Therapeutics and Diagnostic Reasoning - Essay Example

THERAPEUTICS AND DIAGNOSTIC REASONING There is a growing necessity for nursing practitioners in both primaryand secondary care settings to enlighten themselves with various issues surrounding drug administration, diagnostic reasoning and pharmacokinetics. With the introduction of independent prescribing procedures in health care institutions, it is paramount for nursing practitioners to maintain formidable knowledge base in contemporary pharmacokinetics and pharmacology (American Academy of Pediatrics, 2003). This will enable them to contribute positively to successful medical care in the current multi-disciplinary environment. This presents a multi-faceted approach to the many issues that relate to drug administration and related procedures. The paper then provides an overview of several aspects of diagnostic reasoning and pharmacokinetics as they relate to the realm of nursing care (American Academy of Pediatrics, 2003). Finally, the paper makes a critical analysis of therapeutic impact of patient care before concluding with a Critical evaluation of alternative approaches and perspectives to care. In order to address the issues raised above, it is important to look at the legal, administrative and ethical issues that relate to drug administration. There are several issues that accompany the critical concept of drug administration. Many of these issues arise in a bid to address many of the mistakes that accompany drugs and intravenous solutions. Therefore these issues may arise during prescription, dispensing, transcription, and the administrative phases of preparing and distributing drugs (American Academy of Pediatrics, 2003). Many of the errors that result during drug administration can either be acts of omission or commission. Moreover, thy may entail the following; wrong dosage, improper routine and drug mix-up. In addition, the omission may be as a result of improper timing of drug administration and contraindications that may result during drug administration. Others include incorrect drug procedure, erroneous infusion rate, and terminated prescription date or several prescription errors. It is important to note that some of these errors can occur either intentionally or unintentionally. Several factors that may cause errors during drug administration errors can be divided into system errors and errors attributable to individual health care practitioners. Another key issue that lies within the contribution of contribution factors to errors in drug administration revolve around the issue of incident reporting (Anderson, &Webster, 2001). It is apparent that the procedure of medication is a multifaceted sub-system of any health institution. Prescription, preparation and administration of medications are dependent on numerous processes that are intended to ensure that all patients are provided with the appropriate treatment. However, in case any issues arise in organizational system or medication process, there is a likelihood that a patient may not receive proper medication (Andersen, 2002). The issues of drug administration that arise due to an individual’s professional practice are multifaceted and varied. Many of these issues are link to errors that are specific to professional characteristics, with a special focus on a physician’s skills, competencies and attributes. For instance, an individual practitioner can contribute to drug administration errors due to an apparent lack of knowledge about medications (Armitage, & Knapman, 2003). Such lack of knowledge can include the inability precisely to calculate drug dosages which significantly contribute to a physicians likelihood of making errors. Before drugs are administered physicians must be aware of the professional responsibilities that accompany drug administration, including drug orders, nursing process and drug delivery systems as they relate to drug therapy. Any ignorance on the physician’s overall responsibility could lead to delays in reception and administration of medications, as well as serious administration errors. In either scenario, nursing care is compromised, and the patient may experience unnecessary suffering (Baker, 1999). The practice of nursing care under a recognized professional license is a privilege for many nursing practitioners. As such, nurses must understand that their responsibility encapsulates overall accountability for their actions and judgments during the nursing practice, including drug administration to their patients. When it comes to drug administration, there are several policy guidelines that have been stipulated by major nursing practice oversight bodies. These guidelines entail some of the following principles: 1. Educational requirements for all nursing practitioners surcharged with drug administration. Under the principle, all health care institutions require their nurses to pass a written test that confirms their level of knowledge and skills in drug dosage calculation, preparation and administration (Baker, 1997). 2. Approved compilations of intravenous medications and solutions that nurses can start or add to an existing infusion (Nagelkerk, 2001). 3. Health care institutions are expected to have lists of restricted medications that can only be administered by the approved staff members. All nursing practitioners are expected to adhere to this guideline at all time during their nursing practice (Barker, Flynn, and Pepper, 2002b) 4. All nursing practitioners who are responsible for drug administration should be conversant with the list of abbreviations that should not be used in documentation for purposes of avoiding drug administration errors (Sage, 2003). The nursing practitioner should have a current practicing license before performing any act of drug administration. Furthermore, drug administration personnel are expected to have clear policy statements outline their roles, as well as a medication order. These are to be overseen and signed by the practitioner licensed with drug prescription privileges (Berntsen, 2004). The practitioner must be conversant with the individual patient’s symptoms and diagnosis that correspond to the required rationale for drug use. The practitioner must understand the expected actions, proper dilution, the usual dosage, expected minor side effects, route and rate of administration, and the adverse effects that should be reported (Cohen, 2002). The increase sensitivity of ethical issues that underlie the issue of drug administration requires nursing practitioners to understand legal impacts in drug administration. Therefore, it is important for practitioners to inform their clients (patients) of any form of inaccurate prescriptions and administration that may be detrimental to their health (King, 2004). In cases where wrong drug administration results in death, there is an increased legal requirement for practitioners to inform the next –of-kin about the circumstances that precipitated such death. Due to the great legal liability that accompanies such disclosures, it has been a challenge for medical practitioners to follow the laid down regulations concerning incident reporting. The best way to avoid such liability is for practitioners to ensure maximum responsibility during drug administration procedures (Hurley, 1998). In instances where drugs are to be administered by use of similar syringe at the same intravenous site, the practitioner is expected to confirm drug compatibility before the administration (Helsm, &, 2006). In the case of any doubts about these crucial medication points, the practitioner must consult an authoritative resource at the institution before performing any drug administration. In essence, the nurse should be very accurate in the calculation, preparation, and administration of the necessary drugs (Lunney, 2001). The practitioner must first and foremost evaluate the patient in order to ascertain that therapeutic and adverse effects that accompany any medication regiment are accurately reported. Nursing guidelines stipulate that all physicians should be able to collect patient information at regularly scheduled intervals and make records for all observations within the patient’s charts for assessing the effectiveness of any drug administered. Any claims of unaccustomed with any of these nursing care tasks, in cases where preventable complications arise, are intolerable. In fact, such amounts to negligence of nursing responsibility (Vincent, 2003). Thus, all health care practitioners who are associated with drug administration procedures and processes are expected to take active roles in educating patients and family members. This would help in preparation for patient discharge from the health care environment (Alm-Roijer, Stagmo, & Uden, 2004). This is meant to ensure that the patients can follow the stipulated drug administration procedures even long after they have left the health care environment at the medical facility. The ability to ensure that nurses and their patients are commensurate with the standard drug administration procedures mean that health practitioners should be aware of the critical aspects of pharmacokinetics and diagnostic reasoning as discussed below. Clinical diagnostic reasoning and pharmacokinetic monitoring are integral components of nursing care for patients based on their particular pharmacotherapy, treatment goals, disease states and other related factors. It is important to note that pharmacokinetic monitoring is important in achieving positive results for patients across the continuum of care. Examples of these results include decreased treatment durations, decreased mortality, decreased morbidity and decreased admission to the hospital (Avorn, Monette, & Lacour, 1998). Furthermore, proper diagnostic reasoning results in decreased adverse effects that may result from incorrect drug therapy. Within the nursing care setting, physicians’ clinical duties should entail suitable and cost-effective therapeutic drug checking, as well as the establishment of experimental pharmacokinetic appraisals. Clinical diagnostic reasoning is essential when the range between minimal efficacy and toxicity is narrow, and the outcomes of the drug assay offer significant information for clinical decision making. For instance, the absence of drug concentration measurements and patient-specific characteristics, physiological markers can be used to make clinical pharmacokinetic evaluations and make the necessary dosage-regimen recommendations (DiMatteo, 2004). Pharmaceutical diagnosis entail the definition of the nature of specific drug-related issues, with each diagnosis serving a foundation for desired results, treatments, evaluation parameters and subjects for patient education and counseling. One of the greatest tests in becoming a competent drug prescriber is the attainment of appropriate clinical cognitive and diagnostics. Critical diagnostic is a complex thinking process that is utilized in the acquisition and evaluation of data and facilitate decision-making concerning the diagnosis and treatment (Horne, & Weinman, 1999). Nursing practitioners are expected to develop their sound clinical and diagnostic skills through practice and experience while working under clinical experts. Sound treatment decisions, which is the ultimate objective of clinical and diagnostic reasoning, relies on the depth and length of the physician’s knowledge base and experience level for various treatments and medications. This knowledge includes a clear understanding of the side effects, efficacy, contra-indications, indications, mechanism of action and the expected complications (Benner, Tanner, & Chesla, 2006). Firstly, within the high-dependency unit where most patients are often critically ill and physiologically unstable, a rigorous clinical evaluation may not always be possible, and this is likely to influence treatment decisions. For instance, a patient may have had an altered level of consciousness, affecting the quality of history taking. Secondly, patients who may be deteriorating rapidly usually require prompt diagnosis and treatment that is often dependent on clinical information in order to help in the diagnosis. The diagnosis here includes blood results and medical case notes which may often be incomplete or unavailable (Rew, & Barrow, 2007). There are patients who may have several conditions or diseases that may require extensive knowledge of their side effects, indications, contraindications, complications, and interactions between several treatments. Competent diagnostic reasoning and sound pharmacokinetics skills are essential pre-requisites for efficient and safe prescription of drugs (Kink, & Clark, 2002). Many health care scholars have expressed their concerns that nursing practitioners and other allied health professionals often lack the necessary evaluation and diagnostic skills for effective diagnosis and management of several conditions and diseases. There have been increased calls for nursing practitioners to be adequately prepared to perform competent clinical and diagnostic reasoning in order to assume accountability and authority to handle varying clinical conditions and diseases (Bucknall, 2003). Some of the common disease conditions where critical diagnostic reasoning is paramount include diabetes, asthma, depression and caring for children and infants. These cases are handled separately in the sections below. Diagnostic reasoning and therapeutics recommendations in such diabetes cases should be aimed at ensuring that patients easily select the effective objectives for the management of their conditions (McQueen, 2004). Furthermore, therapeutic consideration often revolves around the treatment of the diabetic condition with insulin. There is also the treatment of variations in hyperglycemia and hypoglycemia as may be necessitated by the outcomes of the study of variations in blood sugar levels. During the treatment of hypoglycemia, the nurse should have the necessary diagnostic reasoning skills that will facilitate the appropriate recognition of the several symptoms of hypoglycemia. During the process of injecting insulin, the practitioner must be able to prepare insulin doses, perform the injections and change injection sites as required (Whitney, 2003). Nursing care for asthmatic patients should be able to apply their diagnostic reasoning skills in selecting the necessary objectives for the management of health condition (Bell, Caspi, Schwartz, Grant, Gaudet, & Rychener, 2002). Furthermore, the practitioner is expected to utilize their pharmacokinetic skills in managing the condition with the necessary prescription regimens. Recognition of the symptoms at the onset is very important, and this calls for appropriate application of the physician’s diagnostic reasoning skills. When it comes to treatment regimen, the physician must be able to select a range of medications according to their pharmacological properties. Principles of pharmacokinetics, such as bioavailability, distribution, and metabolism should be accurately understood before the nurse can make the choice for the most appropriate treatment for each patient (Fowler, 1997). For the management of depression, effective collaboration across specialty and primary care is of fundamental importance in the effective diagnosis and pharmacokinetic care of depression. Diagnostic reasoning enhances the detection, recognition, and treatment of the condition. Furthermore, the adherence to evidence-based guidelines enhances diagnosis and treatment outcomes (O, Neill, & Dulhy, 1997). The apparent lack of exact science in the determination of the correct medication for all children necessitate the application of multiple resources and diagnostic reasoning skills in pharmacotherapy (Adcock, 2006). In this regard, pediatric clinicians should have a great know-how on the effects of physiological development on absorption, distribution, metabolism, and excretion in children and neonates. Age is among the most important variables that influence drug processing and the subsequent effect on the body, and clinicians must be able to utilize their diagnostic reasoning skills in making drug administration determinations for children. It is important to note that childhood is a very unstable and dynamic period as a result of the ongoing growth and development processes within the body. Hence, clinical practitioners must be able to understand the variations in pharmacokinetic characteristics between children and adults. The processes of abortion, distribution, metabolism and excretion of drugs take different variables in children and adults. Thus, nurses should use their diagnostic reasoning skills in dealing with these variations (Edmunds, & Mayhew, 2004). Consultations with pediatric physician are important when doing drug prescription to children with chronic health conditions or other physiological alterations in development of organs and organ systems. This is because such alterations have the potential to disrupt pharmacokinetics aspects such as absorption, distribution and excretion (Gorman, 2003). The core competencies of therapeutic interventions include the role of the nursing practitioner in stabilizing the patient, reducing physical and physiological complications and increasing the patient’s general health potential. The final objective of any medical psychotherapy is to fulfill sought after goals within the apprehensive patient. These anticipated results are portion of the purposes in the management of various health conditions and diseases. However, despite the many efforts applied by health care professionals, these results may not be achieved in cases where the patient becomes non-compliant. In health care practice that takes place outside the hospital environment, more than 80% of conditions and diseases treated are often chronic (Suggs, 2000). Even though much of the available treatment is very efficient, its quality is usually far from satisfactory. Many patients often fail to comply with medication instructions, with less than 50% of them adhering to the laid down prescriptions and treatments correctly. Research studies have indicated that the reason for these trends is because most patients are inadequately informed about their medical condition, with few of them getting any professional help in managing or taking responsibility for their treatment modules. Even though most nursing practitioners are efficiently competent in diagnostic reasoning and treatment, very few of them pass this knowledge to their patients for purposes of managing their treatments (Basford, 2003). One of the major reasons for these trends is that the early teaching for many health care practitioners is centered mainly on identification and selection of a particular treatment. In this regard, therapeutic patient education should be designed to equip patients with skills of self-management and adaptation to treatment that is specific to their chronic condition. Within the field of nursing care, therapeutic patient education should be managed by health care experts who have been trained in patient education. The major purpose of this training is to enable patients management their treatment regimen and help in the prevention of avoidable complications and contraindications while at the same time maintaining or improving the quality of life. The core determination of therapeutic tutoring is to yield a therapeutic impact in additional to the other involvements such as physical therapy and pharmacological interpositions (Leach, 2010). For Asthma patients, therapeutic knowledge is essential in informing the selection of objectives for the management of the condition. Patients should be trained on how to recognize their symptoms, as well as how to take the necessary steps for the prevention of other attack symptoms. When it comes to the health care practitioners, therapeutic knowledge is important during the selection for the necessary medication, with due regard to their properties, as well as patient characteristics. This knowledge is essential in the [prevention of complications such as contradictions and contraindications. Other essential elements of this knowledge include the ability to use a bronchodilator after detecting the first signs o the condition. For diabetes type 2 patients, therapeutic information is necessary for informing the patients on the best management practices for the disease. Patients should be advised accordingly on the best ways to modify their nutrition, and follow the prescribed treatment regimen. Therapeutic information should also include the need for patients to involve in physical activity on a regular basis. As for the most appropriate diet, patients should be informed on how to prepare balanced diets, with emphasis on taking sufficient carbohydrates in every meal and having their meals on a regular schedule. When it comes to medication and treatment, patients should be informed on the best ways for adhering to the prescribed drug dosage. Moreover, they should be guided on taking medicines in a regular schedule, and the recognition of any form of insufficiency in their treatment procedure (Doenges, & Morrhouse, 2012). A number of recent trends indicate that conventional medicine that puts great emphasis on diagnostic reasoning and pharmacokinetic parameters may yield pluralistic health care system. This would be where various models of care may have to co-exist. However, it is notable that the co-existent of various health care modalities does not necessarily produce an integrative system of health care (Barnes, Abbot, Harkness, & Ernst, 1999). Within the present health care system, providers and patients encounter problems when multiple, yet uncoordinated, approaches are followed during diagnostic reasoning and pharmacokinetic considerations. Some of the succinct alternative approaches to nursing care include the introduction of integrative care that not only enhances the strengths of conventional health care approaches, but also helps in balancing its deficiencies. The deficiencies addressed here include the possible undesirable side effects of poly-pharmacy and discrete pharmacological proxies (Faass, 2001). Other issues include high costs and the depersonalizing nature of the current technological interventions. Integrative care is also effective in addressing the suppression of symptoms that does not necessarily result in the promotion of overall healing (Marcum, 2008). Decision making is a very core process, especially in cases where decisions are made concerning patient’s health care issues, optimal modes of interaction and the most effective therapeutic interventions. The decision-making process relies on the attributes such as complexity, difficulty and uncertainty. The concept of an evidence-based nursing exercise relies upon combining of proof from a diversity of sources and relating the same in the upkeep needs for persons and populace. When it comes to the application of evidence-based practice in the realm of patient care, decisions should prudently consider the factors such as patient’s lifestyles, allergies, drug sensitivities and co-morbidities (Zenk, 1994). Nursing practitioners who may wish to improve the safety and quality of care can opt to improve the consistency of information interpretation that characterizes evidence-based practice. Before the commencement of evidence-based diagnostic reasoning and drug administration, there should be subtle clinical judgment of patient needs and resources. In the process of giving nursing care, clinicians should give sufficient attention to the patient’s condition. Moreover, the potential for adverse reactions should be monitored in cases that could be detrimental to the patients, and the patient’s responses to health care interventions. It is important to note that the judgment concerning the patient’s condition influences the subsequent therapeutic interventions and overall patient outcomes (Taxis, & Barber, 2003). In this regard, it is necessary to develop clinical knowledge that is applicable in specific patient populations as discussed below. An extensive experience base with a particular patient population can enable the physician to form comparisons, distinctions and nuanced differences within a given population of patients with certain injuries, conditions or diseases. The comparison between several specific patients can facilitate the creation of a matrix comparison for clinicians. Such a matrix can enable the clinicians to perform effective patient-specific detective procedure. This should be done in cases where patients fail to fulfill the desired, and predictable outcomes following therapeutic intervention (Keepnews, & Mitchell, & 2003). It is important to note that background and foreground information, in regards to a clinician’s attention, often shifts as predictable changes in the patient’s condition emerge. This can be seen as patients recover from operations such as heart surgery, or during the expected times of labor and subsequent delivery. With time, the physicians develop a better understanding that enables the application of expert intervention skills and precise diagnostic reasoning skills (Mello, & Brennan, 2002). References Adcock, K, 2006. Prescribing principles for children. Foundations of rational approach. 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