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Application of clinical decision making process

Discuss about the Medication Management and ADPIE Frame Work.

ADPIE is a framework for clinical decision making for the nurses that provides the nurses with a set of systemtic step by step process, following which the nurse will be able to complete a thorough assessment analysis, diagnosis and intervention implementation in order to address each and every concerns of the patient (Alfaro-LeFevre, 2012). ADPIE stands for assessment, diagnosis, planning, implementation and evaluation in a care scenario. As this assignment focuses majorly on the medication management, only three sections of the ADPIE frame work will be used namely assessment, implementation and evaluation.

The first step is the assessment step, where the medical professional attempts to discover the care issue of the patient and establishes a database of the care cues of the patient by interviewing the patient or their family members. Registered nurse will have two core nursing responsibility in this segment of care delivery. The first responsibility of the nurse will be to assess the drug history of the patient, including the prescription drugs and the over-the-counter drugs and the hypersesnsitivity of the patient to drug agents (Inzucchi et al., 2012). The patient had been taking metformin 500mg for her diabetes but she kept forgetting to take her medication, while in admission she had been given metformin, glibenclamide, atorvastatin, and erythromycin for wound infection management. The second responsibility of the nursing professional will be to assess the patient history such as the biographical data, lifestyle and beliefs, sensory and cognitive status as well. In regards to the cultural requirements, the nurse will have to ensure to adhere to the culturally appropriate and traditional approach to care while approaching the patient and be able to provide optimal cultural safety to the patient.

In this case, the first responsibility of the registered nurse will be to incorporate constant communication and collaboration with the health care team and follow the “eight rights” of the medication administration, such as right patient, right medication, right dose, right route, right time, right documentation, right reason and right response or all three medications. The second core responsibility will be to analyze the pharmacologic profile of the medication and educate the patient with a detailed account of the medication and how it is helping her. Metformin is a biguanide antihyperglycemic agent which is used mainly for treating the non insulin dependent Diabetes mellitus. The generic name is metformin with brand names Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet. This is a schedule two drug and for mechanism of action, metformin decreases the blood glucose levels by reducing the hepatic glucose production (Bailey et al., 2010). The side effects of the drugs like abdominal discomfort, cough, decreased appetite, diarrhea, shallow breathing and fever may occur, for which Mavis will need to contact the care facility. Similarly, for Glibenclamide, the generic name is glibenclamide or glyburemide and brand names are Dionil, Glucovance, Glucobene, semi-dionil. Mavis will need to be educated on how the medication binds to the ATP-sensitive potassium channels on the pancreatic cell surface and causes membrane depolarization and stimulation of calcium ion influx inducing the secretion and exocytosis of insulin (Seino et al., 2010). Mavis will need to be educated on the side of effects of the medixation which are nausea, vomiting, constipation, diarrhea and hypoglycemic attack. Lastly for atorvastatin as well, the generic name is atorvastatin and the brand name is Lipitor. Mavis will need to be educated on how statin group of drugs selectively and competitively inhibits the hepatic enzyme HMG-CoA reductase, in turn increasing hepatic uptake of LDL-C and reducing serum LDL-C concentrations. The education will include the side effects like memory problems or confusion, rhabdomyolysis and autoimmune myopathy, muscle pain, fever or unusual tiredness, changes in urine, etc. with regards to cultural appropriatenessm the registered nurse will need to provide the education in a culturally appropriate manner in a simple language that she will understand preferably taking the assistance of a cultural liaison officer and language interpreter (Kirmayer, 2012).

Assessment phase

The third stage of this process is the evaluation where the nursing professional will be needed to evaluate the success of the planning and implementation procedure. In this case, the nurse will have to monitor the response of the patient to the drugs administered, monitor the difference between expected and unexpected responses and assess the therapeutic effects, side effects, adverse effects and toxic effects (Nursingmidwiferyboard.gov.au 2018). This is the last step before the discharge and here the nurse will have to ensure that the patient understand all aspects associated with the safe and effective medication administration. The nursing responsibilities will include discharge planning and safe medication administration guidance. The nurse must educate the patient to take the right dosage at the right time and in case she missed a dosage the nurse will have to ensure taking the next dose according to the regular dosing schedule and that Mavis is not supposed to take double dosage of any medication to make up for missed dosage. The nurse will educate Mavis further on storing metformin is a closed container at room temperature, away from heat, moisture, and direct light (Inzucchi et al., 2012). The nurse will also educate Mavis to not consume alcohol while taking metformin. For Glybenclamide, the nurse will educate the patient to take the medication in the morning immediately after breakfast and if missed a dose, not to take double doses either. Mavis will need to be educated to seek medical advice if the patient experiences nauseam vomiting, constipation, diarrhea and hypoglycemic attack (White et al., 2013). Nurse will also need to educate Mavis to store the medicine in a cool, dry place, away from direct heat and light. For atorvastatin, Mavis will need to know to store the medication room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture and especially away from the bathroom (Jin et al., 2012). Along with that Mavis will be strictly advised to never skip a dose and in case she forgets to move on to next dosage and never overdose to make up for missed dose as well. Lastly the nurse will have to educate Mavis to keep the medication in a secure locked cabinet so that her granddaughter cannot access them at all (Roth et al., 2012). For the cultural appropriateness the nurse will have to ensure involving a cultural liaison officer and a language expert in the discharge planning and implementation session to ensure that Mavis understands the entire procedure and can equally participate in it. The RN will also have to ensure that the patient education details are provided in a written format in a culturally and linguistically appropriate manner using aboriginal language and symbols. Lastly the RN will have to ensure approaching the patient in a culturally safe and appropriate manner with utmost respect to the patient autonomy and dignity (Kirmayer, 2012).

Conclusion:

On a concluding note, it has to be mentioned that self medication administration can be a very risky procedure, especially for the culturally diverse populations with limited health literacy and lack of English language proficiency which can lead to the patient missing doses and administering wrong dosages and storing the medication in inadequate manner. Hence the role of a nursing professional is monumental in educating and guiding the patient for safe and effective medication administration. This essay had utilized the ADPIE clinical decision framework with respect to medication administration and safe application of drug therapy along with incorporating cultural safety guidelines for an aboriginal patient.

References:

Alfaro-LeFevre, R. (2012). Applying nursing process: the foundation for clinical reasoning. Lippincott Williams & Wilkins.

Bailey, C. J., Gross, J. L., Pieters, A., Bastien, A., & List, J. F. (2010). Effect of dapagliflozin in patients with type 2 diabetes who have inadequate glycaemic control with metformin: a randomised, double-blind, placebo-controlled trial. The Lancet, 375(9733), 2223-2233.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... & Matthews, D. R. (2012). Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia, 55(6), 1577-1596.

Jin, D., Wu, Y., Zhao, L., Guo, J., Zhang, K., & Chen, Z. (2012). Atorvastatin reduces serum HMGB1 levels in patients with hyperlipidemia. Experimental and therapeutic medicine, 4(6), 1124-1126.

Kirmayer, L. J. (2012). Rethinking cultural competence.

Nursingmidwiferyboard.gov.au. (2018). Nursing and Midwifery Board of Australia - Professional standards. [online] Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 15 May 2018].

Roth, E. M., McKenney, J. M., Hanotin, C., Asset, G., & Stein, E. A. (2012). Atorvastatin with or without an antibody to PCSK9 in primary hypercholesterolemia. New England Journal of Medicine, 367(20), 1891-1900.

Seino, Y., Rasmussen, M. F., Nishida, T., & Kaku, K. (2010). Efficacy and safety of the once-daily human GLP-1 analogue, liraglutide, vs glibenclamide monotherapy in Japanese patients with type 2 diabetes. Current medical research and opinion, 26(5), 1013-1022.

White, W. B., Cannon, C. P., Heller, S. R., Nissen, S. E., Bergenstal, R. M., Bakris, G. L., ... & Wilson, C. (2013). Alogliptin after acute coronary syndrome in patients with type 2 diabetes. New England journal of medicine, 369(14), 1327-1335.

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