Selected Case
Providing care as a nurse practitioner to our patients demands that we as clinicians understand the pathophysiology of the disease as well as the pharmacology related to the drugs used to treat conditions. While every patient is unique and at times can be complex, understanding the pharmacokinetics and pharmacodynamics is essential for treatment. The impact of the body on the drugs is the basis of the pharmacokinetics, the process of moving the drugs to the sites of action throughout the body (Arcangelo, Peterson, Wilbur & Reinhold, 2017, p. 17). This entails understanding how the medications are circulated, administered, absorbed, and ultimately discarded from the body. On the other hand, Arcangelo, Peterson, Wilbur, and Reinhold (2017) defines pharmacodynamics the implications of the drugs on the body; this is the toxic or therapeutic effect of the drugs at the systemic or cellular level (p. 17). Practitioners or providers must understand these processes related to the drug and apply them to the individual or patient. Providers must understand the advanced pharmacology principles as well as be able to interpret them in practice (Laureate Education, 2012). The case selected was a 65-year-old male presented to with congestive heart failure exacerbation. Patient A was experiencing increased swelling to the lower extremities that resulted in pitting 3+ pitting edema, as well as increased shortness of breath. Upon examination, the patient was found to have, and fluid in the lungs, and breath sounds had diminished to the lower lobes bilaterally. Patient A had an extensive medical history that included prior open-heart surgery, x4 vessels, hypertension, stage IV kidney disease, and diabetes. The patient was in hospice care and receiving the maximum dosage of Lasix to combat the buildup of fluid.
Individual Factors
The importance of pharmacokinetic process is getting the drugs to the sites of action to produce their pharmacodynamic effects (Arcangelo, Peterson, Wilbur & Reinhold, 2017, p.17). Behavior and pathophysiological changes played a large role in this situation that led to the disruption in the pharmacokinetics of Lasix. While there is an abundance of information related to Lasix and the effectiveness of the drug related to helping decrease fluid in the body, there is also detailed information related to the toxic effect on the kidneys. Fluid buildup is common in patients suffering from congestive heart failure, and Lasix is usually the drug of choice. However, it is vital that providers ensure that they are monitoring the health of the kidneys.
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Preliminary data has indicated that aggressive loop diuretics are capable of activating the neurohumoral pathways adversely and hence eventually cause renal blood flow impairment as well as glomerular filtration rate (GFR) decrement (Kuzner, 2013). The glomerular filtration rate is a test that is used in determining whether the kidneys are working optimally. One of the factors related to the fluid buildup was related to behavior. The patient was not limiting the number of fluids being consumed even though his medical conditions warranted such an intervention. Genetics was also a key player in the effectiveness of the Lasix medication as it related to kidney failure and the fluid buildup in the body. Due to the presence of kidney failure, the patient was susceptible to increased damage to the kidneys from the high dose of Lasix.
Personalized Care Plan
In the health care profession, it is important that we understand the pathophysiology of disease as well as the pharmacotherapeutics involved in caring for our patients. As such, Hilmer, McLachlan and Le Couteur (2007) argues that prescription for geriatric patients demands a thorough and advanced knowledge on the effectiveness of the medications in weak and highly vulnerable older people, risk evaluation on the side effects, deliberation on the cost-benefit ratio while consulting the patients, a decision regarding the dosage regimes and vigilant monitoring on the response of the patient.
In this specific case, a personalized care plan was developed and applied to the care of the patient. The care plan incorporated the history of the patient and adjusted the medications that were available to treat the disease’s present as well as the symptoms he was experiencing. The plan consisted of the patient continuing the recommended dosage of Lasix, as well as incorporating atropine drops under the tongue, as well as implementing fluid restrictions and decreasing the amount of salt in the diet. Atropine is a medication that is designated as an anticholinergic but has been shown to work well in decreasing the amount of fluid retention in the body. This medication has also been beneficial to congestive heart failure patients. While not all these patients require this treatment, this was the treatment that worked well for this patient. The patient is still in hospice care a year and a half later and doing well. Recently I was able to speak with him, and he is still enjoying life, retired and working on his farm.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Hilmer, S. N., McLachlan, A. J., & Le Couteur, D. G. (2007). Clinical pharmacology in the geriatric patient. Fundamental & Clinical Pharmacology , 21(3), 217–230.
Kuzner, W. (2013). High Furosemide Dosage May Harm Kidneys . Retrieved from https://www.renalandurologynews.com/cardiovascular-disease-cvd/high-furosemide-dosage-may-harm-kidneys/article/321800/
Laureate Education, Inc. (Executive Producer). (2012). Introduction to advanced pharmacology . Baltimore, MD: Author.
