Discussion responses

DISCUSSION RESPONSES

This is a discussion class, pls on a master’s level pls answer these 3 discussion topics in 3 separate pages with references each. No introductory section needed for all of them. Give in-depth insight, highly important tnx

1-RESPONSE 1 to another student (olowabumi Omotayo)

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

Pharmacokinetics and Pharmacodynamics

COLLAPSE

The concept of pharmacokinetics and pharmacodynamics must always be considered by all healthcare practitioners when prescribing medications. The prescription medication’s purpose should be reviewed to a specific disease process and specific age groups. Pharmacokinetics is what the body does through absorption, distribution, metabolism, and the excretion of drugs, whereas pharmacodynamics describes what the medication does to the body. For example, biochemical, cellular, and physiological effects for the drugs and their mechanisms of action (Rosenthal & Burchum, 2018). We all can agree that over time older individuals have or experience altered cellular physiology that interferes with how they absorb, metabolize, and excrete medications, leading to mild or severe adverse effects of the drug (Carlo & Alpert, 2015). Therefore all healthcare practitioners need to understand these concepts to effectively manage and provide safe medication outcomes for this specific group. 

The Patient Case from My Experience 

In my former work environment,t which is a med-surgical unit, most of the patients are primarily the elderly. Then, I had an 85-year-old female living at a group home. Her admitting diagnosis was sepsis, which required antibiotics, fluids resuscitation, and close cardiac monitoring based on her significant medical history. This patient presented with confusion, agitation, fever, shortness of breath, hypotension, decreased appetite, dehydration, and no urine output. While the patient was in the ER department, the doctor ordered blood culture and urine to be collected.  Intravenous fluid, antibiotics were initiated, and lorazepam was administrated due to patient agitation. The family reports patient baseline before hospital admission has been independent; however, she has become frail for the last few days. This patient was at high risk for falls.

Pharmacokinetics & Pharmacodynamics

 The patient list of home medications revealed that this patient was on Rivaroxaban for his known atrial fibrillation and Furosemide to manage a recent mild congestive heart failure diagnosis. Arcangelo and Peterson’s studies detail that pharmacodynamics can be defined as how the drug affects the body (2014, p.15).  Studies have shown that Polypharmacy is associated with fall risk in the elderly rather than the number of their existing comorbidities (Gujjarlamudi, 2016). Therefore these medications could have contributed to this patient been a fall risk. 

Polypharmacy is associated with fall risk in the elderly rather than the number of their existing comorbidities (Gujjarlamudi, 2016). Therefore these medications could have contributed to this patient been a fall risk. 

Literature suggests that taking five or more drugs has been significantly associated with an increased risk of falls among the elderly population. In older people, medication such as benzodiazepines can alter the patient cognitive abilities and causing unsteady gaits; also, diuretics can lead to dehydration and weakness in older patients who experience poor fluid intake and appetite. Finally, older patients on blood thinners have to be monitored closely due to the adverse side effects of these medications. For example, when patients fall while taking anticoagulant medication, they tend to develop life-threatening injuries such as subdural hematomas or gastrointestinal bleeding.

Care Plan

Since this patient already presented with symptoms of dehydration and confusion, medication such as Furosemide, Lorazepam, and Rivaroxaban should have been reassessed for smaller doses or not administered because a decreased urine output should have been addressed with fluids resuscitation first. This patient would have also benefited from fall prevention protocol and neurological assessment. A delayed medication excretion should have been considered to prevent adverse side effects from the patient’s home medications. In the elderly population, benzodiazepines should be avoided because the rate of metabolism and its pharmacokinetics can increase the altered level of consciousness and respiration depression.

Therefore to better address these issues, the healthcare practitioner needs to minimize or avoid prescribing these medications. Likewise, an extensive medication review and reconciliation should also be initiated on every elderly patient hospital admission. Engaging in this practice and collaborating with the facility pharmacist can minimize adverse side effects among the older population. In conclusion, I believe staff education is essential to reinforce and reduce benzodiazepines in the elderly population. Older patients can benefit from standardized care plans such as mandatory medication reconciliation and fall prevention protocol over 65 years and above.

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.

Timothy Ventrello: Main Post, Week 1

COLLAPSE

A male patient in his early 40s was admitted to the observation unit via the emergency department due to an automobile accident. The patient was in stable condition but had sustained a severe closed fracture to his right 4th and 5th metacarpals. The hospitalist was hoping to have the orthopedic surgeon consult with the patient to determine if further action was needed. The patient had no significant health history and, up until this point, claimed to have never been hospitalized. The patient had no known allergies and was alert and oriented to time, person, place, and situation.

At the time of processing through the emergency department, a CBC was completed along with a drug and alcohol screening. The patient did not test positive for any drugs, and his BAC was negative. I distinctly remember his AST and ALT levels were elevated, but the patient denied any alcohol use or liver disease history. The patient’s liver values were advanced enough to warrant further testing to include screening for hepatitis. While the patient did not have any orthopedic surgery completed, his overall health and mental state began declining after approximately 24 hours due to alcohol withdrawal.

While the patient’s age and health history did not warrant any concern regarding pharmacokinetic or pharmacodynamic processes, his elevated liver enzymes, and later admission to long-term alcohol abuse did. Following an automobile accident coupled with impaired renal function, the two major concerns for this individual are diagnostic imaging and analgesic therapy (acetaminophen) for his acute pain (Lyle, 2021).  

Although the patient did not have any CT imaging completed following his automobile accident (to my knowledge), avoidance of contrast dye would need to be avoided when reviewing his plan of care. CT imaging is consistently completed in conjunction with trauma cases, and due to the nature of this patient’s admission to the observation unit, it would not be unwarranted. Liver disease, specifically cirrhosis, has been identified as a significant risk factor for contrast dye individuals. Contrast-induced nephropathy (CIN) is a common cause of renal failure with a risk factor of over 50% in patients with underlying liver disease such as cirrhosis (Lodhia et al., 2019, p. 1460-1461).

Norco is a drug used for pain control and a common PRN medication administered to patients with acute injury relegated pain such as this patient. Norco contains various dosages of hydrocodone in conjunction with 325mg of acetaminophen. According to Rosenthal et al. (2021), “Regular alcohol consumption increases the risk for liver injury from acetaminophen” (p. 501). Prolonged alcohol use is often associated with liver damage making patients intolerant to injury from acetaminophen. Also, alcohol use increases P450-containing enzymes and improves the overall amount of acetaminophen’s toxic metabolite during the metabolism process (Rosenthal et al., 2021, p. 501).

References

Lodhia, N., Kader, M., Mayes, T., Mantry, P., & Maliakkal, B. (2019). Risk of contrast-induced nephropathy in hospitalized patients with cirrhosis. World journal of gastroenterology15(12), 1459–1464. https://doi.org/10.3748/wjg.15.1459

Lyle, C. (2021). Alcohol Withdrawal: Individualized Care and Pharmacologic Treatment. Clinical Advisor24(3), 33–36.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:

  • Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
  • Suggest additional health-related risks that might be considered.
  • Validate an idea with your own experience and additional research.

Discussion Main post by (April Agnes Martinez )

Building a Health History

         Health history is critical. The information gathered by any means can significantly guide and direct care when treating a patient (NCBI, n.d.). It is imperative to establish a rapport with the patient to pull together the necessary details or information from a patient. Communication and interview techniques are the key to acquiring health history from the patient.

Unique Communication and Interview Techniques

         The presented client is a 38-year-old Native American pregnant woman living on the reservation. The unique communication and interview techniques are patient-centered approaches. It is essential to seek a connection to the patient and building trust to develop a partnership. The meaningful partnership has been conceptualized as patient-centered care as a vital element of high-quality care identified by the Institute of Medicine (Ball et al., 2018).

         A primary goal is to discover the details about a patient concern, explore expectations for the encounter and display genuine interest, curiosity, and partnership (Ball et al., 2018). To explore/gather more detailed information, ask a patient-centered and open-ended question: How are you feeling? Is there anything you would like to discuss? In addition, it is undeniable that therapeutic communication is complex; however, consultation and several constructs and frameworks have been proposed over the decades to aid the practitioner/clinician in working with patients as partners (Diamond-Fox, 2021).

Target Questions Based on Social Determinants of Health

         Pregnancy-related deaths per 100 000 live births (the pregnancy-related mortality ratio or PRMR) for black and American Indian/ Alaska Native women older than 30 was five times as high as white women (CDC, 2016). The client is a-38 -year-old Native American (NA) pregnant living in a reservation is at high risk. The need for medical condition assessment is imperative. The initial interview includes history, evaluation of health practices, identification of potential risk factors, and evaluation of the patient knowledge, expectation, and perceptions as they affect pregnancy (Ball et al., 2018).

Risk Assessment

         Identify conditions from history and physical examinations or circumstances that threatened the patient and or fetus well-being (Ball et al., 2018). I will utilize the risk assessment tool and questionnaire from the Centers for Disease Control and Prevention (CDC). The Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project of the CDC and Health Departments (CDC, n.d.). The questions include attitudes and feelings about the most recent pregnancy, preconception of care, breastfeeding, the content of prenatal care, cigarette smoking and alcohol use, Medicare and WIC participation, physical abuse, health insurance coverage, infant healthcare, and contraceptive use (CDC, n.d.).

Potential Health-Related Risk

         Her environmental setting and her ethnicity have potential risks for smoking and alcohol abuse. In comparison to other ethnic groups, NA has the highest rates of alcohol use, placing them at risk for experiencing the alcohol-related problem (Fish et al., 2016). The mother and fetal health are at risk due to the client’s ethnicity and living in a reservation.

Risk Assessment Instrument

          In this case, I will utilize a CAGE questionnaire that stands for Cutting down, Annoyance by criticism, guilty feeling, and Eye openers.  A questionnaire will be a helpful tool for screening the client of alcohol use. CAGE use does not ensure absolute sensitivity in detecting the problem (Ball et al., 2018).

Targeted Questions

         The targeted questions should be patient-centered and open-ended to build a history. I will start with the previous history, identify potential risk factors, assess health practices, and assess the patient’s knowledge, expectations, and perceptions as they affect pregnancy (Ball et al., 2018).  The targeted questions are the following:

  1. In the last year, what type of healthcare visits did you have?
  2. Can you describe your current pregnancy?
  3. What are your issues of concern?
  4. Have you ever felt you should cut down on your drinking? (Ball et al., 2018).
  5. Are you interested in getting help?

         The client is a 38-year-old Native American pregnant, gravida one para 1. Her last medical office visit was over eight months ago. She admits that she takes more than two drinks at night. She does have a unique practice. She prefers to use herbal products. She is interested in getting help due to concerns of complications from her previous pregnancy.

Conclusion

         There are resources available for providers to obtain a health history. Screening questionnaires are advantageous in detecting early health issues and risks. Effective questioning is a great skill to help a patient. Communicating effectively with patients can improve treatment, quality, and safety metrics (Diamond-Fox, 2021).

References

Ball RN DrPH CPNP, Jane W., Dains DrPH JD RN FNP-BC FNAP FAANP, Joyce E., Flynn MD MBA MEd, John A., Solomon MD MPH, Barry S., & Stewart MD MS MBA, Rosalyn W. (2018). Seidel’s guide to physical examination: An interprofessional approach (mosby’s guide to physical examination) (9th ed.). Mosby.

Centers for Disease Control and Prevention. (2016, January 1). Cdc newsroom. CDC. https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html

Centers for Disease Control and Prevention. (2021, August 20). Pregnancy risk assessment monitoring system | cdchttps://www.cdc.gov/prams/

Diamond-Fox, S. (2021). Undertaking consultations and clinical assessments at advanced level. British Journal of Nursing30(4), 238–243. https://doi.org/10.12968/bjon.2021.30.4.238

Fish, J., Osberg, T. M., & Syed, M. (2016). “this is the way we were raised”: Alcohol beliefs and acculturation in relation to alcohol consumption among native americans. Journal of Ethnicity in Substance Abuse16(2), 219–245. https://doi.org/10.1080/15332640.2015.1133362

National Center for Biotechnology Information. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK534249/