Florida National University Nurses Evidence Based Practice Competencies Response

List specific goals of treatment for M.W.

The client visited the clinic to conduct a clinical evaluation of the recurrent shortness of breath. The situation and the patient’s past medical report revealed that she is a victim of hypertension which triggered the conditions like diabetes mellitus type 2. On the other hand, the patient has COPD with respiratory failure, Deep vein thrombosis, and chronic renal insufficiency. Similarly, M.W. a 69-year-old individual is an alcohol abuser which I am certain many of his present conditions have not been healed or even managed. We, therefore, have specific goals for the patient to follow for him to control his health problems more appropriately.

·For hypertension, the patient work on losing extra pounds which will help to lower his blood pressure down. Exercises regularly and eating healthy meals are also of the ways the patient can manage hypertension including reduction of his drinking habits.

·The interventions for diabetes type 2 are related to that hypertension. It involves taking insulin and other medications as prescribed by the professional physician (Palmer et al., 2017). Also eating a planned diet by the physician entails eating meals rich in fiber and healthy carbohydrates.

·Patients with respiratory failure in COPD often get pharmacological treatment, supplemental oxygen, and also via mechanical ventilation.

·For chronic renal insufficiency which was the major diagnosis, the patient can work on his blood pressure, manage the glucose levels, monitor the progress of the kidney, and above all, M.W should take medications as prescribed by the physician including developing a dietitian meal plan (Beddhu et L., 2018).

·All the mentioned interventions will surely control heart failure problems and other related conditions.

What drug therapy would you prescribe? Why?

The patient’s major diagnosis was Anemia of CKD which is a critical condition that needs serious medical and other appropriate interventions. The treatment Anemia of CKD involves erythropoietin and iron or an artificial erythropoietin-stimulating agent (ESA) and it is given under the skin. Iron pills are injected into a patient’s veins which are essential in reducing the symptoms of CKD. Another crucial treatment for the condition involves Vitamin B12 supplements orally (Shlipak et al., 2021). ESA and adjuvant iron therapy exhibit the primary treatment for anemia in CKD. In that ESA expands hemoglobin concentrations without altering the blood transfusion and thereby enhancing the quality of life of the patient. Although the medications are quite expensive and need a parenteral route of care and drug administration.

What are the parameters for monitoring the success of therapy?

To evaluate the success of ESA and that of iron pills should be focused on the maximally efficacious of erythropoiesis. The evaluation stages take place in Anemia treatment which involves the management of hemoglobin, the frequency and the mode of iron supplements, CKD condition. The evaluation procedure should focus on delaying the progression of CKD, diagnosing and treating the pathological manifestations of chronic kidney disease including the timely plan for long-term renal replacement intervention.

Discuss specific patient education based on the prescribed therapy

The patient should note that the prescribed therapy which involves ESA and Iron pills, those iron pills are meant to delay other possibilities of anemia interventions in the predialysis individuals to decrease the needed dosage of ESAs in HD individuals has come to the fore. It is also crucial for the patient to comprehend that Iron pills are also meant to add up hemoglobin levels without the application of ESA to enhance iron stores before the administration of ESA intervention. It is also meant to improve the response to ESA once administered or to manage iron deficiency due to ESA treatment.

List one or two adverse reactions for the selected agent that would cause you to change therapy

ESA has been used for several decades due to its effective nature in regards to the patient’s recovery speed. However, the therapy has its effects that may have diverse effects on the patient and several pieces of researches have confirmed that it relates to high CV and thrombosis risk to cancer and mortality rates increases. Other side effects include swelling, fever, dizziness, nausea, hypertension, and also pain at the site of the injection. Similarly, Iron pills have side effects such as stomach upset and pain, constipation. When such symptoms arise, it would be advisable to change medication that will have fewer effects on the patient.

What over-the-counter and/or alternative medications would be appropriate for M.W.?

From the clinical knowledge, it is obvious that patients with kidney disorders often experience the worse type of hypertension. Therefore, Dialysis can be the best intervention for M.W. The therapy involves removing wastes and fluids from the patient’s blood due to the inability of the kidney to perform such tasks (Palmer et al., 2017). On the other hand, another alternative intervention can be a kidney transplant which entails surgical replacing of a healthy kidney from a donor. The kidney can come from deceased individuals or living volunteers. however, the patient will require medication to manage his condition for the rest of his life to prevent the body from rejecting the strange organ.

What dietary and lifestyle changes would you recommend for M.W.?

Many cardiovascular disorders require a dietitian plan for the successful management of the disease. Fresh fruits and vegetables as opposed to canned ones are much recommended since they contain all the relevant nutrients that are meant to keep the immunity of the patient much stronger (Palmer et al., 2017). The renal dietitian can provide the best directives for patients like M.W. Meals that are low in fats are also recommended including whole grains, poultry, fish, foods low in sodium including beans.

References

Beddhu, S., Greene, T., Boucher, R., Cushman, W. C., Wei, G., Stoddard, G., … & Chertow, G. M. (2018). Intensive systolic blood pressure control and incident chronic kidney disease in people with and without diabetes mellitus: secondary analyses of two randomized controlled trials. The Lancet Diabetes & Endocrinology, 6(7), 555-563.

Palmer, S. C., Maggo, J. K., Campbell, K. L., Craig, J. C., Johnson, D. W., Sutanto, B., … & Strippoli, G. F. (2017). Dietary interventions for adults with chronic kidney disease. Cochrane Database of Systematic Reviews, (4).

Shlipak, M. G., Tummalapalli, S. L., Boulware, L. E., Grams, M. E., Ix, J. H., Jha, V., … & Zomer, E. (2021). The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney International, 99(1), 34-47.