Discuss about the NURS12154 Pharmacology for Nursing Practice: Drug Protocol Development.
Drug Therapy Protocol For Administering Atorvastatin For The Treatment Of Hypercholesterolemia
Clinical Indication for Use
Hypercholesterolemia, reducing risk of atherosclerotic vascular disease. (Mclever et al., 2017)
Prevention of cardiovascular disease
Hyperlipidemia (Ferreira et al.,2017)
As an adjunct to diet in Fredrickson II and IIb and adults with Fredrickson (Bhatt et al., 2016)
Current medication with Cyclosporine, Tipranavir plus Ritonavir and Telaprevir
Patients with HIV and Hepatitis C risk myopathy thus precaution required.
Pregnancy (Barrios., et al 2015)
Pharmacodynamics (Mechanism of Action)
Atorvastatin is a selective competitive inhibitor of HMG-CoA reductase. An enzyme that converts 3-hydroxy-3methylglutaryl-coenzyme A to mevalonate, which is a precursor to body sterols including cholesterol. Atorvastatin thus lowers blood plasma cholesterol by inhibition of the enzyme HMG -CoA reductase and cholesterol synthesis in the liver. Also increases the hepatic LDL receptors enhancing LDL catabolism and uptake.
Atorvastatin is rapidly absorbed after oral administration. Within 1-2 hours maximum plasma concentration is reached. Food availability decreases rate and extent of drug absorption by 25% and 9 % respectively. Evening administration shows lower plasma concentration as compared to evening. LDL -C is however reduced regardless of time of administration.
Atorvastatin has a mean volume of distribution of 381 litres.
Approximately 98 % of atorvastatin is bound to plasm proteins with poor penetration of 0.25 into red blood cells. Atorvastatin is secreted in human milk.
Atorvastatin is metabolized in the liver to ortho and parahydroxylated derivatives and other beta oxidation products.
Atorvastatin and its metabolites are primarily eliminated in bile. (Patel et al ., 2015 )
Clarithromycin -Atorvastatin AUC increased, thus in patients using clarithromycin, dosage should not exceed 20 mg.
Protease inhibitors -HIV protease inhibitors and hepatitis protease C inhibitor increase atorvastatin AUC thus the lowest dose should be use in such patients.
Itraconazole – AUC of atorvastatin increased with administration of 40 mg atorvastatin and 200mg Itraconazole
Cyclosporine -increases bioavailability of atorvastatin. Administration of both concomitantly should be avoided. (Patel et al ., 2015 )
Dose, Route, Duration of Therapy
Oral administration 10 -80 mg daily
(Bays et al.,2015 )
Common: Nasopharyngitis, Arthralgia, Diarrhea, Pain in extremities Urinary tract infection, Dyspepsia, Nausea, Musculoskeletal pain, Muscle spasms, Myalgia, Insomnia, Pharyngolaryngeal pain
Rare: Pyrexia, Hepatitis, Epistaxis, Blurred vision (Adams et al.,2015)
Response to Adverse Event (this is directed at the practitioner to respond to an adverse event occurring)
Stop the medication immediately.
Assess the extent of severity.
Conduct lab hepatic tests.
In clinical decision-making process, nurses gather relevant information available and utilize the information gathered to appropriately evaluate prevailing patient conditions and thus make sound judgement. Clinical decision making is a pivotal skill required by all nurses (Morton et al.,2017), more often newly registered nurses or novices encounter challenges as they try to execute this responsibility. Clinical decision-making process plays a major role in the quality of nursing care provided by the nurses to the patients. The decision-making process entails application of sound decisions at each stage in the processes, which are diagnosis, planning, implementation of existing patient needs and prevailing health demands that require to be attended to (Goode et al.,2015). For this essay requirements the assessment implementation processes will be elaborately discussed.
Assessment entails obtaining and gathering relevant informant regarding a patient’s psychological, health, physiological status, usually by a registered nurse. (Jin -Kyoung et al.,2015). Nursing assessment is the first step to be undertaken in the nursing process. The assessment in order, involves inspection, palpation, percussion then followed by auscultation of the patient. Health history of the patient is also obtained from records and verbal questions. Assessment data is then recorded. The assessment must be comprehensive and systematic.
In the presented case study, where Mavis is the patient, adequate assessment is conducted whereby adequate history is obtained even including her social and psychological status whereby, it is clear that she is the one who takes care of her husband who is got a below the knee amputation. This would cause her psychological stress. also tells the nurse that she doesn’t have enough time to ensure she eats healthy, she further says she is not able to read her watch anymore this implies progression of her condition as her sight is affected. She also forgets to take her medication thus the nurse is aware that Mavis condition if not mediated could go out of hand. Further assessment indicates that Mavis has put on weight and she is currently 85 kg with a BMI of 37. Mavis has come to hospital presenting a wound on her left foot that is not healing.
Thus, admission for wound management s advised by the doctor. At this juncture, the registered nurse in charge must conduct an admission assessment. Vital parameters of blood pressure, temperature, heart rate or pulse are obtained. Further tests due to her condition are also obtained, the blood sugar level, cholesterol level, triglycerides level is taken. The tests indicate elevated blood sugar level and serum cholesterol levels. During patient assessment, questions on prevailing allergies are key and from the assessment it comes to the nurse’s attention that Mavis is allergic to Penicillin. The nurse ought to ensure that the information obtained from assessment is complete, accurate and properly documented. It is from the information obtained during the assessment that the nurse can plan for appropriate patient care.
The implementation phase of the nursing process follows the planning stage that happens just after the diagnosis stage. (Freisen -Storms et al., 2015). In implementation, the nurses take on the responsibility of putting into action the clinical intervention plan set out to manage the prevailing condition of the patient. The plan set out to be implemented is usual specific, measurable, achievable, realistic and timely. In implementation the nurse monitors the patient for any deteriorating or improvement signs, executing proper nursing care for the patient, performing health education for the patient, making contact to the patient for a follow up regime. Usually this phase can extend to varied time periods from hours to even several months.
The final phase of the nursing process is the evaluation phase. Evaluation is a planned, ongoing, purposeful activity whereby the health professionals check on the progress of the patient towards the achievement of the desired goal. Evaluation is always continuous as health always varies. The measures implemented from the planning are thoroughly and adequately assessed and the effectivity discussed. Questions as to whether the patient is making progress are key and whether the desired goals have been achieved is also considered. If the patient shows no or minimal progress then, reassessment of the plans is done and decisions of modification or elimination are made by the medical personnel evaluations enable doctors and nurses to follow the right course of action for the wellbeing of the patients. For Mavis, evaluation on whether the prescribed drugs are improving her condition is key to determining whether the dosage can be adjusted or the drugs changed. The effectiveness and appropriateness of the medications can be determined. It is through evaluation, that the nurse in charge shows required responsibility and accountability for the actions and decisions they made and undertook. It is a demonstration of the willingness to help the patient recover and feel better through adoption of more effective actions, disregarding the ineffective actions and procedures.
Nursing comes with a myriad of challenges and responsibilities to be executed for the care of the patient, one of which is patient education and sensitization. (Shin et al.,2015 ). Without effective patient education, is minimal effective healthcare with improved outcomes in the long -run. Incorporation of patient education by nurses in their daily routine, increases the possibility of positive and optimal patient outcomes.
In the execution of patent education, the patient ought to be assessed so that he or she receives relevant education on what is related to his or her case .For ,instance ,Mavis is diabetic and has hypocholesteremia .Relevant education on the importance of checking her diet, limiting the sugar she consumes ,consuming more vegetables and water for appropriate renal function and not forgetting incorporating exercise and deviation from sedentary lifestyle would be handy .The nurse should also remind Mavis on the importance of taking her medication regularly and on time to avoid further complications resulting from high blood sugar levels .
Nurses, ought to provide culturally competent care in the execution of their nursing care and patient education responsibilities. (Jeffreys and Marianne ,2015). Nurses in practice, encounter varied cultural elements that have a direct or indirect influence on the reactions of patients and families in an event of illness. Culturally competent nursing, enables the patient needs to be fulfilled. There should be an element of cultural awareness, cultural knowledge, cultural skill, cultural encounter and a cultural desire. For instance, Mavis is an indigenous ,45-year-old woman from Darwin. In this case the nurse should be competent enough to avoid using medically complicated jargon while issuing medication to Mavis. The nurse ought to use the simplest terms possible, be slow but sure to ensure that Mavis fully understands, her medication regime to ensure both medication safety, reduces medication errors and achieve a desirable patient outcome.
Adherence to the nursing process in practice incurs overwhelming benefit to both the patient and the registered nurse in charge. This is because, the whole process provides a stipulated systematic method of nursing care provision, nursing efficiency is enhanced, quality care is increased as the actions taken are of deliberation and duplication of care and service is curtailed. The fact that the nursing process is goal -oriented, makes the possibility of the patient outcome be favorable thus proper management of patient conditions and enhanced recovery periods.
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