experience patient centeredness

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experience patient centeredness

Respond to your colleagues and offer alternative views on the impact of patient preferences on treatment plans or outcomes, or the potential impact of patient decision aids on situations like the one shared

At least 2 references in each peer responses!

In my experience patient centeredness has always been an important aspect of healthcare. Melnyk and fineout-overholt (2018) define patient centeredness as the required integration of patient preferences and values into evidence-based decision making. With the modern technology available today, patients are more informed than ever and more capable than ever to be involved in the decision-making process. One experience that I recently encountered was a patient making decisions about end of life care. The patient was suffering from ALS, and initially elected to have life extending procedures performed. The patient stated a desire to see his daughter get married and wanted to live several more months in order to be present at the wedding. This was important to him, and to abide by the patients wishes, the patient was trached, placed on a ventilator, and received a PEG tube. After educating the family and setting up a home healthcare plan the patient was sent home. Several months later, the patient returned, and as previously indicated, wanted all care discontinued. Personally, I have been involved in multiple end of life scenarios where treatment is withdrawn, but this situation was different from most. The patient was to the point in his disease process where he had severe physical limitation, but was fully alert and able to communicate. It was a foregone conclusion that as soon as the ventilator was removed, the patient would not have the strength to take an effective breath, but the patient and family were clear they did not want to continue care given the patients quality of life. This was a difficult case to be a part of, but looking back, I believe all the correct decisions were made.

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Respond to at least two of your colleagues on two different days 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. Main Post Pharmacokinetics and Pharmacodynamics A solid understanding of how drugs impact the body is essential. Pharmacokinetics explains how the body metabolizes drugs, and pharmacodynamics describes the effect of the drug on the body. This post will explore a patient case, including factors that might have altered the patient response to medication therapy and a discussion of a personalized plan of care for the above patient.The case is about an adverse drug reaction (ADR). According to Rosenthal and Burchum (2018), there has been a dramatic increase in ADRs despite efforts to reduce them. Although many of these events are preventable with careful prescribing, some are not. About two years ago, I went to work and received morning report for my patients. One particular patient stood out. He was an otherwise healthy 19-year-old with no known medication allergies, no active home medications, or medical conditions. The prior evening, he had become agitated because he wanted to leave the hospital and received Haldol 5 mg, Ativan 2 mg, and Benadryl 50 mg. I went to assess him and saw him unresponsive to his environment, standing at the wall, facing it, and mumbling. He was not alert to person, place, time, nor situation. I immediately suspected rhabdomyolysis and alerted the provider. The provider looked at him and stated: "he is just crazy." I explained the patient history and demanded an order to send the patient to the emergency department (ED), which occurred. Later on, I called the ED, and the diagnosis was indeed rhabdomyolysis. It would be too easy to state that the scenario above was merely an unfortunate adverse event. Dr. Buttaro had it correct when she mentioned in the video that prescribing is about ensuring the right drug, right patient, right time, and the right dose (Laureate Education, 2019). I believe that a different medication choice in the scenario would have prevented rhabdomyolysis or lower doses. The most likely etiology of the rhabdomyolysis was the administration of these medications. I do not think genetics, sex, age, ethnicity, or existing disease impacted this scenario. All three drugs increase the risk of developing rhabdomyolysis, especially for someone who had never taken antipsychotics or benzodiazepines (Stanley & Adigun, 2018). My plan of care for the patient would include verbal de-escalation as the first line of treatment and a low dose of hydroxyzine for agitation if needed. This medication choice would most likely be sufficient for someone who does not take medications at all. A safe rule for a prescriber is to go low and slow when prescribing drugs and monitor responses to therapy accordingly.