The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable since very few drugs have been specifically researched and tested with children.

When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion. Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.

To prepare:

• Review the Bazzano et al. and Mayhew articles in the Learning Resources. Reflect on situations in which children should be prescribed drugs for off-label use.
• Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.

With these thoughts in mind:

By Day 3

Post an explanation of circumstances under which children should be prescribed drugs for off-label use. Then, 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.

CLASS RESOURCES

Arcangelo,  V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.).  (2017). Pharmacotherapeutics for advanced  practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams  & Wilkins.
Review Chapter 4, “Principles of Pharmacotherapy in Pediatrics” (pp. 53-63)
This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.

Chapter 17, “Ophthalmic Disorders” (pp. 221-243)
This chapter examines the causes, pathophysiology, diagnostic criteria, and drug treatment for four ophthalmic disorders: blepharitis, conjunctivitis, keratoconjunctivitis sicca, and glaucoma. It also explores methods of monitoring patient response to treatment.

Chapter 43, “Attention-Deficit/Hyperactivity Disorder” (pp. 743-756)
This chapter explains the process of diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD). It also identifies drugs for treating patients with ADHD, including proper dosages, selected adverse events, and special considerations for each drug.

Chapter 51, “Immunizations” (pp. 906-926)
This chapter explores vaccines that are licensed for use in the United States and provides a recommended vaccination schedule for pediatric patients and adults.

Chapter 52, “Smoking Cessation” (pp. 927-943)
This chapter examines clinical implications of smoking. It also covers various approaches for aiding patients who are dependent on nicotine but want to stop smoking.

Chapter 54, “Weight Loss” (pp. 945-956)
This chapter begins by reviewing patient factors that contribute to obesity. It also examines drug therapy for initiating weight loss in patients, as well as alternative non-drug treatments.

Bazzano, A. T, Mangione-Smith, R., Schonlau, M., Suttorp, M. J., & Brook, R. H. (2009). Off-label prescribing to children in the United States outpatient setting. Academic Pediatrics, 9(2), 81–88.
Note: Retrieved from the Walden Library databases.

This study examines the frequency of off-label prescribing to children and explores factors that impact off-label prescribing.

Mayhew, M. (2009). Off-label prescribing. The Journal for Nurse Practitioners, 5(2), 122–123.
Note: Retrieved from the Walden Library databases.

This article reviews the prevalence of off-label prescribing, including its benefits and risks. It also explores issues regarding the safety of off-label prescribing and when it is unavoidable.

Drugs.com. (2012). Retrieved from http://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

Discussion: Finance and the Healthcare Manager

With all the advances in healthcare in recent decades, one question that continues to stir debate within the political arena and cause great concern to the public is how to pay for the rising costs of healthcare. Healthcare managers must be good stewards of their resources to allow the funds available to do the greatest good for the largest number of people. Healthcare finance information is critical to assessing the financial condition of an organization, as well as assessing whether the resources being spent are achieving the goals of the organization.

To prepare for this Discussion:

• Select a recent (within 5 years) relevant article from the Walden University Library.
• Review current information from Centers for Medicare & Medicaid Services and the Healthcare Financial Management Association Knowledge Center which addresses the importance of healthcare finance information in decision-making within the healthcare setting.
• Choose one of the individuals described in the Good Samaritan Hospital’s Organizational Chart: Week 1 or Welcome to Waldenville media. Consider how the individual’s particular healthcare setting influences financial decision-making and application of financial strategies.
• Consider how healthcare managers apply principles of financial management in decision-making—assessing the financial condition of an entity or stewardship or assessing the efficiency, effectiveness, and compliance with organization directives.
• What are some of the financial challenges healthcare leaders and managers would face considering today’s factors? Consider real-life internal and external environmental factors such as defunding of programs and increased competition from other organizations.

By Day 4

Post a comprehensive response to the following:

• Briefly summarize a potential financial situation faced by the individual you selected in the Welcome to Waldenville or Good Samaritan Hospital: Week 1 media and explain why it is a challenge.
• Explain how the healthcare manager depicted might successfully apply the principles of financial management in his or her decision-making within the healthcare setting.
• What role, if any, did healthcare setting play in application of the financial management principles?

Create a 15-minute oral presentation (3–4 pages) that examines the moral  and ethical issues related to triaging patients in an emergency room.

Working in an emergency room gives rise to ethical dilemmas. Due to time  restraints and the patient’s cognitive impairment and lack of medical  history, complications can and do occur. The nurse has very little time  to get detailed patient information. He or she must make a quick  assessment and take action based on hospital protocol. The organized  chaos of the emergency room presents unique ethical challenge, which is  why nurses are required to have knowledge of ethical concepts and  principles.

Your supervisor has asked you to do a 15-minute oral presentation at a  staff meeting about a recent issue that occurred at another hospital in  town. Following an industrial accident, two patients arrived at the  emergency room of that hospital at the same time, presenting with very  similar inhalation injuries. The hospital received a great deal of  negative press due to how the patients were triaged in the ER. Your  supervisor would like you to use the specifics of this case to review  triage procedures and best practices at your facility. Here are the  details:

• One is a 32-year-old firefighter, Frank Jeffers, who is  presenting with respiratory difficulties that he obtained while  evacuating victims of an industrial accident. He is a married homeowner  and father of two young boys. He has lived in the community all his  life. He has full and comprehensive health insurance through his  employer.
• The other is Brent Damascus, a 58-year-old man. Brent is  presenting with respiratory difficulties with the same intensity as Mr.  Jeffers above. He is well known at the hospital emergency room, as he is  a frequent visitor with various complaints, including asthma,  headaches, and tremors. He is homeless, unemployed, and uninsured. He  stays many nights at the YMCA and eats lunch at the soup kitchen. He has  lived in the community for over 10 years and has been arrested several  times for petty theft.

Preparation

Search the Capella library and the Internet for scholarly and  professional peer-reviewed articles on best practices in triage nursing.  You will need at least three articles to use as support for your work  on this assessment.

Directions

Create a 15-minute presentation (3–4 pages) that examines the moral  and ethical issues that occurred when triaging these two patients and  the best practices for managing this in the future.

Divide your draft into a number of talking points that you can  summarize neatly. Keep in mind that an oral presentation requires  slightly different language than an essay. The aim is to communicate  your message so keep sentences simple and focus on the key points you  want to deliver. Address the following in your presentation:

• Explain the health care policies and protocols that are in place that direct triage care in an emergency situation.
• Explain how health care disparities impact treatment decisions.
• Identify the health care policies that are in place that direct  care for uninsured individuals. Is there a difference in how these  individuals are triaged?
• Describe the moral and ethical challenges nurses can face when  following hospital policies and protocols. Is there a conflict when a  severely injured person is also uninsured?
• Recommend evidence-based strategies that should be applied for managing the care of uninsured and indigent population.

Additional Requirements

Your presentation should meet the following requirements:

• Written communication: Written communication should be free of errors that detract from the overall message.
• References: Include a reference section with a  minimum of three references; a majority of these should be peer-reviewed  sources. All resources should have been published within the last 5  years.
• APA format: Resources and citations should be formatted according to current APA style and formatting.
• Length: 3–4 typed, double-spaced pages, excluding title page and reference page. Use Microsoft Word to complete the assessment.
• Font and font size: Times New Roman, 12-point.

Imagine that you are a leadership consultant.

1. Use your example of conflict in your professional practice (from the Conflict resolution assignment you did last week) and build on the readings, videos, and peer input you received. (See attachments)

2. Critically analyze the situation and create a plan that would have helped to resolve the conflict and promote collaboration among the group.

3. Your plan should include 7 to 10 scholarly references, and be seven to eight pages long (page count does not include the cover or references list). Review your conflict scenario and include the following

– Comprehension: Review the details of the conflict scenario, identifying the type and effects of the conflict.

– Application: Relate course content on delegation, empowerment, group dynamics, and constructive group roles and behaviors to the identified conflict scenario.

– Analysis/Synthesis: Clarify understanding of the internal and external variables contributing to the conflict. Create a plan that would have helped to resolve the conflict and promote a high functioning health care team.

– Evaluation: Summarize the value of effective conflict resolution skills for the nurse leader.

FREE OF PLAGIARISM
APA STYLE 6th EDITION (Seven to eight pages long)

7 to 10 scholarship references.