Below are 4 articles/stories regarding legalization of marijuana. The first article explains the conflict in laws and the other 3 discuss conflicts that have arisen in different areas because of the states’ choice to “legalize” marijuana.Do you think the federal government should amend the Controlled Substance Act to eliminate these conflicts? Why or why not?
Should the legalizing state be required to cover costs incurred by neighboring “nonlegalized” states?
We know that marijuana can be detected days and even weeks after use, depending on the period of time used and amount and strength of drug used. Should employers allow people to work at occupations while testing positive for marijuana? What about drive?

Asthma is a frequent health problem in children. It is chronic. There are more than 3 million cases per year in the USA. It can be a minor problem or it can interfere with daily activities. In some cases can be life-threatening. As adults get older the illness can decrease in frequency and severity. We need to instruct our patients that certain foods can trigger asthma symptoms, for example milk, eggs, shellfish, peanuts, soy, and wheat might be responsible. Children with asthma should have a humidifier in their rooms, avoid sleeping with pets, avoid dust, and avoid dust mites, that can get in sheets and pillows.
We need to tell the parents as well as the child to try to always have inhalers available. The most common are beta agonist, which give quick bronchodilatation, also useful are steroids and leukotrine modifiers.
We as nurse practitioners are in a unique place to give appropriate health care advice, by instructing the patient and their parents or caregivers what to avoid in the environment and the diet, and what things would be beneficial. On of the most common question is what foods to avoid and which ones to use. All exercises are useful but never to over do it. Some individuals can have an attack trigger by vigorous exercise. Also avoid changes in temperatures,because it is well known that bronchospasm occurs in colder temperatures.
In my personal experience I had a 5 year old that developed attacks of difficulty breathing, which was treated successfully in the emergency room on several occasions, when we got involved with the family, we were able to obtain an extensive history, including the fact that they had recently moved to a new house, which turned out to have lot of mold, when this was addressed then the frequency and severity of the attacks diminished.
Reference:
Stucky, B. D., Sherbourne, C. D., Edelen, M. O., & Eberhart, N. K. (2015). Understanding asthma-specific quality of life: moving beyond asthma symptoms and severity. The European respiratory journal, 46(3), 680-7.
Van Aalderen W. M. (2012). Childhood asthma: diagnosis and treatment. Scientifica, 2012, 674204.
Lisette,
NAME: E.B AGE: 50 y/o SEX: male
*SUBJECTIVE INFORMATION*
CHIEF COMPLAINT : ”I have cough and expectoration every morning for month”
HISTORY OF PRESENT ILLNESS:
Pt is a 50 y/o hispanic male with past medical history of infertility for which it was studied years ago and was diagnosed with α1 antitrypsin deficiency, non-smoker who comes with a chief complaint of cough and morning sputum for month. The espectoria is abundant and smells of wet plaster, thick. Also in these last days he has presented fever of 102 F and the cough has become constant and annoying and sputum more green and abundant.
PAST MEDICAL HISTORY: α1 antitrypsin deficiency
IMMUNIZATIONS:
Vaccine updated
ALLERGIES: to Dust, type of reaction: runny noise.
CURRENT MEDICATION: Vitamin C PO 500 mg daily.
FAMILY HISTORY:
Mother: Bronchial Asthma
Father: CVD, PVD
SOCIAL HISTORY:
Denies illicit drugs, or drink alcohol.
MARITAL STATUS: married without child for infertility
REVIEW OF SYSTEMS
• RESPIRATORY: Productive cough and smelly expectoration with a smell of wet plaster
*OBJECTIVE INFORMATION*
VITALS SIGNS: Blood Pressure: 110/65 Pulse: 60 bpm Respiration: 22rpm Temperature:102 F O2 saturation: 93% at room air.
Weight: 1300 lb.
Pain level: 0/10
RESPIRATORY: Crackles and wheezing on lung auscultation. No dyspnea noted.
MUSCULOSKELETAL: Clubbing of the digits
⎫ Dieses/Condition
DIAGNOSIS: BRONCHIECTASIS WITH (ACUTE) EXACERBATION
Bronchiectasis refers to an irreversible airway dilation that involves the lung in either a focal or a diffuse manner and that classically has been categorized as cylindrical or tubular (the most common form), varicose, or cystic.
DIFFERENTIAL DIAGNOSTIC:
1- COPD
3- Strep Pneumonia
4- Tuberculosis
⎫ Population affected:
The overall reported prevalence of bronchiectasis in the United States has recently increased, but the epidemiology of bronchiectasis varies greatly with the underlying etiology. For example, patients born with CF often develop significant clinical bronchiectasis in late adolescence or early adulthood, although atypical presentations of CF in adults in their thirties and forties are also possible. In contrast, bronchiectasis resulting from MAC infection classically affects nonsmoking women >50 years of age. In general, the incidence of bronchiectasis increases with age. Bronchiectasis is more common among women than among men.
The most affected population is:
1. People that aspirated foreign body or had a tumor mass
2. People with recurrent infection (bacterial, nontuberculous mycobacterial)
3. People with Immunodeficiency (hypogammaglobulinemia, HIV infection, bronchiolitis obliterans after lung transplantation)
4. People with genetic causes (cystic fibrosis, Kartagener’s syndrome, α1 antitrypsin deficiency)
5. People that suffer from Autoimmune or rheumatologic causes (rheumatoid arthritis, Sjögren’s syndrome, inflammatory bowel disease); immune mediated disease (allergic bronchopulmonary aspergillosis)
6. Recurrent aspiration of toxics agents
7. People with α1 Antitrypsin Deficiency.
⎫ Impact on Quality of Life.
Manifestations The most common clinical presentation is a persistent productive cough with ongoing production of thick, tenacious sputum.
The aspect that most affects people with bronchiectasis are recurrent respiratory infections that can limit their quality of life due to a compromise of respiratory function.
Outcomes of bronchiectasis can vary widely with the underlying etiology and may also be influenced by the frequency of exacerbations and (in infectious cases) the specific pathogens involved. In one study, the decline of lung function in patients with non-CF bronchiectasis was similar to that in patients with COPD, with the forced expiratory volume in 1 s (FEV1) declining by 50–55 mL per year as opposed to 20–30 mL per year for healthy controls.
⎫ Current EBP that will benefit this patient with the specific disease.
Bronchiectasis doesn’t have reversibility; however, we can compensate it with an adequate therapeutic. After I have carried out a search, such as FNP, the therapeutic alternatives within our reach are the following:
1. clearance techniques: Manual techniques may be offered to enhance sputum clearance when the patient is fatigued or undergoing an exacerbation.
2. Mucoactive: Consider the use of humidification with sterile water or
3. Normal saline solution to facilitate the purification of the respiratory tract. You can also use some mucolytic mucinex.
4. Anti-inflammatory therapies: Do not routinely offer corticosteroids to patients with bronchiectasis without other indications (such as ABPA, chronic asthma, COPD and inflammatory bowel disease)
5. Antibiotic: Consider long-term antibiotics in patients with bronchiectasis who experience 3 or more exacerbations per year and in the short term in case of exacerbations. The choice of antibiotic depends on the type of patient:
P. aeruginosa colonised patients
a. Use inhaled colistin for patients with bronchiectasis and chronic Pseudomonas aeruginosa infection.
b. Consider inhaled gentamicin as a second line alternative to colistin for patients with bronchiectasis and chronic P. aeruginosa infection.
c. Consider azithromycin or erythromycin as an alternative (eg, if a patient does not tolerate inhaled antibiotics) to an inhaled antibiotic for patients with bronchiectasis and chronic P. aeruginosa infection.
d. Consider azithromycin or erythromycin as an additive treatment to an inhaled antibiotic for patients with bronchiectasis and chronic P. aeruginosa infection who have a high exacerbation frequency.
Non- P. aeruginosa colonised patients
a. Use azithromycin or erythromycin for patient with bronchiectasis.
b. Consider inhaled gentamicin as a second line alternative to azithromycin or erythromycin.
c. Consider doxycycline as an alternative in patients intolerant of macrolides or in whom they are ineffective.
6. Bronchodilators: Use of bronchodilators in patients with bronchiectasis and co-existing COPD or asthma should follow the guideline recommendations for COPD or asthma,
7. Pulmonary rehabilitation: Offer pulmonary rehabilitation to individuals who are functionally limited by shortness of breath (Modified Medical Research Council (MMRC) Dyspnea Scale ≥ 1)
⎫ Recommendation for treatment.
In the case of this patient as FNP I indicated:
1. Tylenol PO 400 mg every 8 hours PRN
2. Azithromycin PO 500 mg daily per 3 days
3. Mucinex 1 tablets every 12 hours.
4. Follow-up with pneumology.
5. Follow-up with physiotherapeutic for specialized respiratory physiotherapy
⎫ How as the FNP caring for this patients (teaching)
As FNP I can contribute to the quality of life of the patient by educating him in avoiding the factors that trigger an exacerbation and how to control his illness
1. Educate on medication compliance.
2. Chest physiotherapy (eg, postural drainage, traditional mechanical percussion in the chest through palms in the chest hand)
3. Drink plenty of liquid
4. Reversal of an underlying immunodeficient state (e.g., by administration of gamma globulin for immunoglobulin-deficient patients) and vaccination of patients with chronic respiratory conditions (e.g., influenza and pneumococcal vaccines) can decrease the risk of recurrent infections.
5. Patients who smoke should be counseled about smoking cessation.
6. After resolution of an acute infection in patients with recurrences (e.g., ≥3 episodes per year), the use of suppressive antibiotics to minimize the microbial load and reduce the frequency of exacerbations has been proposed, although there is less consensus with regard to this approach in non-CF-associated bronchiectasis than in patients with CF-related bronchiectasis. Possible suppressive treatments include (1) administration of an oral antibiotic (e.g., ciprofloxacin) daily for 1–2 weeks per month; (2) use of a rotating schedule of oral antibiotics (to minimize the risk of development of drug resistance); (3) administration of a macrolide antibiotic (see below) daily or three times per week (with mechanisms of possible benefit related to non-antimicrobial properties, such as anti-inflammatory effects and reduction of gramnegative bacillary biofilms); (4) inhalation of aerosolized antibiotics (e.g., tobramycin inhalation solution) by select patients on a rotating schedule (e.g., 30 days on, 30 days off ), with the goal of decreasing he microbial load without eliciting the side effects of systemic drug administration; and (5) intermittent administration of IV antibiotics (e.g., “clean-outs”) for patients with more severe bronchiectasis and/or resistant pathogens.
References
1. Haworth C, Banks J, Capstick T, et al. BTS Guidelines for the management of nontuberculous mycobacterial pulmonary disease. Thorax 2017;72:1–64.
2. Seitz AE, Olivier KN, Steiner CA, et al. Trends and burden of bronchiectasis-associated hospitalizations in the United States, 1993-2006. Chest 2010;138:944–9
3. Bibby S, Milne R, Beasley R. Hospital admissions for non-cystic fibrosis bronchiectasis in New Zealand. N Z Med J 2015;128:30–8
4. Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J 2016;47:186–93
5. van der Bruggen-Bogaarts BA, van der Bruggen HM, van Waes PF, et al. Screening for bronchiectasis. A comparative study between chest radiography and highresolution CT. Chest 1996;109:608–11.

ITS IMPORTANT TO MEET THE COMPETENCIES !
Write a 5–6-page article on a controversial topic related to pharmacology. Explain appropriate use of pharmacology; the relationship between quality patient outcomes, patient safety, and the use of pharmacology; and how the topic affects communities and organizations. Describe inequities regarding access to pharmacological treatments.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Apply practice guidelines and standards of evidence-based practice related to pharmacology for safe and effective nursing practice.
(IMPORTANT) -Explain the appropriate use of pharmacology.
Competency 2: Explain the relationship between quality patient outcomes, patient safety, and the appropriate use of pharmacology and psychopharmacology.
(IMPORTANT) -Explain the relationship between quality patient outcomes, patient safety, and the use of pharmacology.
(IMPORTANT) -Explain how pharmacology affects communities and organizations.
Competency 3: Apply the principles and practices of cultural competence with regard to pharmacological interventions.
(IMPORTANT) -Describe inequities regarding access to pharmacology.
Competency 4: Communicate in a manner that is scholarly, professional, and consistent with expectations of a nursing professional.
(IMPORTANT) -Write content clearly and logically with correct use of grammar, punctuation, and mechanics.
Correctly format paper, citations, and references using current APA style.
Assessment Instructions
In your professional nursing practice, you will likely encounter both patients and coworkers whose personal or cultural views on pharmacology may be quite different from your own. Understanding the most current research on pharmacological topics will help you make informed choices.
For this assessment, imagine your supervisor asks you to write an article on a controversial topic for the organization’s monthly newsletter in which you review the most recent research on the topic. She stresses you must present a balanced overview and equally address the pros and cons of the topic.
Preparation
Complete the following as you prepare to write your article:
Choose a topic from the list below:
The use of medical marijuana.
The use of complementary and alternative medicines (CAM) versus traditional Western medicine.
Experimental drug programs and disease management.
Mandated vaccinations for children and the implications for parental choice not to vaccinate.
Search the Capella library and the Internet to locate peer-reviewed research articles on your selected topic. The information you use to support your work in this assessment must be as recent as possible.
Note: These are very broad topics. Limit your work to the scope of your practice and be mindful of the page-length requirements.
Requirements
Once you have identified your topic, organize your article as you wish. Be sure to include the following:
Explain the appropriate use of the pharmacology related to the topic. Include elements such as diseases or health concerns associated with the topic and the efficacy and applicability of the pharmacology.
Explain the relationship between quality patient outcomes, patient safety, and use of the pharmacology related to the topic. Remember to address both the benefits and limitations of the pharmacology in terms of specific diseases and populations.
Explain how the topic affects both the community and the organization in terms of promoting health and wellness.
Describe any inequities regarding access to the pharmacology related to the topic. Is access limited to specific groups or populations? Who determines access? On what is it based? Does access influence choice?
Follow APA guidelines to format this assessment. Include a title page and reference page.
Additional Requirements
Number of pages: 5–6 (no more than 7).
At least 4 current scholarly or professional resources.
Times New Roman, 12 point, double-spaced font.

Prepare a 4–5-page review of recent research that examines statistics on the primary health concern of a population, describes the methods and tools used in the research studies, explains the factors that affect health promotion and disease prevention for a population, and recommends a health care initiative.
Note: The assessments in this course build upon each other, so you are strongly encouraged to complete them in sequence.
The ability to locate, evaluate, and apply research is an important skill for nurses to develop in order to provide evidence-based care for individuals, families, communities, and health care systems.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Explain the principles and concepts of disease prevention and health promotion for diverse and vulnerable populations.
( IMPORTANT) -Compare the statistics for a health concern of a vulnerable or diverse population to the statistics for the general population, including ethical, legal, economic, and cultural factors.
(IMPORTANT) -Explain the principles and concepts that influence health promotion and disease prevention for the identified vulnerable or diverse population.
(IMPORTANT) -Recommend an evidence-based health care initiative for a specific health care concern of a vulnerable or diverse population.
Competency 3: Apply basic epidemiological concepts, data analysis methods, tools, and databases to determine the effectiveness of health promotion and disease prevention initiatives for diverse and vulnerable populations.
(IMPORTANT) -Describe the epidemiological concepts, data analysis methods, tools, and databases used in research studies related to health concerns for a vulnerable or diverse population.
(IMPORTANT) -Describe health care initiatives used by organizations to address the health care concerns of vulnerable or diverse populations.
Competency 5: Communicate in a manner that is scholarly, professional, and consistent with expectations for members of the health care professions.
(IMPORTANT) -Write content clearly and logically, with correct use of grammar, punctuation, APA formatting, and mechanics.
Assessment Instructions
Preparation
Your team has presented its preliminary findings to the executive leadership in your organization, but leadership has some doubts about some of the information they received. Each member of the team has been charged with doing a critical examination of recent research around each member’s area of expertise. As the team’s nursing representative, you need to look specifically at the health care concerns identified in the Windshield Survey assessment.
The first step in preparing to write a review of the research is to define your topic. For this assessment, your review will provide a comprehensive overview of the needs of the population you identified in the Windshield Survey assessment in terms of health promotion and disease prevention, the factors that contribute to health disparities for the population, and the need for the organization to improve health care delivery to the population.
In the Capella library (Capella University), search for current scholarly or peer-reviewed professional research articles that:
Examine the health care risks and needs of your population.
Analyze the need to improve health care delivery to the population.
Evaluate, critically, the factors that affect health promotion and disease prevention for the population.
Examine strategies to reduce health disparities for your population.
Locate at least 5–7 resources so that you can eliminate 2–3 if necessary. You may discover, for example, as you read each article more in-depth, that they may not all have the focus you need for your review.
Requirements
For this assessment, you need to develop several points around which to apply the research from the articles you located. Specifically, you need to:
Compare statistics for the primary health concern of your population to the rest of the general population in the United States. This would include frequency of occurrence, age groups most at risk, frequency of fatality, and so on.
Describe the epidemiological concepts, data analysis methods, tools, and databases used in the research studies you located. Address any flaws or biases you believe are present.
Explain the factors that affect health promotion and disease prevention for the population. (Hint: These may be things such as language barriers, cultural values, generational differences, social fear, and access to services.)
Describe the types of health care initiatives that have been tried by other organizations specifically for the primary health care concern or the population.
Recommend one health care initiative for your population, based on your research,
These should be the ideas, or points, that your review is based on. For each point, present all of the evidence you located. For this assessment, that should be at least four current research articles, although not all of the articles will typically offer evidence on all of your points.
Be sure your assessment includes:
An introduction that presents the points you will cover.
The body that presents the research on the points.
A conclusion that restates the points in your introduction.
Your assessment should be 4–5 pages in length, not including the title page and reference page. Be sure you follow APA guidelines for style and format.
Additional Requirements
Include a title page and reference page. The completed assessment should be 4–5 pages in length, not including the title page and reference page.
Reference at least four current scholarly or professional resources.
Use current APA format.
Use Times New Roman font, 12 point.
Double-space.