NR 510 Week 4 TD

NR 510 Week 4 TDPART 1: You are a Family Nurse Practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers. Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of Amoxicillin with her and asked if she could have a refill. You noted the patient’s name on the label and the date on the bottle was one week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie, nor do the other providers in the practice. Discussion Question: What is your next logically sound course of action? Provide evidence to support your response. To begin with, Stephanie is practicing outside of her approved duties. Furthermore, she is putting the health and safety of the patient at risk and she is jeopardizing the NP’s license. Since the NP was examining Mrs. Smith at the time she requested the refill, the NP should take this time to fully evaluate her cough complaint. Obtaining information about the cough and her general health history is necessary. A thorough physical exam should then be performed to check for any swollen lymph nodes or redness/irritation in her throat. Elements to consider when evaluating Mrs. Smith include is this cough acute or chronic, is she immunocompromised, is she a smoker, is she producing purulent sputum, ect. (Weinberger & Silvestri, 2016). It is possible Mrs. Smith’s cough does not require antibiotics, maybe it is caused by a postnasal drip or simply requires antihistamines. If she is a smoker, Mrs. Smith may need a chest x-ray to rule out cancer. Did Stephanie verify Mrs. Smith does not have a penicillin allergy? Moreover, if the cough is related to a bacterial infection, is amoxicillin the correct medication to prescribe or is the dose and length of treatment appropriate? There are many factors to evaluate before prescribing medications and Stephanie should understand the ramifications that can occur if something goes wrong