In nursing practice, accurate identification and application of research is essential to achieving successful outcomes. The ability to articulate research data and summarize relevant content supports the student’s ability to further develop and synthesize the assignments that constitute the components of the capstone project.

The assignment will be used to develop a written implementation plan.

For this assignment, provide a synopsis of the review of the research literature. Using the “Literature Evaluation Table,” determine the level and strength of the evidence for each of the eight research articles you have selected. The articles should be current (within the last 5 years) and closely relate to the PICOT question developed earlier in this course. The articles may include quantitative research, descriptive analyses, longitudinal studies, or meta-analysis articles. A systematic review may be used to provide background information for the purpose or problem identified in the proposed capstone project.

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
the PICOT you did is about diabetic

At least 250 words and 2 scholarly references within last 5 years

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different medication than your peers. Include the name of the medication in the subject line so that the medications can be followed. Include your references in APA style.

At least 250 words and 2 scholarly references within last 5 years

Choose a medical condition from the cardiovascular system and lymphatic system and explain the pathophysiology changes that may occur. What patient education would need to be included related to this disorder? Choose a medical condition different from that of your fellow students.

Reply to classmate’s post, At least 150 words and 1 scholarly references within last 5 years

POST
Alteplase is a thrombolytic agent that is manufactured by recombinant DNA technology.It is FDA approved for use in acute ischemic stroke, pulmonary embolism, acute myocardialinfarction, and occluded catheters. Off-label indications include catheter-directed thrombolysis inthe treatment of peripheral arterial occlusive disease and deep vein thrombosis. (Reed, Kerndt, & Nicolas, 2020).

Mechanism of Action

Alteplase is a fibrinolytic agent; it also is referred to as tissue plasminogen activator(tPA). Alteplase converts plasminogen to the proteolytic enzyme plasmin, which lyses fibrin aswell as fibrinogen. Intravenous alteplase is cleared primarily by the liver with an initial half-life of fewer than 5 minutes and a terminal half-life of 72 minutes. When alteplase 2 mg is instilled into occluded catheters to restore catheter function, it is unlikely that plasma will attain pharmacologic concentrations of alteplase. (Reed, Kerndt, & Nicolas, 2020).

Monitoring

Patients require assessment for bleeding and hypersensitivity reactions. Neurological status and blood pressure require monitoring during intravenous therapy. Laboratory parameters to follow include hemoglobin, hematocrit, platelets, fibrinogen, and activated partial thromboplastin time. If serious bleeding occurs, stop the alteplase therapy and provide supportive care. If a hypersensitivity reaction occurs, stop the alteplase and provide supportive therapy such as antihistamines and corticosteroids. Coagulation tests may be unreliable during alteplase therapy because alteplase may degrade fibrinogen in blood samples. (Reed, Kerndt, & Nicolas, 2020).

Side Effects

Side effects of alteplase include bleeding, angioedema, anaphylaxis, and fever. The risk of bleeding is highest in patients with the following conditions: recent intracranial hemorrhage, major surgery, cerebrovascular disease, recent trauma or major bleeding, uncontrolled hypertension, acute pericarditis, hemorrhagic ophthalmic conditions, advanced age, concurrent anticoagulant or antiplatelet agents, and any coagulopathy that makes patients more susceptible to bleeding. There have been case reports of cholesterol embolization in patients treated with thrombolytics, including alteplase. (Reed, Kerndt, & Nicolas, 2020).

Drug Interactions

Alteplase breaks down clots and thereby interferes with the body’s ability to stop bleeding. Therefore, drugs which also interfere with the body’s ability to form blood clots (or the clot-promoting effects of platelets) increase the risk of bleeding in patients receiving alteplase. Such drugs include:

Warfarin (Coumadin, Jantoven).
Aspirin, and
nonsteroidal anti-inflammatory drugs (NSAIDs), for example,
Ibuprofen (Motrin, Advil)
Naproxen (Naprosyn, Aleve)
Nabumetone (Relafen), and
platelet inhibitors such as clopidogrel (Plavix), prasugrel (Effeint), cangrelor (Kengreal), ticagrelor (Brilinta). (Ogbru & Marks, 2020).