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As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples
  Pharmacology is the study of the interactions between drugs and the body. The two broad divisions of pharmacokinetics refers to the movement of drugs through the body, whereas pharmacodynamics refers to the body’s biological response to drugs. Pharmacokinetics describes the drug’s exposure by characterizing absorption, distribution, bioavailability, metabolism, and excretion as a function of time, while pharmacodynamics describes drug response in terms of biochemical or molecular interactions (Arcangelo et al., 2017). The focus of this discussion will be in the process of warfarin in term of pharmacokinetics and pharmacodynamics of it in the body.   Ms. J.J. ‘s Health issue:   I was in charge of Ms. J. care couple years ago, a 85 year old African American women who was diagnosed with dementia cerebral infarction due to unspecified occlusion of cerebral artery, arthropathy, major depressive disorder, atrial fibrillation with a history of long-term use of anticoagulants, contracture of muscle, constipation, hypertension and GERD. She is currently on coumadin for the atrial fibrillation and the blood levels are monitoring every week in order to control the drugs therapeutic levels and avoid any adverse reactions.  Pharmacodynamics versus pharmacokinetics of this anticoagulant:  Many statistics from the stroke prevention in atrial fibrillation (SPAF) trial suggest that safety of anticoagulant in the elderly can be maximized through a careful monitoring and maintenance of the INR which is between 2 and 3. Ms. J’s therapeutic window for warfarin 2 to 3 which is the normal range for coumadin therapeutic level. Her weekly dosage is adjusted to her current blood levels. Bleeding is the most related complication of anticoagulant. Amy INR that increasing to 3.4 or 4.0 from Ms. J will result in nose bleeding, decreasing the coumadin or stop it for one or two days will be the only option (Horton & Bushwick, 1999).     Factors influencing Ms. J’s drugs therapy:   Multiple factors may affect the absorption of her medication. For example, the presence or the absence of flood in the stomach, blood flow to the area for absorption, and the dosage form of the drug. In Ms. J’s case, the most critical factor. Influencing her absorption of coumadin is gastric motility due to the history of constipation that she has, while a routine laxative dose and stools softens are administered daily for bowel movement.  Patient-centered care plan for management of constipation:   A non-pharmacologic care plan management can be introduced for the constipation in order to reduce the frequency and the quantity of laxative and stool. Softens doses that Ms. J is getting and ultimately gain a net decrease in gastrointestinal absorption of coumadin. Increasing a dietary fiber in her menu, encourage fluid and prune juice can have a significant impact on her bowel movement (Portalatin & Winstead, 2012).     Portalatin, M., Winstead, N. (2012). Medical Management of Constipation. Clinic in Colon and   Rectal Surgery. Doi: 10.1055/s-0032-1301754. Retrieved from   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348737/  Horton, J. D., Bushwick, B. M. (1999). Warfarin Therapy: Evolving Strategies in Anticoagulation American Family Physician. 59(3):635-646. Retrieved from   https://www.aafp.org/afp/1999/0201/p635.html     Arcangelo, V. P., Peterson, A. M., Wilburg, V., Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. (4th Ed.). Wolters Kluwer Lippincott Williams &
 

 

Please go to the following web address:

https://adfs.rasmussen.edu/adfs/ls?wa=wsignin1.0&wtrealm=urn%3aextranet%3aportal&wctx=https%3a%2f%2fportal.rasmussen.edu%2f_layouts%2f15%2fAuthenticate.aspx%3fSource%3d%252F&wreply=https%3a%2f%2fportal.rasmussen.edu%2f_trust%2fdefault.aspx  Please sign in with the following information:

Username: mikayla.schumacher@smail.rasmussen.edu

Password: Addie!0823

Click on Courses on the left side, and then click on Technology Today for Medical Administration, click on Module 4, then assignments. Scroll down to Module 04 Quiz. Complete that quiz.

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 Learning Resources

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 1, “The History and Interviewing Process”This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.

Chapter 5, “Recording Information”This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–29)

Deckx, L., van den Akker, M., Daniels, L., De Jonge, E. T., Bulens, P., Tjan-Heijnen, V. C. G., … Buntinx, F. (2015). Geriatric screening tools are of limited value to predict decline in functional status and quality of life: Results of a cohort study. BMC Family Practice, 16, 1–12.  https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-015-0241- x 

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, (1079), 508–513. 

Lushniak, B. D. (2015). Surgeon general’s perspectives: Family health history: Using the past to improve future health. Public Health Reports, (1), 3. 

Jardim, T. V., Sousa, A. L. L., Povoa, T. I. R., Barroso, W. K. S., Chinem, B., Jardim, L., … Jardim, P. C. B. V. (2015). The natural history of cardiovascular risk factors in health professionals: 20-year follow-up. BMC Public Health, 15(1111), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-015-2477-8 

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY

Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us 

Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)

Document: Sh

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Response

• 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.

 Respond to this post. At least 2 citations. APA format. 7th edition

Building a Health History

My assigned patient for this week’s discussion is a 14-year old biracial male living with his grandmother in a high-density public housing complex.  As clinicians, it is very important to gather as much pertinent information as you possible can. This will help with building health history and identify potential issues or concerns. Building health history and gathering pertinent information also give clinicians the opportunity to customize care to a patient’s individual needs. This will also help with forming diagnosis and implementing plan of care.

Interview and Communication Techniques

When conducting an interview with an adolescent, it is imperative that you develop a rapport with the patient, parents, or guardian. Developing a rapport will make the adolescent comfortable and easier to communicate with. I would provide privacy so that the patient and I are away from his family. This will allow the patient to share information with me that he may not disclose if his family was present. I would first find out about his interests, hobbies, and other things he enjoys doing. I would inform him that the environment is a safe space, and he should express himself as he sees fit. I would then begin my head to toe assessment, informing the patient of what I am doing while doing it. While doing my head to toe assessment, I would allow the teen to talk about any concerns he may currently have. I would also use the opportunity to enquire about school, nutrition, health, activities with friends and his homelife. After completing my assessment, I would invite his guardian to rejoin us and give her the opportunity to express any concerns or issues she may have. I would advocate for my patient as I see fit and I would educate all parties involved on any abnormal findings and the best plan of care. When communicating, I would use simple words that are easily understood, to prevent any miscommunication or misunderstanding.   

Risk Assessment Instrument

I chose the HEADSS interview tool for my adolescent patient. This is a screening tool that is used to facilitate communication and to create a sympathetic, confidential, and respectful environment where youths may be able to attain adequate healthcare (BC Children’s Hospital, n.d.).

Home: Who lives with the adolescent? Does he have roommates? What are the relationships like with the other persons living in his household?

Education and Employment: Which school is he attending? How are his grades? What is his favorite subject? Does he like going to school? How is his relationship with his teachers and classmates? What are his future goals?

Activities: Sports activities, hobbies, favorite music/movies, and exercise regimen.

Drugs: Any tobacco use, illicit drug, or alcohol use?

Sexuality: Sexual orientation, any physical or sexual abuse, ask if patient is sexually active, knowledge of STD, and use of condoms.

Suicide/Depression: Enquire about suicidal or homicidal ideation (past or present), mood swings, emotional outburst, and feelings of depression.

Substance abuse is an identified risk factor among adolescents. According to the World Health Organization (2018), harmful drinking among adolescents is a major concern because it is an underlying cause of injuries, violence and premature deaths.

Five Targeted Questions

My five target questions are:

• Have you ever had any thoughts of harming yourself or anybody else?

• Are you sexually active and if so, are you using condoms?

• Have you ever used alcohol, or illicit drugs?

• Do you feel comfortable at home or at school?

• Tell me about how you feel at home. Are you comfortable, do you think you are being treated

   fairly?

References

BC Children’s Hospital (n.d.). H.E.A.D.S.S.- A Psychosocial Interview for Adolescents.

 http://www.bcchildrens.ca/youth-health-clinic-

site/documents/headss20assessment20guide1.pdf 

World Health Organization (2018). Adolescents: health risks and solutions.

 https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-

solutions#:~:text=prevent%20these%20deaths.-

,Mental%20health,of%20developing%20mental%20health%20problems.

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Compare the EBP competencies for Practicing Registered Nurses and Advanced Practice Nurses:

1. Identify the competencies that you are currently meeting. Provide examples as to how you are meeting them.

2. Discuss how you will plan to meet the EBP competencies for Advanced Practice Nurses as you are pursuing the nurse practitioner role (Advanced Practice) or seeking advanced nursing practice via the leadership track.