Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Patient HL has nausea, vomiting, and diarrhea symptoms. However, before medication, it’s important for the care provider to understand HL’s medical history as the medication can impact on measures undertaken to improve their health. In this case, the patient has prescribed the following drug; Synthroid 100 mcg daily, Nifedipine 30 mg daily, Prednisone 10 mg daily. For instance, the prednisone prevents the production of discharge in the body which can cause inflammation. It can also suppress an individual’s immune system, and there is a necessity to comprehend why a patient needs this medication. The history showed the patient had Hepatitis C, which is a liver infection that can lead to acute inflammation of the liver. Long-term infection 

with the hepatitis C causes high blood pressure, yellow discoloration of the skin and eyes and many others. Prescription of Nifedipine drug lowers patient blood pressure and makes it easier for heart to pump blood around the body. Watery diarrhea, Nausea, vomiting, and hepatitis C can be due to intestinal infection. 

In this case, the patient HL is likely suffering from acute gastroenteritis which is the inflammation of the mucous membrane of the gastrointestinal tract and featured by vomiting. This disorder is common in children. In many cases, the gastrointestinal disease is caused by a virus which usually spreads from an individual to another or, through close contact with an infected individual, such as sharing food. For this reason, nurses and the child care have a high risk of viral gastroenteritis disease, especially if they do not clean their hands after coming contact with the infected person. 

Diagnosis for the Patient and the Rationale for Diagnosis.

The diagnosis can be made clinically. In this situation, the doctor will assess the abdominal pain, abdominal cramping, and loose stools. These assessment results are commonly linked to diarrhea. If gastroenteritis encompasses the large intestine, the colon is not able to engross enough water, and the patient’s stool becomes watery. Evaluation of defecation is also very significant. Samples should be taken from the patient to identify the pathogen and establish the immediate treatment of the disease. Samples should be cultured for the bacteria and tested for the pathogen. Quick diagnosis allows for the isolation of the patient to prevent nosocomial contagion, which is often used as an indicator of the efficiency of precautions to control contact infection. Diagnosis can also be made by educating the patient concerning perianal care after every bowel movement. The rationale for this is that the anal part should be carefully cleaned in order to prevent the irritation of the skin and spread of disease-causing microorganism. 

Drug Therapy Plan

Antimicrobial Agents

Nasogastric Rehydration (NGTR): The patient takes 25ml/kg/hr for 4 hours. 

For initial treatment of acute diarrhea infections like in the patient HL, rehydration should be included, which can be gained with oral electrolyte solutions. In this patient, antibiotic is required because the disorder is usually self-limiting (Rosenthal, & Burchum, 2018). Nasogastric Rehydration (NGTR) is a safe and actual way of rehydrating the patient; even after vomiting. It is recommended over the IV route. Any deliberation of antimicrobial therapy will be carefully considered against unintentional and potentially harmful outcomes. However, empirical and precise antimicrobial therapy can be considered in this situation. Moreover, treating gastroenteritis because of Shiga toxin creating Escherichia coli bacteria with antibiotics can upsurge the risk of hemolytic-uremic disorder.

Antiemetic Agents and Supplemental Zinc Therapy

Ondansetron wafer dose (drug dose)

 Weight Ondansetron wafer dose

 8 -15 kg 2mg

15-30 kg 4mg

> 30 kg 8 mg

The patient HL has a severe vomiting condition; therefore, there is a need to prevent further dehydration and to avoid the desire for IV therapy and frequent hospital admission. Ondansetron, a discerning serotonergic 5HT3 receptor adversary, has revealed to be a more effective antiemetic agent (Rosenthal, & Burchum, 2018). Also, the patient should be prescribed with Metoclopramide which has been confirmed to be more effective than the placebo. Zinc is an important micronutrient that usually guards the cells against oxidative injury. In this case, the patient has acute diarrhea; there is a substantial loss of zinc due to enlarged intestinal output. Giving the patient zinc supplements may increase the absorption of water. 

(theoretical foundation of nursing)—name of the course

Also, write a summary reflection answering the following questions based on the readings and discussions throughout the course: 

• As an art and a science, how has your personal nursing philosophy unfolded?
• Have there been ideas that have challenged your personal values or assumptions?
• Have there been ideas that have caused you personal conflict and may lead to deconstructing those dispositions in a critical manner?
• What actions have you taken that illustrate your personal nursing philosophy?
• Describe your own definition of the concepts involving the meta-paradigm of nursing.
• Has your first written philosophy of nursing changed? In what ways? 

Your paper that includes both your philosophy and reflection together should be 2–3 pages in length, in APA format, typed in Times New Roman with 12-point font, and double-spaced with 1″ margins. If outside sources are used, they must be cited appropriately.

 Not all medical errors carry extreme consequences like those described in this week’s introduction, but they are harmful just the same. Most people have experienced some form of medical error. For example, perhaps you were prescribed a medication that interfered with another of your medications. Perhaps you received an inaccurate diagnosis that led to unnecessary testing or prolonged discomfort. For this Journal, you reflect on an experience you had with a medical error and explore tools that could have assisted in prevention.

references:

 

Johnson, J. K., & Sollecito, W. A. (2020). McLaughlin & Kaluzny’s continuous quality improvement in health care (5th ed.). Burlington, MA: Jones and Bartlett.
Chapter 9, Assessing Risk and Preventing Harm in the Clinical Microsystem (pp. 234–251)

Agency for Healthcare Research and Quality. (2019c). Measurement of patient safety. Retrieved from https://psnet.ahrq.gov/primers/primer/35/Measurement-of-Patient-Safety

Agency for Healthcare Research and Quality. (2019a). Checklists. Retrieved from https://psnet.ahrq.gov/primer/checklists?q=/primers/primer/14

Agency for Healthcare Research and Quality. (2019b). Detection of safety hazards. Retrieved from https://psnet.ahrq.gov/primer/detection-safety-hazards

Agency for Healthcare Research and Quality. (2019d). Root cause analysis. Retrieved from https://psnet.ahrq.gov/primer/root-cause-analysis 

 Describe a time when you experienced a medical error as a student, practicing nurse, patient, or family member. Be sure to explain the circumstances of the error, as well as the quality and safety methods and tools that could have helped prevent the error. Be specific and provide examples. 

Now that each one of you is very close to completing this major accomplishment in your nursing career, please share your professional development plans to keep up to date in your chosen specialty and nursing in general.

• In what professional nursing organizations do you currently participate?
• What organizations might you think about participating in for the future?
• What nursing certifications are you considering?
• How might consideration of continuing your education to pursue a graduate degree fit into your future plans?

 

Answer these essay questions:

Essay #1: Give your reasons to your answer to this question: “Can unethical behavior occur for a leader who has proper values and intentions?” Why or why not?

Essay #2: Describe the GLOBE project and tell why it is important.

Essay #3: Case Study: Madison, Jones, and Conklin

After graduating from a prestigious business school, Laura Kravitz accepted a job at Madison, Jones, and Conklin, a medium‐sized firm that did accounting and consulting projects for corporate clients. After a series of successful assignments working as a member of a project team, Laura was promoted to a team manager position with broader responsibilities. Laura felt confident about her qualifications. The other team managers seemed to respect her, and clients were happy with the projects she managed. With this record of success, Laura hoped to eventually become a partner in the company. However, as the only woman manager in a male‐dominated company, she knew that there would be some obstacles to overcome.

Laura felt that some of the senior managers were very conservative and did not accept her as an equal. In the quarterly planning meetings, these managers were often inattentive when she spoke and seemed unreceptive to her suggestions for improvements. Several times she proposed an idea that was ignored, and that same idea was later suggested by someone else who received the credit for it.

Laura did not have a mentor in the company to tell people about her skills and help to advance her career. Moreover, she did not feel accepted into the informal network of relationships that provided opportunities to interact with senior managers. She did not like to play golf and was not a member of the exclusive golf club to which many of the male managers belonged. She was not invited to most of the social activities hosted by senior managers for friends and select members of the company.

Laura also felt that the assignment of projects was biased. The high‐profile projects were always given to the male managers. When Laura asked her boss for more challenging projects, she was told that the older clients usually preferred to deal with men. Because she was not given the more profitable accounts, her performance numbers did not look as good as the numbers for some of the male managers. Two male managers who had joined the company around the same time she was hired were promoted ahead of her.

Frustrated by the apparent “glass ceiling” at the company, Laura asked to meet with the president to talk about her career. The president was surprised to hear that Laura was unhappy about her advancement in the company. He assured her that she was a valuable employee and should be patient about a promotion. However, after another year with little improvement in how she was treated, Laura resigned from the company. With two friends from graduate school who also felt unappreciated, she formed a new company and served as the chief executive officer. In a relatively short time, this company became highly successful.

1. What forms of gender discrimination did Laura experience?
2. What could Laura have done to overcome the obstacles she encountered?
3. What could the president have done to create equal opportunity in this company?

Essay #4:  Using the Internet, survey current research comparing male and female leaders, summarize the major trends.