Sample Answer for NUR-635 Topic 13 DQ 1 Included After Question
David is a 19-year-old male who has been sexually active with multiple partners in the last month. The patient presents to the clinic with painful urination, swelling in testicles, and purulent discharge from his penis. David has been diagnosed with gonorrhea. Discuss the following:
Briefly describe the bacteria associated with gonorrhea. Include which bacteria are associated with the highest prevalence and how these bacteria are classified (e.g., gram-negative, gram-positive, etc.)
Determine a treatment strategy for David. Include the drug, dose, frequency, and treatment length, and explain your rationale for choosing this medication, including spectrum of coverage and mechanism of action.
Determine monitoring, side effects, and drug-drug interactions associated with each medication.
The FNP seeing David also wants to cover co-treatment for chlamydia. Explain the rationale for co-treatment of chlamydia and gonorrhea.
How does this change your treatment strategy for David? Include the drug, dose, frequency, and treatment length, and explain your rationale for choosing this medication, including spectrum of coverage and mechanism of action.
Determine monitoring, side effects, and drug-drug interactions associated with each medication.
American Association of Colleges of Nursing Core Competencies for Professional Nursing Education
This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2
A Sample Answer For the Assignment: NUR-635 Topic 13 DQ 1
Title: NUR-635 Topic 13 DQ 1
Briefly describe the bacteria associated with gonorrhea. Include which bacteria are associated with the highest prevalence and how these bacteria are classified (e.g., gram-negative, gram-positive, etc.)
Neisseria gonorrhoeae, the causative agent of gonorrhoea, is a Gram negative, coffee-bean shaped facultative intracellular diplococcus bacterium, the classical sexually transmitted bacteria (Yeshanew & Geremew, 2018).
Determine a treatment strategy for David. Include the drug, dose, frequency, and treatment length, and explain your rationale for choosing this medication, including spectrum of coverage and mechanism of action.
Because of increasing resistance to cephalosporins, preferred treatment now consists of a combination of two drugs: ceftriaxone intramuscular(IM) plus azithromycin oral (PO) (Rosenthal & Burchum, 2020). In adults, it is recommended to take Ceftriaxone, 1 g IM or IV every 24 h, plus azithromycin, 1 g PO once (Rosenthal & Burchum, 2020).
Determine monitoring, side effects, and drug-drug interactions associated with each medication.
Pharmacokinetic parameters of ceftriaxone are highly variable in clinical situations such as severe renal insufficiency, liver and renal insufficiency, the elderly, the neonates less than 1 week of age and critically ill patients. In these clinical situations associated or not with high minimal inhibitory concentration (MIC) level, the relationship concentration-clinical outcome based on the ratio between trough plasma concentration and MIC can allow a dose adjustment. Consequently, therapeutic drug monitoring (TDM) of ceftriaxone could be possibly useful in these situations, whereas the necessity of TDM has still to be demonstrated to monitor toxicity (Dailly et al., 2012).
Common side effects are, black, tarry stools, chest pain, chills, cough, fever, painful or difficult urination, shortness of breath, sore throat, sores, ulcers, or white spots on the lips or in the mouth, swollen glands, unusual bleeding or bruising, and unusual tiredness or weakness (Mayo Clinic, 2023).
The FNP seeing David also wants to cover co-treatment for chlamydia. Explain the rationale for co-treatment of chlamydia and gonorrhea.
The FNP is recommending co-treatment for chlamydia due to, chlamydial and gonococcal infections in men are often asymptomatic; however, gonorrhea is more likely than chlamydia to cause symptoms in men than in women. Both types of infection can increase risk of acquiring or transmitting HIV (USPSTF, 2021).
How does this change your treatment strategy for David? Include the drug, dose, frequency, and treatment length, and explain your rationale for choosing this medication, including spectrum of coverage and mechanism of action.
Based on review of recent evidence, CDC recommends a single 500 mg intramuscular dose of ceftriaxone for uncomplicated gonorrhea. Treatment for coinfection with Chlamydia trachomatis with oral doxycycline (100 mg twice daily for 7 days) should be administered when chlamydial infection has not been excluded (CDC, 2020).
Determine monitoring, side effects, and drug-drug interactions associated with each medication.
There are no standard routine tests to monitor the use of doxycycline. The most significant side effect is hepatic injury, which can be avoided by administering doxycycline hyclate at the recommended dosage and keeping contraindications and adverse effects in mind. Common reactions include, mild diarrhea, photosensitivity, nausea, vomiting, skin rash/itching, headaches and tooth discoloration. There is limited evidence for severe reactions, however, they include, bloody diarrhea, leukopenia, migraines, hemolytic anemia, throat irritation or trouble swallowing, chest pain, exacerbation of systemic lupus erythematosus, shortness of breath, irregular or fast heart rate, dysuria, intracranial hypertension and esophagitis/esophageal ulcerations if taken without water (Patel & Parmar, 2023).
Reference:
Centers for Disease Control and Prevention. (2020, December 17). Update to CDC’s treatment guidelines for gonococcal infection, 2020. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm
Dailly E, Verdier MC, Deslandes G, Bouquié R, Tribut O, Bentué-Ferrer D. Niveau de preuve du suivi thérapeutique pharmacologique de la ceftriaxone [Level of evidence for therapeutic drug monitoring of ceftriaxone]. Therapie. 2012 Mar-Apr;67(2):145-9. French. doi: 10.2515/therapie/2012018. Epub 2012 Aug 2. PMID: 22850101.
Mayo Clinic. (2023, February 1). Ceftriaxone (injection route) side effects. https://www.mayoclinic.org/drugs-supplements/ceftriaxone-injection-route/side-effects/drg-20073123
Patel RS, Parmar M. Doxycycline Hyclate. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555888/
Rosenthal, L. D., & Burchum, J. R. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.
US Preventive Services Taskforce. (2021, September 14). Chlamydia and gonorrhea: Screening. Recommendation: Chlamydia and Gonorrhea: Screening | United States Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening
Yeshanew AG, Geremew RA. Neisseria Gonorrhoae and their antimicrobial susceptibility patterns among symptomatic patients from Gondar town, north West Ethiopia. Antimicrob Resist Infect Control. 2018 Jul 17;7:85. doi: 10.1186/s13756-018-0376-3. PMID: 30026943; PMCID: PMC6050735.
