This course supports the assessment for Pathopharmacological Foundations for Advanced
Nursing Practice. The course covers 5 competencies and represents 3 competency units.
Introduction
Overview
In Pathopharmacological Foundations for Advanced Nursing Practice, you will gain application
skills by examining syndromes rather than looking at body systems independently. The course
includes pathophysiologies, the associated pharmacological treatments, and social and
environmental impacts. Most students will need at least 6–8 weeks to accomplish the
process-oriented competencies in the course.
You are encouraged to look now at the performance assessment associated with this course.
Then you can organize your notes and study habits and be prepared to advance quickly through
the performance assessment.
Pathopharmacological Foundations for Advanced Nursing Practice is an integrated examination
of five common and important disease processes:
asthma
heart failure
obesity
traumatic brain injury
depression
These processes are relevant to advanced nursing practice because of their prevalence and
impact on the healthcare system and the health of the nation.
Competencies
This course provides guidance to help you demonstrate the following 5 competencies:
Competency 7002.1.1: Pathophysiology
The graduate evaluates high volume, high impact disease processes, including
associated pharmacological interventions and implications for advanced practice.
Competency 7002.1.2: Evaluation of Pharmaceutical Impact
The graduate analyzes pharmaceutical impacts, including physiological, psychological,
financial, and lifestyle factors on the selected disease processes.
Competency 7002.1.3: Managing Care Transitions
The graduate evaluates salient pharmacological issues in managing patient care
transitions.
Competency 7002.1.4: Salience
The graduate distinguishes between general information and relevant assessment
findings to manage and minimize pathologies and risk factors to promote optimal patient
outcomes.
Competency 7002.1.5: Care Management
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The graduate integrates relevant patient and population data to develop
pathopharmacological management strategies for populations.
Nursing Dispositions Statement
Please review the Statement of Nursing Dispositions.
Preparing for Success
The information in this section is provided to detail the resources available for you to use as you
complete this course.
Learning Resources
The learning resources listed in this section are required to complete the activities in this course.
For many resources, WGU has provided automatic access through the course. However, you
may need to manually enroll in or independently acquire other resources. Read the full
instructions provided to ensure that you have access to all of your resources in a timely manner.
Automatically Enrolled Learning Resources
You will be automatically enrolled at the activity level for the following learning resources.
Simply click on the links provided in the activities to access the learning materials.
VitalSource E-Texts
The following textbooks are available to you as e-texts within this course. You will be directly
linked to the specific readings required within the activities that follow.
McCance, K.L., Huether, S.E. (2014). Pathophysiology: The biologic basis for disease in
adults and children (7th ed.). St. Louis, Missouri: Mosby Elsevier. ISBN:
978-0-323-08854-1
Frandsen, G. & Pennington, S.S. (2013). Abrams’ clinical drug therapy: Rationales for
nursing practice. (10th ed). Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins Print ISBN: 9781609137113, 1609137116
Note: These e-texts are available to you as part of your program tuition and fees, but you may
purchase hard copies at your own expense through a retailer of your choice. If you choose to do
so, please use the ISBN listed to ensure that you receive the correct edition.
Other Learning Resources
You will use the following learning resources for this course.
WGU Library E-Reserves
This course utilizes resources located in the WGU Library E-Reserves, with articles available for
you to download. For instructions on how to access WGU Library E-Reserves, see
the “Accessing WGU Library E-Reserves.”
Specific titles and links to these resources will be provided as needed in the activities.
Nursing Standards
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You will be able to access Nursing Professional Standards as they apply to your program
through the WGU Library. Please access these documents at the following website:
WGU Library Nursing E-Reserves
Topics and Pacing
This course overview suggests a balanced pacing structure for completion of the required
learning activities for Pathopharmacological Foundations for Advanced Nursing Practice.
Introduction
Preparing for Success
Learning Resources
Topics and Pacing
Pathophysiology
Pathophysiology
Evaluation of Pharmaceutical Impact
Evaluation of Pharmaceutical Impact
Salience
Salience
Managing Care Transitions
Managing Care Transitions
Case Management
Case Management
Final Steps
Course Support
Follow the instructions under each topic in the course of study to assure successful preparation
and completion of the required performance assessment.
Watch the following video: Course Communities Walkthrough
Note: To download this video, right-click the following link and choose “Save as…”: download
video.
Pathophysiology
Pathophysiology is the study of pathological changes in organ system function. It can be
defined as the general study of the physical, biochemical, and mechanical manifestations of
disease and their relation to underlying abnormalities or physiological disturbances.
Pathophysiology attempts to explain the processes in the body that result in the manifestation of
signs and symptoms of a disease.
Pathophysiology
This topic addresses the following competency:
Competency 7002.1.1: Pathophysiology
The graduate evaluates high volume, high impact disease processes, including
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associated pharmacological interventions and implications for advanced practice.
This topic highlights the following objectives:
Identify key pathophysiology and pathological processes in selected disease processes.
Recognize diagnostic features, signs, and symptoms of selected disease processes.
Identify the inflammatory mechanisms involved in disease processes.
Evaluate the state of the science related to the selected disease processes.
Indicate how environmental, socioeconomic, and genetic/genomics factors impact the
disease process.
Review: Genes, Environment, and Common Diseases
Review the influence of genetics and environment for common diseases.
Review the following resources as they relate the five disease processes you will focus on in
this course (asthma, heart failure, obesity, traumatic brain injury, and depression)
chapter 5 (“Genes, Environment, and Common Diseases”) in Pathophysiology: The
Biologic Basis for Disease in Adults and Children
HealthyPeople.gov: Genomics
Diseases and Condtions: Tramatic brain injuury
Asthma-Read: Background Information
Review basic pathophysiologic background information about asthma by responding to the
following prompts as you read the materials listed below:
Identify anatomical structures associated with the lower respiratory tract and their
functions.
Explain how the nervous system regulates airflow in the lower respiratory tract and how
the process can be modified by drugs.
Read the following chapters in Pathophysiology: The Biologic Basis for Disease in Adults and
Children:
chapter 8 (“Adaptive Immunity”)
chapter 35 (“Alterations of Pulmonary Function”)
Asthma-Explore: Guidelines
Identify key pathological processes and recommended treatments.
Explore the following article for resources to find information on diseases and processes:
Diagnosis and management of asthma – Statement on the 2015 GINA Guidelines
Asthma-Begin: Case Study: Part 1
Read the following case study:
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Asthma Case Study
As you apply what you’ve learned to an asthma case study, answer the following prompts:
Describe the course of the disease and include the effects on other body systems.
Consider the pediatric patient in the scenario. What are the possible short-term and
long-term effects that poorly treated asthma could have on his body systems?
Heart Failure-Read: Background Information
Review basic pathophysiologic background information about heart failure as you read the
following chapters in Pathophysiology: The Biologic Basis for Disease in Adults and Children:
chapter 31 (“Structure and Function of the Cardiovascular and Lymphatic Systems”)
chapter 32 (“Alterations of Cardiovascular Function”)
Heart Failure-Explore: WebMD
While heart deterioration is part of the aging process, certain disease process can accelerate
decreased cardiac function. Review the following contributors to heart failure. Describe briefly
how they decrease cardiac function. Review your understanding of preload and afterload.
Categorize the disease process into preload or afterload categories for the following conditions:
coronary artery disease (CAD)
mitral stenosis
chronic hypertension
diabetes mellitus
Search WebMD for reliable information that will help you address the instructions above.
Heart Failure-Begin: Case Study
Apply what you’ve learned to the following case study:
Heart Failure Case Study
As you read the case study, answer the following prompts:
Describe the pathophysiology of cardiac disease across the lifespan.
Consider the pediatric patient in the scenario. What are specific cardiac issues with
diagnosing and treating teenagers?
Obesity-Define: Obesity
In your notes, explain the clinical diagnosis of obesity. You may want to add to or change this
definition as you work through the sections in this course related to obesity. You can begin your
definition by searching for information on the following website:
Endocrine Facts and Figures: Obesity
Obesity-Review: Etiology
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Review the following section about the etiology of obesity in Pathophysiology: The Biologic
Basis for Disease in Adults and Children:
“Obesity” (pages 1447-1450) in chapter 41 (“Alterations of Digestive Function”)
Obesity-Read: Alterations of Hormonal Regulation
You should already have a comprehensive understanding of the pathophysicological
mechanisms of disease processes based on your previous studies and experiences.
As you read, scan for key principles. Make sure you understand how various organ systems are
impacted by metabolic disorders. For example, you should be able to identify the
pathophysiological effects of metabolic disorders on endocrine, cardiovascular, renal, and
digestive systems.
Read the following chapter in Pathophysiology: The Biologic Basis for Disease in Adults and
Children:
chapter 22 (“Alterations of Hormonal Regulation”)
Obesity-Complete: Case Study Part 1
Read the following case study and write your recommendations for the patient:
Obesity Case Study
After you have compiled your recommendations for this patient, read the suggestions in the
following section of the case study:
Suggestions, Obesity Case Study: Part 1
Obesity-Read: Health Disparities
Read the following section of the CDC’s Health Equity Resource Toolkit for State Practitioners
Addressing Obesity Disparities:
“Scope of the Problem” (pp. 9–12)
Traumatic Brain Injury?Read: Trauma
Review basic pathophysiologic background information about TBI as you read the following
section in Pathophysiology: The Biologic Basis for Disease in Adults and Children:
“Trauma” section (pages 581-590) of chapter 18 (“Disorders of the Central and Nervous
Systems and Neuromuscular Junction”)
Traumatic Brain Injury-Read: Chapter 17
Many body systems may present symptoms that result from TBI. Note the multiple and varied
symptoms that may lead you to suspect TBI as you read the following chapter
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in Pathophysiology: The Biologic Basis for Disease in Adults and Children:
pages 525-582 in chapter 17 (“Alterations in Cognitive Systems, Cerebral
Hemodynamics, and Motor Function”)
Traumatic Brain Injury-Summarize: Pathophysiology
Explore the following resources to differentiate characteristic symptoms of mild TBI and severe
TBI:
Diagnosing & Treating Brain Injury
Depression-Read: General Audience Resources
Read the following resources, which give a comprehensive overview of depression for
non-professional audiences:
NIMH: Depression
Depression-Read: Nursing Resources
Review the overall characteristics and forms of depression from a more professional nursing
perspective.
Read the following sections in Pathophysiology: The Biologic Basis for Disease in Adults and
Children:
pages 337–359 in chapter 11 (“Stress and Disease”)
pages 443–465 in chapter 15 (“Structure and Function of the Neurologic System”)
pages 647–664 in chapter 19 (“Neurobiology of Schizophrenia, Mood Disorders, and
Anxiety Disorders”)
Evaluation of Pharmaceutical Impact
Evaluation of pharmaceutical impact is defined as the investigation of the pharmacodynamic
and pharmaceutical impacts (including physiological, psychological, financial, and lifestyle
factors) on selected disease processes and patients.
Evaluation of Pharmaceutical Impact
This topic addresses the following competency:
Competency 7002.1.2: Evaluation of Pharmaceutical Impact
The graduate analyzes pharmaceutical impacts, including physiological, psychological,
financial, and lifestyle factors on the selected disease processes.
This topic highlights the following objectives:
Identify the drug classes typically used to treat selected disease processes.
Identify how drugs affect the mechanisms of disease processes.
Identify the anticipated effect of the drugs used for treating the selected disease
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processes.
Evaluate current treatment trends in pharmacotherapeutics related to treatment for the
selected disease processes.
Identify possible complementary and alternative therapies for the selected disease
processes.
Identify potential interactions among prescribed and over-the-counter medications that a
patient may be using.
Analyze factors that impact the effectiveness of pharmaceutical agents.
Examine any special considerations for drug therapy for special patient populations.
Identify medications used to treat the selected disorders with high risk for misuse or
abuse.
Asthma-Read: Background Information
Review basic pharmacological background information about asthma.
Read the following chapters in Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice
by Frandsen and Pennington:
Chapter 27 Drug Therapy to Enhance the Adrenergic Response
Chapter 46 Drug Therapy for Myasthenia Gravis and Alzheimer’s Disease
Chapter 29 Drug Therapy for Nasal Congestion
Chapter 30 Drug Therapy to Decrease Histamine Release and Allergic Response
Chapter 31 Drug Therapy for Asthma and Bronchoconstriction
Chapter 43 Drug Therapy for Addison’s Disease and Cushing’s Disease
Asthma-Complete: Case Study Part 1
Review part 1 of the following case study to evaluate the pharmaceutical impact:
Asthma Case Study
Answer the following questions:
How do medications treat this disease?
The patient was started on a high-flow nasal cannula at 100% oxygen.
Does this decrease his respiratory rate?
Does this increase his oxygen saturation?
How do his lungs sound on auscultation?
Does he have wheezing?
Is there evidence of rhonchi?
The patient’s initial arterial blood gas indicates a low pH, high CO2, and low oxygen
content.
Determine how his lungs are functioning.
What do you expect to find?
How has his elevated CO2 levels affected his neurological status?
Would you expect his brain functioning to change before and after the PICU treatment?
Describe what you would expect from his heart sounds.
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Describe how his chest X-ray would look.
What would you expect from the patient’s appearance once treatment has stabilized
him? Breathing, heart rate, skin appearance, and comfort level?
Would he likely maintain proper renal output while on antibiotic and antiviral
medications? (Some antibiotics, particularly Vancomycin, can cause renal shutdown or
renal insufficiency, as evidenced by bloody urine.)
Would you expect his urine to be proper in color and consistency?
Given the type of treatment provided to the patient, what would you expect from his fluid
status?
Heart Failure-Review: Drugs
Review mechanisms of drug action in heart disease throughout Abrams’ Clinical Drug Therapy:
Rationales for Nursing Practice by Frandsen and Pennington. Especially review carefully the
following chapters:
Chapter 8 Drug Therapy for Dyslipidemia
Chapter 24 Drug Therapy for Heart Failure
Chapter 26 Drug Therapy for Angina
Chapter 25 Drug Therapy for Dysrhythmias
Heart Failure-Complete: Case Study Part 2
Continue to apply what you’ve learned to the following case study:
Heart Failure Case Study
As you read the case study, answer the following questions:
When taking a patient history, what specific questions would you ask the patient about
medication use?
Describe polypharmaceutical use/abuse and how it relates to cardiac issues in
adolescents.
What “drugs” could lead to cardiac issues in young people?
After you have compiled your recommendations for this patient, read the suggestions in the
following section of the case study:
Suggestions, Heart Failure Case Study: Part 2
Obesity-Complete: Case Study Part 2
Refer back to the following case study:
Obesity Case Study
Suppose that you have performed and ordered the necessary tests and found that the patient’s
blood glucose level is 140 and her ketones are negative. How would you treat her?
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You may want to answer this as you work through the other activities for this topic. After you
have compiled your recommendations for this patient, read the suggestions in the following
section of the case study:
Suggestions, Obesity Case Study: Part 2
Obesity-Explore: Clinician Perspective
Review the objectives highlighted in the topic description for this topic (“Evaluation of
Pharmaceutical Impact: Obesity”). With these objectives in mind, spend time researching the
pharmaceutical impact of obesity using the following website:
American Family Physician: Obesity
Which has more influence on your confidence in the findings: the website you find them on, or
the date that an article or guideline was published?
Obesity-Search: Guidelines for Treating Patients
The AHRQ guideline document listed below includes different treatment plans. Search the
document to find the treatments that include pharmacotherapy. Make a chart comparing those
recommendations with the drug therapies in the readings from the previous activity. Include the
side effects and contraindications of each pharmacotherapy.
Read the following guideline:
American Association of Clinical Endocrinologists, The Obesity Society, and American
Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the
perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery
patient
Traumatic Brain Injury-Search: Drug Therapies
Search in Abrams’ Clinical Drug Therapy: Rationales for Nursing Practice by Frandsen and
Pennington to find answers to the following questions:
What body defense makes brain injury particularly resistant to drug therapy?
What drug class reacts unexpectedly to this body defense?
What is a particular danger in using exogenous vasopressin for acute care of brain injury
patients?
You might start with the following two chapters:
Chapter 54 Drug Therapy for Depression and Mood Stabilization
Chapter 47 Drug Therapy for Parkinson’s Disease and Anticholinergics
Salience
Salience is the state or condition of being prominent. It allows the practitioner to distinguish
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between general information and relevant assessment findings to manage and minimize
pathologies and risk factors in order to promote optimal patient outcomes.
Salience
This topic addresses the following competency:
Competency 7002.1.4: Salience
The graduate distinguishes between general information and relevant assessment
findings to manage and minimize pathologies and risk factors to promote optimal patient
outcomes.
This topic highlights the following objectives:
Evaluate the patient’s current health status with regard to physical function,
pharmacological therapies, and disease processes.
Prepare a plan of intervention for adverse drug reactions to determine that nurses are
recognizing changing signs and symptoms and intervening appropriately.
Identify the key components of disease status that may impact the patient’s quality of
life.
Develop cost-effective, patient-centered strategies to optimize outcomes for patients
with similar pathologies.
Asthma-Read: Patient-Centered Care
Read the following article:
Patient-centered care and its effect on outcomes in the treatment of asthma
This article examines research regarding finding the best practices for patients with asthma. It
includes an examination of provider practices, as well as barriers to compliance.
As you read the article, identify specific instances that call for the providers to be alert to the full
impact of their care and care plans. Attending to the patient as a whole person within a physical,
social, and lifestyle environment requires remaining alert to many factors, whether they are
obvious and salient or more obscure.
Asthma-Begin: Case Study Part 2
Read part 2 of the following case study:
Asthma Case Study
Answer the following questions:
Summarize the key indicators affecting treatment (consider the patient’s health status
before, during, and after treatment.)
Consider physical function, pharmacological therapies, and the disease process.
Review treatment options and identify which treatments increased efficacy of
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outcomes.
Summarize the standard asthma treatment pathway used in the case study and efficacy
of care of the child in this scenario, who is presenting in the ER with moderate to severe
asthma symptoms.
Based on your observations, what could have been done by the family or healthcare
providers to reduce severity and recurrence of the child’s asthma symptoms short-term
and long-term? Develop an asthma management plan.
Heart Failure-Complete: Case Study
Continue to apply what you’ve learned to the following case study to consider inpatient care:
Heart Failure Case Study
As you review the case study, consider if the nurse attended to following patient issues:
How has her fast heart rate affected her neurological status? A heart beating too fast will
affect oxygen circulation to the brain and other organs.
How does her heart sound?
How do her lungs sound?
How is she able to move?
Is she able to sit up?
If she is permitted to eat, does she have any problems with fine motor skills?
Is she completely off sedation medication? If so, what signs of withdrawal do you expect
to see, if any?
How are her kidneys functioning?
Review the following section of the case study:
Heart Failure Case Study: Part 1
Obesity-Complete: Case Study Part 3
Refer back to the following case study:
Obesity Case Study
Complete the following:
Evaluate the patient’s current health status with regard to physical function,
pharmacological therapies, and disease processes (obesity and also any comorbid
conditions). What are the key components of obesity that impact this woman’s quality of
life?
As the nurse for this patient, describe how you would incorporate emerging
genetic/genomic evidence in providing advanced nursing care. How would you use the
information you know about obesity to develop an appropriate care plan for the patient?
Explain how polypharmaceutical use/abuse relates to obesity.
Prepare a plan of intervention that will minimize adverse drug reactions for the patient.
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How would you recognize any changing signs and symptoms and intervene
appropriately if she did have an adverse reaction to a drug?
After you have compiled your recommendations for this patient, read the suggestions in the
following document:
Suggestions, Obesity Case Study: Part 3
Traumatic Brain Injury-Watch: Living with a Traumatic Brain Injury
The following 30-minute video shows the dramatic range of effects and how TBI affects quality
of life for four different patients:
Living with a Traumatic Brain Injury
While you watch, make notes about
the education that you’ll need to give your patients about expected issues they will likely
face in day-to-day living,
possible coping mechanisms that these patients have used, and
the roles and specialties of the various members of the care team who are involved in
creating and managing the care plan.
Managing Care Transitions
The term care transitions refers to the movement of patients between their healthcare provider
and the hospital setting as their condition and care changes during the course of an acute or
chronic illness.
Managing Care Transitions
This topic addresses the following competency:
Competency 7002.1.3: Managing Care Transitions
The graduate evaluates salient pharmacological issues in managing patient care
transitions.
This topic highlights the following objectives:
Indicate ways in which different members of the healthcare team contribute to
pharmacotherapeutic management when patients transition from one care setting to
another.
Identify essential aspects of medication reconciliation when a patient transitions from
one inpatient care setting to another.
Identify essential aspects of medication reconciliation when a patient transitions from an
inpatient care setting to outpatient care.
Identify essential components of a drug management plan for patients as they are
dismissed from hospital care to a home setting.
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Identify essential components of a drug management plan for patients as they are
dismissed from hospital care to a home setting.
Read: Medication Management
Using the ASHP-APhA Medication Management in Care Transitions Best Practices booklet,
respond to the following prompts:
What is unique about the medication management plan for patients with asthma when
they are transitioning to home or self-care?
Describe the consequences if a medication management plan is not completed.
Asthma-Continue: Case Study Part 2
Read part 3 of the following case study:
Asthma Case Study
Prior to the patient discharge home, you will need to consider the following questions:
What are the typical over-the-counter (OTC) medications the patient’s parents might
give him? Why?
How could the OTC meds react with and/or interfere with his prescribed
medications?
What are the potential side effects of these medications?
Are healthy bowel sounds expected early in treatment or after discharge?
Is he likely to develop diarrhea (antibiotics especially, with prolonged use, may cause a
condition that requires treatment)?
What medications will he be discharged home with?
How could the patient’s care continue for best healthcare outcomes? Provide
examples.
As you plan for this patient to go home, review the parent question results in the case
study and determine how to prevent further exacerbations of this disease.
Heart Failure-Plan: Care Transitions
Review the following websites for information about planning care transitions and care
management for a heart failure patient:
IHI: “Good Heart Failure Care Follows Patients Home”
Right at Home: “Hospital System Reduced Heart Failure Readmissions with Better Care
Transitions”
Heart Failure-Complete: Case Study Care Transitions
Describe a plan for discharge for the patient in the following case study:
Heart Failure Case Study
Include pertinent information you would discuss with her parents. Consider the following issues:
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What medications would this patient be discharged with?
Why is it important to understand what other medications or alternative treatments the
patient is taking?
What teaching must occur?
How would you include talking about not sharing each other’s medications?
How has her fast heart rate affected her neurological status?
Read the suggestions in the following section of the Heart Failure Case Study:
Suggestions, Heart Failure Case Study: Part 4
Obesity-Complete: Case Study Part 4
Refer back to the following case study:
Obesity Case Study
Consider how you would help this patient receive the treatment she needs:
How do you approach this young woman, who believes she is not at risk of developing
any diseases, who does not believe that her blood sugar is “too high,” and who does
not have any desire to see a physician?
How do you approach this same young woman who wants to change herself for the
better?
How can you help with care transitions? How would different members of the healthcare
team contribute to the health outcomes of this patient?
How do you incorporate other issues, physical or not, into helping this young woman
become more healthy?
What can you teach the patient about obesity as the nurse?
How do you educate and promote change with your client?
How would you ensure that medication is handled appropriately as the patient
transitions from one healthcare setting to another?
Based on what you have learned throughout the case study how would you create a
plan for this client to assist her with their disease? Include a drug management plan for
the patient.