Posted: September 1st, 2022

Respond to the two following discussion post response 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.
APA format 150 to 250 word count
2 scholarly References within the last two years for each post
Plagiarism free, Turnitin report

Discussion post reply #1
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Working in long term care; I have patients that are affected frequently with bacteria infections. Common infections range from UTIs to MRSA, all the way to wound infections. One scenario I experienced is with a patient that had ESBL in her urine. The patient was a 75 year old African American women with a history of chronic kidney disease, diabetes, hypertension, and hyperlipidema. The patient was prescribed the antibiotic, Nitrofurantoin before the sensitivity report results were in. Nitrofurantoin is an old drug used for uncomplicated UTI. Kashanian et al. has mentioned about the potential role of nitrofurantoin for uncomplicated UTI in the growing resistance era ( Tulara, 2018). When dealing with Pharmacokinetics it is important that medication is absorb and distributed properly to each individual to produce positive results. When a provider prescribes medication, it is with the ultimate goal of a therapeutic outcome while minimizing adverse reactions. A thorough understanding of pharmacokinetics is essential in building treatment plans involving medications ( Grogan & Preuss, 2022). If the medication doesn’t fit each patient it can cause adverse reactions and delay proper treatment. Since the patient had chronic kidney disease, the drug Nitrofurantoin was a risk factor for this patient to take. The medication plasma levels increases since the renal impairment is altered from CKD. As renal function deteriorates, the nitrofurantoin bladder concentration decreases and plasma levels increase. Therefore, in renal impairment efficacy is reduced and the potential for adverse reactions increased ( Medsafe, 2015). The patient started to develop generalized rashes on her body because of the pharmacodynamics of the patient, since she had CKD. In the future if I had a patient with ESBL and my first line of treatment was the medication Nitrofurantioin, I would make sure that the patient doesn’t’ have any kidney issues. If the patient has kidney issues I would get a creatinine lab to determine if the drug is suited for the patient, after a sensitivity report is ran.
Post 2 for Discussion

When caring for a patient, it’s important to keep in mind that everyone is different and needs care that’s tailored to them. There are a lot of different things that can change how a patient reacts to treatment. Disease processes are one of these factors. I have been a nurse for eight years, and for the last eight years I have been a critical care nurse. I have worked in intensive care units for surgery, neurology, medicine, and trauma. I decided to work as an outpatient dialysis nurse while I finish my degree. Before now, I never really thought about how much daily medications can be affected by renal dysfunction. As a nurse in the ICU, I always knew how important kidney function was for regulating fluids and electrolytes. However, I usually had more important things to worry about when taking care of my patients. As a dialysis nurse, I have to figure out how the patient’s kidney function will affect their treatment, especially if they are taking Digoxin.
Because of kidney disease and dialysis, the amount of electrolytes like potassium in the body changes. This change in potassium in Digoxin patients can make them more likely to get sick from the drug (Shah, et al. 2021). Digoxin poisoning can cause confusion, a decrease in apatite, nausea, vomiting, diarrhea, changes in vision, and irregular heartbeats (Mayo Clinic. 2022). I just saw a patient for dialysis who had most of these symptoms. The patient was a Caucasian woman who was 89 years old and had been on dialysis for many years. She is usually aware, knows where she is, and walks with a walker. On this day, however, she was confused and had to use a wheelchair. She was tired, and when her heart rate was checked, it was found to be slow and irregular, in the 30s. She was taken to the hospital by ambulance, where it was found that she had too much digoxin in her body.
As a preventive measure, a personalized care plan for each patient should be made. I would do a thorough evaluation of this patient’s mental, physical, and mental health to make sure she can follow her medication schedule. If it was thought to be necessary, the right referrals or accommodations would be made to make sure that her medications are managed and given to her in a safe way. With the patient and her caregiver, a lot of information would be given about medications and dialysis. During her dialysis treatments, her electrolyte panels and digoxin levels would be checked in the lab every week until she was considered stable. Her dialysate concentrations (for example, a 3K+ dialysate bath) would be looked at and changed based on her lab results to make sure that she was getting the right amount of electrolytes. Her care plan would also include monthly meetings with a registered dietician to talk about her diet. This would help her avoid getting too much potassium, sodium, fluid, etc. Lastly, there would be a plan of care meeting and a consultation with her prescribing cardiologist and primary care physician to figure out if Digoxin is the safest drug for her based on her other health problems.Post 2 for Discussion

When caring for a patient, it’s important to keep in mind that everyone is different and needs care that’s tailored to them. There are a lot of different things that can change how a patient reacts to treatment. Disease processes are one of these factors. I have been a nurse for eight years, and for the last eight years I have been a critical care nurse. I have worked in intensive care units for surgery, neurology, medicine, and trauma. I decided to work as an outpatient dialysis nurse while I finish my degree. Before now, I never really thought about how much daily medications can be affected by renal dysfunction. As a nurse in the ICU, I always knew how important kidney function was for regulating fluids and electrolytes. However, I usually had more important things to worry about when taking care of my patients. As a dialysis nurse, I have to figure out how the patient’s kidney function will affect their treatment, especially if they are taking Digoxin.
Because of kidney disease and dialysis, the amount of electrolytes like potassium in the body changes. This change in potassium in Digoxin patients can make them more likely to get sick from the drug (Shah, et al. 2021). Digoxin poisoning can cause confusion, a decrease in apatite, nausea, vomiting, diarrhea, changes in vision, and irregular heartbeats (Mayo Clinic. 2022). I just saw a patient for dialysis who had most of these symptoms. The patient was a Caucasian woman who was 89 years old and had been on dialysis for many years. She is usually aware, knows where she is, and walks with a walker. On this day, however, she was confused and had to use a wheelchair. She was tired, and when her heart rate was checked, it was found to be slow and irregular, in the 30s. She was taken to the hospital by ambulance, where it was found that she had too much digoxin in her body.
As a preventive measure, a personalized care plan for each patient should be made. I would do a thorough evaluation of this patient’s mental, physical, and mental health to make sure she can follow her medication schedule. If it was thought to be necessary, the right referrals or accommodations would be made to make sure that her medications are managed and given to her in a safe way. With the patient and her caregiver, a lot of information would be given about medications and dialysis. During her dialysis treatments, her electrolyte panels and digoxin levels would be checked in the lab every week until she was considered stable. Her dialysate concentrations (for example, a 3K+ dialysate bath) would be looked at and changed based on her lab results to make sure that she was getting the right amount of electrolytes. Her care plan would also include monthly meetings with a registered dietician to talk about her diet. This would help her avoid getting too much potassium, sodium, fluid, etc. Lastly, there would be a plan of care meeting and a consultation with her prescribing cardiologist and primary care physician to figure out if Digoxin is the safest drug for her based on her other health problems.

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