentiating between bacterial and viral CAP (Ito & Ishida, 2020).  Along with good antibiotic stewardship, it is important to take into consideration comorbidities that may increase the risk of complications due to CAP.  Aside from treating with antibiotics for bacterial suspected CAP, anti-infective medications such as antivirals have been studied and have NOT been proven to be successful in reducing symptoms of CAP unless the patient is also suspected to be infected with influenza (Metlay et at., 2019).

Antivirals in CAP

        Oseltamivir is one such antiviral prescribed within 48 hours of the onset of influenza-like symptoms.  This medication inhibits viral replication by impeding the enzyme neuraminidase preventing the new particles of the virus from budding off the cytoplasmic membrane of the host cells that have been infected by the virus.  Oseltamivir is considered a prophylactic treatment for the prevention of influenza A and B to help alleviate the severity and duration of symptoms. 

This medication is typically well tolerated but can cause nausea, vomiting, and headache and is best taken with food.  This medication should NOT be administered within two weeks of a live attenuated influenza vaccine (LAIV) as this may cause a decreased immune response to the vaccine.  Oseltamivir is protein binding and is metabolized almost solely by the liver and excreted through the urine (Rosenthal & Burchum, 2021).  As the patient is now three days out, this medication would not be proven to be beneficial.

Empiric Therapy for CAP

            In adhering to good antibiotic stewardship, empirical treatment of CAP is not always recommended.  However, as patient is currently being treated in an inpatient setting with oxygen supplementation, empirical treatment would be appropriate.  As the patient is allergic to penicillin other beta-lactam antibiotics should be avoided in those with immediate-type allergic reactions.  As the patient had a delayed allergic reaction, cefadroxil (a third generation cyclosporin/beta-lactam antibiotic) has not been noted to increase the rate of allergic reaction and may be used as an alternative to penicillin in these patients if culture is sensitive to this class. 

This medication is often used in conjunction with azithromycin as an augmentation to help prevent more serious complications such as sepsis.  It is also not uncommon for a patient to experience nausea and vomiting from antibiotic therapy.  Ondansetron could be prescribed, and a probiotic could also be advised to be taken.  Careful monitoring of the patient is crucial and at some point a glucocorticoid such as prednisone may be considered with careful monitoring of blood pressure and blood glucose (Arumugham et at., 2021).

            If the allergic reaction to penicillin was immediate, other classes of antibiotics could be prescribed as empirical treatment.  Fluoroquinolones such as levofloxacin and tetracyclines such as doxycycline have also been shown to be effective and approved for the empirical treatment of CAP.  Newer medications in the class of pleuromutilin (Lefamulin) has been shown to be highly effective as an empirical treatment for CAP and is well tolerated in those diagnosed with COPD.  This medication inhibits protein translation of the bacteria and interrupts the formation of the peptide bond.  This medication can increase the effectiveness of statins and is mainly eliminated in the gastrointestinal (GI) tract resulting in main symptoms being GI related (Russo, 2020).

References

Arumugham, V. B., Gujarathi, R., & Cascella, M. (2021). Third generation cephalosporins, In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK549881/

Finks, S. W., Rumbak, M. J., & Self, T. H. (2020). Treating Hypertension in Chronic Obstructive Pulmonary Disease. New England Journal of Medicine, 382, 353-363. doi: 10.1056/NEJMra1805377.

Ito, A. & Ishida, T. (2020). Diagnostic markers for community-acquired pneumonia. Annals of Translational Medicine, 8(9), 609. doi: 10.21037/atm.2020.02.182

Lu, Y., Chang, R., Xinni, J. Y., Teng, Y., & Cheng, N. (2019). Effectiveness of long-term using statins in copd-a network meta-analysis. Respiratory Research, 20(17), n. p. Retrieved from https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-019-0984-3

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. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67. doi: 10.1164/rccm.201908-1581^ST

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

Russo, A., (2020). Spotlight on new antibiotics for the treatment of Pneumonia. Clinical Medicine Insights: Circulatory, Respiratory, and Pulmonary Medicine, 14, n. p. doi: 10.1177/1179548420982786

Zu, A., Teng, Y., Ge, D., Zhang, X., Hu, M., & Yao, X. (2019). Role of metformin in treatment of patients with chronic obstructive pulmonary disease. Journal of Thoracic Disease 11(10), 4371-4378. doi: 10.21037.jtd.2019.09.84

Scenario 3: Syphilis

A 37-year-old male comes to the clinic with a complaint of a “sore on my penis” that has been there for 5 days. He says it burns and leaked a little fluid. He denies any other symptoms. Past medical history noncontributory. 

SH: Bartender and he states he often “hooks up” with some of the patrons, both male and female after work. He does not always use condoms.

PE: WNL except for a lesion on the lateral side of the penis adjacent to the glans. The area is indurated with a small round raised lesion. The APRN orders laboratory tests, but feels the patient has syphilis.  

Question:

1.     What are the 4 stages of syphilis 

Your Answer:

        Syphilis progresses through four distinct stages, each characterized by specific symptoms and clinical manifestations:

          Primary Stage: This stage begins with the appearance of a painless sore called a chancre at the site of infection, typically within 3 weeks after exposure. The sore is firm, round, and often goes unnoticed. It can last for a few weeks and eventually heals on its own. The chancre is highly contagious and contains the bacterium Treponema pallidum.

        Secondary Stage: After the chancre heals, the secondary stage emerges, usually a few weeks to a few months later. Symptoms during this stage can vary widely and may include a skin rash, mucous membrane lesions (e.g., in the mouth or genitals), fever, fatigue, sore throat, and muscle aches. The rash is typically non-itchy, red or brown, and may appear on the palms and soles. These symptoms can come and go over several weeks.

        Latent Stage: This stage is characterized by the absence of visible symptoms. Syphilis remains present in the body, but there are no outward signs or symptoms. Latent syphilis is further categorized into early latent (within a year of initial infection) and late latent (more than a year after initial infection). During this stage, the infection can still be transmitted to others through sexual contact.

        Tertiary Stage: If left untreated, syphilis can progress to the tertiary stage, which can occur years after the initial infection. Tertiary syphilis is rare due to the widespread use of antibiotics. However, it can lead to severe and potentially life-threatening complications, such as damage to the heart, blood vessels, brain, nerves, and other organs. Neurological complications can lead to significant disability.