NURS 6521 Week1 Discussion

NURS 6521 Week1 Discussion

Name: NURS_6521_Week1_Discussion_Rubric

Diabetes is considered to be  a silent killer disease because the diseases can affect and impair the functioning of diabetic patient’s organs with minimum to very few symptoms over time until the condition causes significant and irreversible damage. Diabetes is a contributing factor to  millions of deaths in many minority communities (Hilliard, Powell,  & Anderson, 2016). As a nurse I  have known patient X for the last 7 years because he has been a patient that comes to our community hospital and we are able to be acquainted well with most of our patients conditions and get to know them well like family. The patients started coming in for poor diabetes management related problems leading multiple hospitalization cases due to Diabetic ketoacidosis episodes. Over time his diabetes was not well managed leading to renal failure and he has now been on hem o dialysis for the last 2 years and loss of his lower left limb through amputation because of poorly healing diabetic wounds that were infected and not healing.

Pharmacokinetics

Pharmacokinetics, refers to the movement of drug into, though, and out of the body and the course it takes to be absorbed, its bioavailability, how it is distributed, its metabolism, and how it is excreted (Doogue,  & Polasek, 2013). My patient Mr. X has undergone significant changes due to his uncontrolled diabetes which have impacted his kidney function and how well and fast he can metabolize medication. Due to his renal failure; and diabetes, he is likely to metabolize certain medications at slower pace and will take longer than usual time to excrete medication out of his body. In some instances, some medication needs dialysis to be excreted.

Pharmacodynamics

Pharmacodynamics is the   body’s biological response to drugs and how someone’s body reacts to drugs. The effect can be as a receptor effect, post receptor effects, or through chemical interactions (Keller& Hann, 2018). My patient has diabetes and kidney failure which impacts how fast or slow his body produces certain enzymes, how he reacts to drugs, and the time it takes for any medication to have the desired impact on him once he take s the medication

Studies show that Kidney dysfunction influences the pharmacokinetic parameters of at least 50% of all essential drugs due to altered physiology and many pharmacokinetic principles. It is therefore important for clinicians to be aware of the patient’s kidney functioning and the impact any medication they prescribe will have on a patient’s health. Failure to taking account of a patient’s kidney diseases status can lead to drug overdose, drug under dosage, adverse effects, or failure of treatment (Lea-Henry, Carland, Stocker, Sevastos, & Roberts, 2018). As a kidney failure patient, Mr. X. has to have frequent blood work done prior to dialysis to determine the level of electrolytes in his circulatory system, drug toxicity levels in the medication he is using such as digoxin and vancomycin, and his fluid intake is under contact scrutiny to prevent fluid overload.

Factors that impact his pharmacokinetic and pharmacodynamic

Drugs pharmacodynamics and pharmacokinetics can be affected by physiologic changes due to disease, genetic mutations, aging, gender, ethnicity, behavior, or other drugs (Ginsberg, Hattis, Russ, & Sonawane, 2005). Mr. X. is a minority who might have a disposition and a high affinity to becoming a diabetic due to hi race; however, lack of compliance in diabetes management and poor blood pressure management played a role in causing his chronic kidney failure. In my patients’ case, Drugs the pharmacodynamics and pharmacokinetics are greatly impacted by his comorbidities which include diabetes, hypertension, and kidney failure.

Plan of care

Kidney failure impacts pharmacodynamics and pharmacokinetics of drugs because the disease impacts drug  clearance and the volume of distribution ((Lea-Henry, Carland, Stocker, Sevastos, & Roberts, 2018). When caring for renal failure patients we must be aware that their ability to absorb, metabolize, and excrete drugs is slow and therefore measures must be taken to prevent drug underdosing, drug overdosing, or adverse reactions. Frequent drug level checks should be done on some of the medication that they take. Nephrologists should be consulted to ensure that the right dose of medication and what classification of medication should be prescribed to renal failure patients.   With Mr. X he has to have his digoxin levels and vancomycin levels checked weekly, he has to have a CMP done prior to his dialysis3  times a week, he has to have a nephrologist consulted prior to changing the dosage of