NR 601 Assignment: Standardized Procedure Worksheet 

NR 601 Assignment: Standardized Procedure Worksheet

NR 601 Assignment: Standardized Procedure Worksheet

Standardized Procedure Worksheet
Preparing the Assignment
Nurse practitioners provide high-quality, comprehensive care to clients in a variety of health care settings. Standardized procedures may be used to help guide care. Boards of Nursing, such as California, provide resources to ensure that NPs provide quality care while functioning within their scope of practice.
Select one of the conditions or disorders below and create a standardized procedure for treatment in the primary care setting:
• urinary incontinence in the older adult

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• urinary tract infections in community-dwelling older adults
• urinary tract infections in facility-dwelling older adults
• benign prostatic hyperplasia in older adults
• erectile dysfunction in older adults
• hormone replacement therapy for menopause
• sexually transmitted infections in older adults
Follow the guidelines below to complete the standardized procedure template (Links to an external site.).
1. Definition
a. Identify the selected disorder or condition.
b. Provide a basic description of the pathophysiology of the selected disorder or condition.
c. Provide a summary of the incidence and prevalence of the selected disorder or condition in the United States.
2. Assessment
a. Identify common subjective findings (symptoms) consistent with the selected diagnosis.
b. Identify pertinent physical examination components and the expected exam findings consistent with the selected disorder or condition.
c. Identify your intended state of practice(ARIZONA) and whether physician collaboration is required, as it is in California. If collaboration is required, describe the circumstances that would require physician consultation.
3. Diagnostic tests
a. List diagnostic tests appropriate for the selected disorder or condition.
b. List expected abnormal results consistent with the selected disorder or condition.
4. Management: Present an evidence-based management plan for the selected disorder or condition.
a. Describe in detail first-line prescribed medications recommended for the selected disorder or condition.
b. Describe in detail second-line medication that should be prescribed IF the client had an allergy to first-line line treatment for the selected disorder or condition.
c. Identify medication details including
i. Trade and generic names for each medication
ii. Typical dose for each medication
iii.  Major contraindications for use
iv. Major drug-drug interactions
d. Identify other recommended treatments, if any, for the selected disorder or condition.
e. Discuss expected client follow-up. If the client called in with persistent or recurrent symptoms after initial treatment, describe the appropriate next action.
f. Describe indications for referral.
g. Use current clinical practice guidelines or U.S.-based scholarly resources appropriate for advanced practice* that has been published within the past 5 years to support management plan
**Textbooks, journals published outside the United States, and journals not intended for advanced practice nurse or physician providers are NOT considered scholarly references for treatment decisions.
Please only use Evidenced- based journal within 5 years that are within the United States

Standardized Procedure Worksheet Rubric
This criterion is linked to a Learning Outcome Diagnosis
1. Identifies disease condition.

2. Provides a basic description of the pathophysiology of the disorder or condition.

3. Provides a summary of incidence and prevalence in the United States.

(3 critical elements

20 pts
Excellent
Three required critical elements are present and thoroughly addressed.

Assessment
1. Lists common subjective findings consistent with the disorder or condition

2. Lists pertinent physical exams to perform

3. Lists expected physical exam findings consistent with the disorder or condition

4. Identifies intended state of practice and whether physician collaboration is required. Describes the circumstances that would require physician consultation.

(4 critical elements)

20 pts
Full Marks
Four required critical elements are present and thoroughly addressed.

Diagnostic Tests
1. Lists appropriate diagnostic tests

2. Lists expected abnormal results consistent with the disorder or condition

(2 critical elements)

20 pts
Full Marks
Two required critical elements are present and thoroughly addressed.

Management
Presents an evidence-based plan including:

1. Describes in detail first-line prescribed medications recommended for the disorder or condition

2. Describes in detail second-line medications that should be prescribed IF the patient had an allergy to 1st line treatment

3. Medication details include ALL of the following:

a. Trade and generic names for each medication

b. Typical dose for each medication

c. Major contraindications for use

d. Major drug-drug interactions

4. Discusses other recommended treatments, if any

5. Discusses expected client follow-up. If the client called in with persistent or recurrent symptoms after initial treatment, describe the appropriate next action.

6. Describes indications for referral

7. Use current clinical practice guidelines or U.S.-based scholarly resources appropriate for advanced practice published within the past 5 years to support management plan

(7 critical elements)

Writing Mechanics
Grammar, Syntax, Spelling, & Punctuation

Scholarly paper has minimal grammar, syntax, spelling, punctuation, or APA Style errors.*

A Sample Of This Assignment Written By One Of Our Top-rated Writers

NR601 Standardized Procedure Worksheet

Name:

1. Definition
2. Disease or Condition

            The selected disease is urinary tract infections (UTI) in facility-dwelling older adults. UTI is defined as an infection that affects the urinary system. It might affect the lower urinary tract only or the upper and lower urinary tracts (Kang et al., 2018). It is associated with various symptoms, including pain with urination, frequent urination, increased urge to urinate with the production of little urine, and vaginal discharge.

1. Pathophysiology

Urinary tract infections among facility-dwelling older adults are associated with various factors related to aging. T-cell dysfunction among the aging population disrupts the working mechanism of the acquired immunity. Normal defense mechanisms allow the body to void completely, eliminating all urine from the body (Godbole et al., 2020). Additionally, the mechanism is responsible for the immunoglobulin production and acidification of urine from organic acids. Thus, a compromised immune system increases the risk of UTIs among elderly adults. The risk of UTI is higher in women than men since women have a shorter urethra and highly-frequent vaginal colonization (Godbole et al., 2020). Estrogen deficiency in women causes urinary incontinence and vaginal prolapse, enhancing the ascending flow of bacteria to the urinary tract, and causing UTIs (Rodriguez-Mañas, 2020). Moreover, loss of pelvic floor muscle tone increases the risk of UTI in older women. Accumulation of comorbidities such as stroke and dementia also increases the risk of UTI in elderly women residing in indwelling facilities. These conditions lead to bowel and bladder incontinence and declined functional capacity, disrupting the body’s defense mechanisms. Lastly, physical limitation among women residing in indwelling settings increases the risk of UTIs.

1. Incidence and Prevalence

Urinary tract infection (UTI) is highly prevalent among facility-dwelling older adults. According to Godbole et al. (2020), UTI is the second most frequent infection among elderly adults, residing in long-term care (LTC), representing more than a third of all nursing home-associated infections. Furthermore, UTI is the most prevalent infection among older adults, representing about 25% of all infections in this population (Godbole et al., 2020). A report by Medina and Castillo-Pino (2019) indicated that UTI is diagnosed in 50% – 60% of total adult women in their life. Additionally, UTI is the most prevalent cause of bacterial infection hospitalizations among geriatrics residing in long-term facilities. 

The prevalence and incidence of UTIs are significantly high in older women than in men. This trend is associated with a relatively shorter urethra in women, allowing bacteria from the intestine to pass easily to the urinary tract system. According to Rodriguez-Mañas (2020), the overall incidence of UTI among postmenopausal community-dwelling women aged from 55 to 75 years was 7 cases per 100 person-years. This rate is relatively high, making UTI one of the most prevalent diagnoses in this population. Another study assessing the rate of UTI among men aged between 65 and 74 years residing in an indwelling facility indicated an incidence rate of 5 cases per 100 person-years (Rodriguez-Mañas, 2020). Therefore, the prevalence of UTIs among women residing in the indwelling facility exceeds that of men.

2. Assessment
3. Symptoms

            Urinary tract infection among adult women residing in the indwelling facility is characterized by various symptoms of flank pain. Urinary frequency is another significant symptom of UTI in elderly women residing in indwelling facilities. The urination frequency among these individuals is more than 7 micturition incidents during waking hours (Czajkowski et al., 2021). Nocturia also characterizes UTIs in elderly women residing in indwelling facilities. Elderly patients with UTIs are interrupted from their sleep at least once due to the need to micturate. Sleep precedes and follows each sleep (Czajkowski et al., 2021). Lastly, UTI in this population is characterized by urinary urgency. Elderly adults with UTIs experience a compelling desire to pass urine that one cannot resist but ends up producing a little amount of urine (Czajkowski et al., 2021).

1. Physical Exam

Physical examination of UTI aims at conforming to clinical manifestation reported by the client during a clinical interview. The physical examination in cases of suspected UTI targets the CVA, the suprapubic region, and general symptoms such as fever (Czajkowski et al., 2021).

1. Intended state of practice (Arizona) whether collaboration is required, if collaboration is required, describe the circumstances that would require physician collaboration

            In Arizona, nurse practitioners (NPs) are allowed to practice independently. Nurses practicing in this state are not required to collaborate or be supervised by a physician during care delivery (American Medical Association, 2021). Thus, an NP practicing in Arizona can treat an adult woman who presented with UTI symptoms independently without collaborating or consulting a physician. However, the NP can refer the client to another health care professional if the presented symptoms exceed NP’s knowledge, skills, and experience. Referring the client to more competent and experienced healthcare providers would protect her health, welfare, and overall well-being.

3. Diagnostic tests
4. Testing

Analyzing of the urine sample: A freshly-collected urine sample is examined under a microscope to detect the presence of bacteria or white blood cells (WBC). According to Czajkowski et al. (2021), a count higher than 10 leuko-cytes/mm3 indicates an infection.

Urine culture: This test is conducted to determine if the infection is caused by bacteria or yeast present in the urine sample.

1. Expected results

            In an elderly patient with UTI, physical examination results should indicate a high or slightly high fever due to an infection. Additionally, in elderly women with UTIs, the suprapubic region is non-tender with touch. However, the suprapubic region becomes tender, or the client experiences signs of flank pain on deep abdominal palpation (Czajkowski et al., 2021). Furthermore, the CVA is tender on palpation or percussion. In addition to physical examinations, the number of white blood in an adult woman with a UTI is expected to be more than 10 cells/mm3 per high-power field (Czajkowski et al., 2021). Lastly, an adult woman with UTI has systemic inflammation, indicating increased WBC in the blood.

4. Management

            Treating urinary tract infection (UTI) for the elderly is the same as treating UTI in young women. The treatment plan consists of pharmacological and non-pharmacological interventions. First-line medications and second-line medications can be used in treating UTIs in elderly patients.

1. First-line medications

            Antibiotics are recommended as the first-line treatment for UTIs in elderly patients. According to Chu and Lowder (2018), trimethoprim-sulfamethoxazole 800/160mg is one of the first-line medications and should be taken for three days, and the patient should take them twice a day. Also, nitrofurantoin monohydrate/macrocrystals 100 mg is recommended and should be taken for five days where the patient needs to take it twice a day too. However, these medications are more viable if the local resistant rates are less than 20 percent. For instance, E. Coli bacteria have low nitrofurantoin resistance rates compared to other bacteria like Enterobacteraciae species, which are commonly experienced in the elderly, thus posing a higher probability of nitrofurantoin resistance (Durkin et al., 2018). Nitrofurantoin is also contraindicated for chronic kidney disease patients that are common in the elderly. Hence, the most preferred first-line medication for UTI in the elderly is trimethoprim-sulfamethoxazole though clinicians should assess local resistance rates to influence their empiric antibiotic choices.

1. Second-line medications

            When intervening for UTIs in the elderly, the second-line treatment involves Beta-lactam antibiotics, which include amoxicillin-clavulanate and cefaclor. These antibiotics are only essential if the other treatments have failed to intervene in the patient’s conditions and should be used within three to seven days (Durkin et al., 2018). However, the healthcare providers should use the second-line treatment sparingly to avoid further implicating the patients’ health.

1. c. Other treatments

Non-pharmacological interventions are also used to treat UTIs in elderly patients. First, the client will be prescribed cranberry products. According to Rodriguez-Mañas (2020), cranberry products effectively treat UTI symptoms in women. Secondly, the client is advised to increase fluid intake, which will flush excess bacteria from the urinary tract system. The client is also advised to void regularly and ensure that the bladder is completely emptied to prevent the accumulation of bacteria in the urinary tract system.

1. d. Follow-Up Care

            The treatment plan for elderly patients with UTIs includes follow-up care. The client is advised to visit the health care clinic after 2 weeks. Follow-up care allows the healthcare provider to monitor how the client is responding to the prescribed medication, including drug-related side effects. According to Gharbi et al. (2019), antibiotics used in treating UTIs in women increase the risk of bloodstream infection. If the prescribed medication has been effective in treating the presented symptoms, the healthcare provider educates the client about maintaining a high level of hygiene and drinking a lot of fluids to avoid recurrence. On the contrary, if the client reports initial symptoms or slight improvement in the initial symptoms during follow-up care, an alternative treatment plan is developed. Alternative treatment should also be prescribed if the client reports adverse drug reactions during the follow-up care.

1. Referral

            The client might be referred to a gynecologist for further examination if the symptoms persist even after completing the prescribed dosage. Additionally, a client might be referred to a gynecologist if other symptoms such as vaginal bleeding, lower back pain, or a mass in the pelvic region are reported. In such cases, the client requires further medical check-ups to rule out other obstetric cases associated with such symptoms.

References

American Medical Association (AMA). (2021). State law chart: Nurse Practitioner Practice Authority. AMA. https://www.ama-assn.org/system/files/2020-02/ama-chart-np-practice-authority.pdf

Chu, C. M., & Lowder, J. L. (2018). Diagnosis and treatment of urinary tract infections across age groups. American journal of obstetrics and gynecology, 219(1), 40-51. https://doi.org/10.1016/j.ajog.2017.12.231

Czajkowski, K., Broś-Konopielko, M. & Teliga-Czajkowska, J. (2021). Urinary tract infection in women. Menopausal Review; 20(1):40-47. DOI:10.5114/pm.2021.105382

Durkin, M. J., Keller, M., Butler, A. M., Kwon, J. H., Dubberke, E. R., Miller, A. C., … & Olsen, M. A. (2018, September). An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections. In Open forum infectious diseases (Vol. 5, No. 9, p. ofy198). US: Oxford University Press. https://doi.org/10.1093/ofid/ofy198

Gharbi, M., Drysdale, J. H., Lishman, H., Goudie, R., Molokhia, M., Johnson, A. P., … & Aylin, P. (2019). Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all-cause mortality: population-based cohort study. BMJ, 364. DOI: https://doi.org/10.1136/bmj.l525

Godbole, G. P., Cerruto, N., & Chavada, R. (2020). Principles of assessment and management of urinary tract infections in older adults. Journal of Pharmacy Practice and Research, 50(3), 276-283. https://doi.org/10.1002/jppr.1650

Kang, C. I., Kim, J., Park, D. W., Kim, B. N., Ha, U. S., Lee, S. J., … & Wie, S. H. (2018). Clinical practice guidelines for the antibiotic treatment of community-acquired urinary tract infections. Infection & chemotherapy, 50(1), 67. DOI: 10.3947/ic.2018.50.1.67

Medina, M., & Castillo-Pino, E. (2019). An introduction to the epidemiology and burden of urinary tract infections. Therapeutic advances in urology, 11, 1756287219832172. https://doi.org/10.1177/1756287219832172

Rodriguez-Mañas, L. (2020). Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs in context, 9. Doi: 10.7573/dic.2020-4-13

Rodriguez-Mañas, L. (2020). Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs in context, 9. Doi: 10.7573/dic.2020-4-13