NGR 5172 Deliverable 3 Clinical Judgment in Advanced Nursing Practice

NGR 5172 Deliverable 3 Clinical Judgment in Advanced Nursing Practice

Student Name

Department of Nursing, Rasmussen University

NGR5172

Professor Name

Date

Handout 1: Your Role in Antibiotic Stewardship

Meaning of Antibiotic Stewardship

It is the attempt to apply antibiotics in the right way to cure infections, protect patients, and fight against antibiotic resistance. It aims at providing the right drug, right dose, right route, and right duration to each patient. 

Importance of Nurses

As the front-line clinician, you observe the response of the patient, administer medications, and are the main person to communicate between the patient, family, and providers. Your decisions and judgments have a direct patient safety and quality of care. (CDC, 2024).

Key Nursing Actions

• Verify Indication: Confirm an antibiotic is truly needed.
• Obtain Cultures: Advocate for cultures before the first dose when possible.
• Monitor Response: Track fever, white blood cell count, and symptoms. Report a lack of improvement.
• De-escalate: Prompt providers to narrow therapy once culture results are available.
• Switch to Oral: Advocate for IV to PO transition as soon as the patient is stable.
• Stop Unnecessary Therapy: Question continued use if an infection is ruled out (Chan et al., 2022).

Lifespan Considerations

• Pediatrics: Dose is weight-based. Compliance using liquid preparations is one of the challenges; teach the parents how to finish the course.
• Adults: Support IV to PO conversion to minimize the risk of infection and encourage movement. Evaluate drug interactions. 
• Older Adults: Aged renal insufficiency augments the risk of toxicity. Watch out for any signs of atypical infection, such as new confusion and C. difficile diarrhea. (Mokrani et al., 2023). 

References

CDC. (2024, June 10). Core Elements of Antibiotic Stewardship. Antibiotic Prescribing and Use. https://www.cdc.gov/antibiotic-use/hcp/core-elements/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fantibiotic-use%2Fcore-elements%2Findex.html

Chan, Y. Q., Chen, K., Chua, G. T., Wu, P., Tung, K. T. S., Tsang, H. W., Lung, D., Ip, P., & Chui, C. S. L. (2022). JAC-Antimicrobial Resistance, 4(2), 1–12. https://doi.org/10.1093/jacamr/dlac036

Mokrani, D., Chommeloux, J., Pineton, M., Guillaume Hékimian, & Charles-Édouard Luyt. (2023). Antibiotic stewardship in the ICU: Time to shift into overdrive. Annals of Intensive Care, 13(1), 39. https://doi.org/10.1186/s13613-023-01134-9

Handout 2: Safe Opioid Administration: Evidence-Based Guidelines

Nursing Responsibility in Opioid Management

Your contribution is important in the balancing of effective pain relief and patient safety. Follow the principles of safe prescribing: the right patient, right drug, right dosage, right route, and right duration, and monitor the efficacy and adverse effects constantly (Dowell et al., 2022). Fundamental Evidence-Based Recommendations.

• Multimodal Analgesia: Use non-opioid analgesics (e.g., acetaminophen, NSAIDs) along with opioids to achieve more efficacy and lessen the opioid needs and side effects. 
• START LOW, GO SLOW: Start therapy with the lowest dose of effectiveness, particularly in opioid naive patients. Gradually titrate according to the response of the patient. 
• Evaluation is Important: Evaluate both pain and function using a standardized pain scale (e.g., 0-10). It is not an aim of zero pain score but better functioning (Shaleesa Ledlie et al., 2024). 
• Watch Adverse Effects: Preemptively evaluate and treat respiratory depression, sedation, nausea, and constipation. Naloxone should always be available.

Lifespan Considerations

• Pediatrics: It is a weight-based dosage. Apply age-related pain scales. One of the most important historians and collaborators in sedation or behavioral tracking is the parents. 
• Adults: Risk factors to screen (e.g., substance use disorder, Personal or family history of substance use disorder). Stress that opioids are used in the management of short-term acute pain in most instances. 
• Older Adults: Sedation, confusion, and falls are more common due to age-related alterations in the metabolic process and polypharmacy. Administer lower doses (usually 25-50 percent lower than the adult dose) and pay close attention to delirium. Constipation is a significant issue; a prophylactic bowel regimen should be started (Thakrar et al., 2023). 

Essential Nursing Actions 

1. Pre-assessment: Check the level of pain, the rate of sedation, and respiration. 
2. Patient Education: Creating realistic expectations. Talk about side effects, safe storage, and disposal. 
3. Use PDMPs: The Prescription Drug Monitoring Program (PDMP) should also be advocated to detect risky patterns of prescription. 
4. Plan on Tapering: To continue with the opioid, discuss with the provider a plan to gradually reduce the opioid to avoid withdrawal.

References

Dowell, D., Ragan, K., Jones, C., Baldwin, G., & Chou, R. (2022). Recommendations and Reports, 71(3), 1–95. https://doi.org/10.15585/mmwr.rr7103a1

Shaleesa Ledlie, Garg, R., Cheng, C., Kolla, G., Antoniou, T., Bouck, Z., & Gomes, T. (2024). International Journal of Drug Policy, 125(1), 104339–104339. https://doi.org/10.1016/j.drugpo.2024.104339

Safety and preliminary outcomes of short-acting opioid agonist treatment (sOAT) for hospitalized patients with opioid use disorder. Addiction Science & Clinical Practice, 18(1), 13. https://doi.org/10.1186/s13722-023-00368-z

Handout 3: Advances in Topical Therapies: Dermatologic, Otic, and Ocular Conditions

The emerging targeted therapies are enhancing patient outcomes and the quality of life of patients with common skin, ear, and eye conditions. The nurses are in the position of teaching patients how to administer these usually sensitive treatments. 

Dermatologic Advances 

Biologics & Janus Kinase (JAK) Inhibitors in situations as psoriasis, atopic dermatitis, and vitiligo, selective systemic drugs are used, which provide better symptom management with fewer side effects compared to general immunosuppressants. A breakthrough to regimentation consists of Topical JAK Inhibitors (e.g., Opzelura® in the case of vitiligo) (Dereiah et al., 2024). Otic (Ear) Advances Novel 

Otic Suspensions

New combination antibiotic/steroid drops are more brilliant in treating resistant organisms in otitis externa. The great breakthrough is the formulation of non-aminoglycoside medications, the use of which does not involve the threat of ototoxicity, which makes their application safer in case the tympanum is ruptured.

Ocular (Eye) Advances

Ophthalmic Biologics: Ophthalmic Biologics include Eylea, which is a drug used to prevent diabetic retinopathy and age-related macular degeneration (AMD) by inhibiting the abnormal proliferation of blood vessels (DiRuggiero et al., 2025). More recent Glaucoma Drops (e.g., Rhopressa®) are available, with another option to be taken by the patients who cannot be treated with the other medications.

Lifespan Considerations

• Pediatrics: child-friendly language. In the case of eye/ear drops, show on a doll. Make sure that parents can administer treatments safely, which is quite tough when dealing with a struggling child.
• Adults: Adults should be focused on compliance, particularly in chronic diseases such as psoriasis or glaucoma, where curative interventions avoid long-term injury. Discuss the high cost of biologics and guide the resources.
• Older Adults: Inquire about difficulty with dexterity (arthritis, tremor) that affects bar drop administration. Refer to assistive devices or engage a caregiver. In the case of AMD treatments, respond to transportation requirements in frequent office-based injections (Fischer et al., 2025).

These innovative therapies are susceptible to proper administration. This is because your patient education gives the patient the full advantage.

References

Dereiah, S., Ghori, M. U., & Conway, B. R. (2024). Pharmaceutics, 17(1), 27. https://doi.org/10.3390/pharmaceutics17010027

DiRuggiero, D., Agopian, J., Baker, A., Blair, A., Brunner, M., Dinallo, A., Love, J., Rygg, K., Sookhoo, A., Young, M., Higham, R., Seal, M., & Hanna, D. (2025). Recommendations for Topical Corticosteroid Use and the Role of Alternative, Advanced Targeted Topical Treatments in the Treatment of Chronic Inflammatory Skin Diseases. The Journal of Clinical and Aesthetic Dermatology, 18(5-6 Suppl 1), S10. https://pmc.ncbi.nlm.nih.gov/articles/PMC12303372/

Fischer, D. L., Foy, V., Fischer, N. E., Litchman, G., Rozenberg, S. S., & Friedman, A. J. (2025). Dermatological Reviews, 6(3), e70036. https://doi.org/10.1002/der2.70036

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