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NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Hepatitis C is one of the main sources of cirrhosis and builds the danger of wellbeing difficulties, particularly when there is liver irritation. Before interceding, there is a need to comprehend the patient’s clinical history since it may impact measures to improve the patient’s prosperity (Rosenthal & Burchum, 2020). For example, prednisone smothers the immune system, and there is a need to comprehend why the patient is utilizing the intercession. The clinical history likewise extends to the period when the side effects have happened and Hepatitis.

Primary Diagnosis

            Although a comprehensive history and physical assessment, a diagnostic workup is expected to concoct a primary diagnostic; in light of the introducing symptoms, I will give a primary finding of intense gastroenteritis (Chalasani, Younossi, & Lavine, 2018). The cause is that the stomach and intestinal system are frequently triggered by the virus and bacterial disturbances/aggravation of foods sullied with viruses and parasites. Squeezing, nausea, groaning, or running can have symptoms. Most of the disease efficiently spread from contact with a weakened person or consumes, and drinks of sullied food or foods often spread the disease (Arcangel & Peterson, 2017). The signs typically occur one to three days after pollution. Because the patient is sick, loose, and thick bowels and does not have a fever, I would end up with severe bacterial gastroenteritis. NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Differential Diagnosis

            In the context of the history of the patient’s drug abuse, I will be speaking of a specific assessment of hepatitis C severity in the use of IV medicines and of adding indications. Hepatitis C is a serious hepatitis disease caused by hepatitis C infection. It usually results from harming blood or bodily fluid, sex, or needle exchange, which may be severe unclear stomach torment, and often diarrhea, individually or separately. It may be caused by the use of illicit drugs or drugs (Rosenthal & Burchum, 2020). Intense hepatitis C causes diarrhea. Though this underlying infection is most unlikely to cause signs, about 21-30 % of people show indicators approximately 1 to 3 months after the infection has occurred.

Drug Therapy and Treatment Plan

            The primary goal of treatment is lessening the indications and the avoidance of complications. Because the patient is vomiting, dehydration and diarrhea, either 0.8 percent of intravenous liquid hydration will lead to the depletion of fluid from and runs and will avoid further dehydration (Chalasani, Younossi, & Lavine, 2018). I advise the patient to drink clear beverages and stock to support the lack of supplants and electrolytes as nausea subsides. On the other hand, if it is bacterial contamination, I will proceed with IV liquid and an anti-infection like an expansive range anti-toxin like Ciprofloxacin.

References

Arcangel, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Wolters Kluwer.

Chalasani, N., Younossi, Z., & Lavine, J. E. (2018). The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases. Hepatology, 328-357.

Rosenthal, L., & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier – Health Sciences Division.

WEEK ONE DISCUSSION

Today I am going to discuss the presented case scenario.  In the scenario there is a 27-year-old male found down and unresponsive for

unknown amount of time by his roommate.  The male was given naloxone by EMS and became responsive complaining of burning pain to his left greater trochanter and left forearm.  In the ED he was found to have a large amount of necrotic tissue over the greater trochanter and forearm.  His EKG was abnormal with a prolonged PR interval and elevated T waves.  His potassium level was at 6.9 which was elevated.

The Role Genetics Plays in the Disease

According to the National Institute on Drug Abuse (2019), 99.9 percent of any two people have the same DNA sequences.  The 0.1 percent difference is very important because it accounts for three million differences in almost three billion base pairs of DNA sequences (National Institute on Drug Abuse, 2019).  These differences are what contributes to certain diseases such as addiction (National Institute on Drug Abuse, 2019).  According to the American Psychological Association (2008), genetics can play a role in addiction and at least half of a persons’ susceptibility to drug addiction can be linked to genetic factors.

NURS 6521 Assignment Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

NURS 6521 Assignment Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

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Why the Patient is Presenting with the Specific Symptoms Described

The patient overdosed on an opioid drug.  According to Schiller et. al. (2020), when an opiate is used in large amounts the opiate pathway is stimulated.  The over stimulation decreases the respiratory status of the patient (Schiller et al., 2020).  Once the patient’s respiratory status decreased, he became unresponsive and laid on the floor on his left side for a period of time as evidenced by his left greater trochanter and left forearm suffering from necrosis.  According to Simon et al. (2020), the blood flow was decreased, which causes a decrease in circulation, which causes a shift in potassium levels, and this causes cardiac irregularities.

 

 

The Physiologic Response to the Stimulus and Why the Response Occurred

According to Schiller et al. (2020), overdose of an opioid occurs when the patient over stimulates their opiate pathway.  When the over stimulation occurs the respiratory status decreases (Schiller et al., 2020).  When the opioid enters the body it goes to the synapses, then to the heart and then to the lungs (Schiller et al., 2020).  In the lungs is where the blood is filled with oxygen before going back to the heart again (Schiller et al., 2020).  The heart then pumps the blood to the entire body and attaches opioid receptors (Schiller et al., 2020).  The heart then slows down and the opioid suppresses the neurological signal which causes oxygen levels to fall (Schiller et al., 2020).  The patient then became unresponsive and laid for an unknown period of time on his left side on the floor where he was found.  According to Schiller et al., (2020), the opiates act on opiate receptors in the brain which causes the mu receptor to release dopamine that blocks the signal of pain and decreases the level of consciousness.  With the patient unresponsive laying in the same position on his left side without any signal of pain necrosis set in to the tissue on the left greater trochanter and left forearm.  According to McCance & Huether (2019), when a cell dies it triggers an inflammatory response and plasma and protein is leaked out of the cells.  This process recruits’ leukocytes in host defense and tissue repair (McCance & Huether, 2019).  The patient’s blood supply was decreased to the greater trochanter and left forearm from the pressure of laying on them too long without movement. This caused the nucleus of the cells to swell.  Then the plasma membrane ruptured and caused cellular and nuclear lysis and inflammation to the areas discussed.  The living tissue broke down, releasing chemicals into the bloodstream and tissue damage occurred and became necrotic when the cells died.

Next the Naloxone was administered by the EMS.  According to the National Institute on Drug Abuse (2018), Naloxone is an opioid antagonist and it binds to the opioid receptors.  It reverses the effects of opioids and blocks them (National Institute on Drug Abuse, 2018).  Normal respirations then occur in the patient and they become responsive. They then start to feel pain again as well.  Once at the ED the patient was found to have an elevated serum potassium level and an EKG with a prolonged PR interval and elevated T waves.  According to Simon et al., (2020), dehydration leads to hypotension and decreased tissue perfusion.  Metabolic acidosis occurs next with decreased circulation of blood flow (Simon et al., 2020).  Next a shift in the potassium occurs, an intracellular shift, and this causes an elevated potassium level (Simon et al., 2020).  According to Yates & Manini (2012), an elevated potassium level causes a prolonged PR interval because opioids decrease sympathomimetic tone and rhythm disturbances occur due to a blockade of potassium.  With the peaked T waves an ion disturbance takes place because the potassium channels are being blocked (Yates & Manini, 2012).

The Cells That Are Involved in This Process

In this scenario the blood cells are involved because of the decrease in blood circulation.  The skeletal muscle cells are involved because the patient was down for a long period of time in the same position.  The nerve cells are involved because the feeling of pain was decreased because the pain receptors were blocked.  The skin cells are involved because of the necrosis that occurred.  So many cells were involved in this overdose and the repercussions from the overdose.

How Another Characteristic Would Change My Response

I am not sure any characteristic would change my response.  Characteristics such as gender, genetics, physical appearance or age would not affect my response.  Whether male or female, old or young, tall or short, with an opioid overdose as in this scenario used, the results would be the same.  If the scenario spoke of healing time, then my response would be different for an example.  The scenario given to me, is going to be the same outcome no matter the characteristics.  All bodies will respond the same way as in the scenario.

References

American Psychological Association. (2008). Genes matter in addiction. https://www.apa.org/monitor/2008/06/genes-addict

McCance, K.L., & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8thed.). St. Louis, MO: Mosby/Elsevier

National Institute on Drug Abuse. (2018). Opioid overdose reversal with Naloxone (Narcan, Evzio). https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-reversal-naloxone-narcan-evzio

National Institute on Drug Abuse. (2019). Genetics and epigenetics of addiction drug facts. https://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addiction

Schiller, E. Y., Goyal, A., Cao, F., & Mechanic, O.J. (2020). Opioid overdose. In StatPearls. Treasure Island, FL: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470415/

Simon, L.V., Hashmi, M.F., & Farrell, M.W. (2020). Hyperkalemia. In StatPearls. Treasure Island, FL: StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470284/

Yates, C., & Manini, A. (2012).Utility of the electrocardiogram in drug overdose and poisoning: Theoretical considerations and clinical implications. https://www/ncbi.nlm.nih.gov/pmc/articles/PMC3406273/

NURS_6521_Week4_Assignment_Rubric

Excellent Good Fair Poor
Explain your diagnosis for the patient, including your rationale for the diagnosis.
Points Range: 23 (23%) – 25 (25%)
The response accurately and clearly explains in detail the diagnosis for the patient, including an accurate and thorough rationale for the diagnosis that supports clinical judgment.
Points Range: 20 (20%) – 22 (22%)
The response provides a basic explanation of 1-2 diagnoses for the patient, including an accurate rationale for the diagnosis that may support clinical judgment.
Points Range: 18 (18%) – 19 (19%)
The response inaccurately or vaguely explains the diagnosis for the patient, including an inaccurate or vague rationale for the diagnosis that may or may not support clinical judgment.
Points Range: 0 (0%) – 17 (17%)
The response inaccurately and vaguely explains the diagnosis for the patient, including an inaccurate and vague rationale for the diagnosis that does not support clinical judgment, or is missing.
Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Points Range: 27 (27%) – 30 (30%)
The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Points Range: 24 (24%) – 26 (26%)
The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Points Range: 21 (21%) – 23 (23%)
The response inaccurately or vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Points Range: 0 (0%) – 20 (20%)
The response inaccurately and vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.
Points Range: 27 (27%) – 30 (30%)

The response provides an accurate, clear, and detailed justification for the recommended drug therapy plan for this patient.

The response includes specific, accurate, and detailed examples that fully support the justification provided.

Points Range: 24 (24%) – 26 (26%)

The response provides a basic justification for the recommended drug therapy plan for this patient.

The response includes only 1-2 examples that fully support the justification provided.

Points Range: 21 (21%) – 23 (23%)

The response provides an inaccurate or vague justification for the recommended drug therapy plan for this patient.

The response may include examples, which may inaccurately or vaguely support the justification provided.

Points Range: 0 (0%) – 20 (20%)

The response provides an inaccurate and vague justification for the recommended drug therapy plan for this patient, or is missing.

The response does not include examples that support the justification provided, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
Points Range: 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
Points Range: 4 (4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors
Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors
Points Range: 4 (4%) – 4 (4%)
Contains a few (1–2) APA format errors
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors
Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors
Total Points: 100
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