Post a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.

Below is the Neurology case study for this week. Please write a 2-4 page paper (in APA format) discussing generalized seizures versus focal seizures. Be sure to follow the case study rubric located under “Important Course Information.”

Use the following items as headings for your paper:

– Pathophysiology

– Examples of each type of seizure

– Typical EEG findings associated with each seizure

– Physical presentation with each seizure

– Common medications used to treat each seizure type.

This is a formal APA paper so, your in text citations and reference list must be in APA format. Be sure to use proper grammar and punctuation. Be sure to use the headings described above in addition to including an intro and conclusion paragraph. A title page and separate reference page are required.

You  must also use 3 credible resources, i.e textbook, journal articles, credible websites. recent within the last five years

Submit your assignment as a Word document to the correct dropbox.

CL.

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

Photo Credit: Getty Images/Ingram Publishing

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare

• Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
• Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
• Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
• Think about a personalized plan of care based on these influencing factors and patient history in your case study.

By Day 3 of Week 1

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples
  Pharmacology is the study of the interactions between drugs and the body. The two broad divisions of pharmacokinetics refers to the movement of drugs through the body, whereas pharmacodynamics refers to the body’s biological response to drugs. Pharmacokinetics describes the drug’s exposure by characterizing absorption, distribution, bioavailability, metabolism, and excretion as a function of time, while pharmacodynamics describes drug response in terms of biochemical or molecular interactions (Arcangelo et al., 2017). The focus of this discussion will be in the process of warfarin in term of pharmacokinetics and pharmacodynamics of it in the body.   Ms. J.J. ‘s Health issue:   I was in charge of Ms. J. care couple years ago, a 85 year old African American women who was diagnosed with dementia cerebral infarction due to unspecified occlusion of cerebral artery, arthropathy, major depressive disorder, atrial fibrillation with a history of long-term use of anticoagulants, contracture of muscle, constipation, hypertension and GERD. She is currently on coumadin for the atrial fibrillation and the blood levels are monitoring every week in order to control the drugs therapeutic levels and avoid any adverse reactions.  Pharmacodynamics versus pharmacokinetics of this anticoagulant:  Many statistics from the stroke prevention in atrial fibrillation (SPAF) trial suggest that safety of anticoagulant in the elderly can be maximized through a careful monitoring and maintenance of the INR which is between 2 and 3. Ms. J’s therapeutic window for warfarin 2 to 3 which is the normal range for coumadin therapeutic level. Her weekly dosage is adjusted to her current blood levels. Bleeding is the most related complication of anticoagulant. Amy INR that increasing to 3.4 or 4.0 from Ms. J will result in nose bleeding, decreasing the coumadin or stop it for one or two days will be the only option (Horton & Bushwick, 1999).     Factors influencing Ms. J’s drugs therapy:   Multiple factors may affect the absorption of her medication. For example, the presence or the absence of flood in the stomach, blood flow to the area for absorption, and the dosage form of the drug. In Ms. J’s case, the most critical factor. Influencing her absorption of coumadin is gastric motility due to the history of constipation that she has, while a routine laxative dose and stools softens are administered daily for bowel movement.  Patient-centered care plan for management of constipation:   A non-pharmacologic care plan management can be introduced for the constipation in order to reduce the frequency and the quantity of laxative and stool. Softens doses that Ms. J is getting and ultimately gain a net decrease in gastrointestinal absorption of coumadin. Increasing a dietary fiber in her menu, encourage fluid and prune juice can have a significant impact on her bowel movement (Portalatin & Winstead, 2012).     Portalatin, M., Winstead, N. (2012). Medical Management of Constipation. Clinic in Colon and   Rectal Surgery. Doi: 10.1055/s-0032-1301754. Retrieved from   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348737/  Horton, J. D., Bushwick, B. M. (1999). Warfarin Therapy: Evolving Strategies in Anticoagulation American Family Physician. 59(3):635-646. Retrieved from   https://www.aafp.org/afp/1999/0201/p635.html     Arcangelo, V. P., Peterson, A. M., Wilburg, V., Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. (4th Ed.). Wolters Kluwer Lippincott Williams &
 

 Respond to  your colleagues by constructively critiquing their interview format and providing feedback. 

NOTE: (POSITVE COMMENT)

                                                           Main Post

Personal Format

In  the psychiatric setting, assessing the needs of a client is mostly done  through personal interaction where the PMHNP is expected to ask various  questions. In fact, it suffices to say that interviews with patients is  one of the most effective ways of assessing their mental health needs  and coming up with the most appropriate interventions. It is widely  known in psychiatry that clinical interviews stand as one of the most  effective diagnostic tools. In this setting, the use of other validating  criteria such as lab tests as well as imaging are not commonly used  (Lin et al., 2003) Therefore, the interview should be done in a proper  manner in order to identify patients’ needs. The best interview format  should be based on the strengths of the interviewer especially in the  initial interaction with the patient where the strengths and weaknesses  of the clint are no known.

   The format that I would use in the initial interview with the patient  is one which is conversational in nature. This is because at this point,  there is no previous relationship between me and the patient. There is  no discernible trust between us, and the patient may nervous. Therefore,  a conversational approach to the initial interview shall be used with  the view of building rapport. The process of building a rapport may help  in identifying various issues about the patient even without  necessarily asking direct questions. For instance, the process of  building rapport may help the practitioner to establish whether a  patient is going through a psychotic issue or a less serious mental  health issue (Varghese & Dahale, 2018). This will determine how the  rest of the initial interview and other interactions with the patient  shall be conducted. 

    Once rapport has been established in the initial discussions which will  have to involve any issues, I can then move on into the health issues  or concerns of the patient. At this point, it is important to make sure  that the perspective of the patient about the prevailing problem as well  as their explanatory model regarding the problem are acknowledged  (Varghese & Dahale, 2018). This does not mean that I should accept  them. However, this will allow me to show compassion, empathy and  implement active listening skills. This will not only strengthen the  trust between the patient and myself but also improve the therapeutic  relationship between us at an early stage. This initial interview should  be used to collect information about the patient including such as age,  gender, marital status, and occupation. The chief complaint or  presenting problem, the history of present illness, precipitating  factors, social history, behavioral patterns, psychiatric

history  of the patient, family history, alterations in roles as well as social  functioning and the performance of a mental health examination, among  others. 

     Ideally, at this initial stage, I would use the opportunity to perform a  comprehensive psychiatric assessment of the patient to establish what I  am dealing with and to start the necessary interventions as soon as  possible. While I take notes during the interview, I will ensure that I  record what the patient says as he or she says it .I will also add notes  regarding how the patient presents his or her information. This will  help in proper diagnosing. The questions shall not be structured. They  will be random and open-ended to suit the different needs of the  patient. As it is a psychiatric condition, we must pose leading  questions on behavior and prevalent health conditions. The questions  posed include symptoms of the illness, how long the illness started its  gradual shift to critical condition, current life stresses, the criteria  of the illness in the DSM-IV, any suicidal or homicidal ideations, and  the impact of the illness on the overall quality of the patient’s life.  However, if it is established during the early stages that the patient  may be psychotic, the initial interview shall continue using structure  questions that are more focused than in other cases.  This is because in  such patients, open-ended questions may be confusing and disorganizing  (Sadock, Sadock & Ruiz, 2014).

             During the initial interview, the rules of engagement shall be set out  and the patient shall be allowed to ask questions to clarify on issues  regarding the rest of the sessions. This is also the right stage to  inform the patient about the prevailing legal and ethical issues such as  the confidentiality of the information that shall be shared during all  sessions. Simply put, the format of the initial interview for my case  shall focus on building rapport, collecting all the necessary  information to make a diagnosis and helping the patient to understand  how the therapeutic relationship shall be optimized in the subsequent  sessions.

Preceptor’s Format and Helpful Elements

   The preceptor uses the format like I have described. Instead, there is a  checklist or a template that exists in the facility. The preceptor uses  the template in all cases. This template was created by the preceptor,  but it is varied in different cases depending on the presenting  patient’s problem. Most of the questions in the checklist are  structured.  The preceptor tends to ask too, if the patient has  medications of mental treatment to establish the duration of treatment,  type of therapy allocated as well as any arising symptoms , entails  substance abuse history to investigate if the patient has any  addictions, determination of the personal history of the patient such as  family history and experiences, and sexual history. It suffices to say  that after many years of experience, the preceptor has developed an  approach that works. The facility also gets a high traffic of patient  and the template allows the preceptor to effectively handle each case in  a quick manner. The downside here is that this approach may prevent the  preceptor from developing a rapport early and this may not suit the  needs of patients.  My interview format is not restricted. It allows the  practitioner to maneuver between the different needs of patients hence  providing patient-centered care. The most helpful element of the model  is the personal history of the patient because it provides the origin of  where the problems started. For example, if the patient has suicidal  ideations it could be traced to their childhood experiences and how they  deal with stress. (Parker, J 2014) reiterates that mental healthcare at  the primary level requires an effective short consultation. One of my  philosophies in nursing is to provide care that focuses on the needs,  values, preferences, and beliefs of the patient while ensuring that a  therapeutic relationship is established.  It also reveals to the  psychiatrist how well the patient’s family can support in recovery. It  also helps to understand mental illness through cultural lenses  (Lauracuente,2019). It is also an element that determines how open and  communicative the patient is willing to be throughout the entire  process.

References

Lin,  D., Martens, J., Majdan, A., & Fleming, J. (2003). Initial  psychiatric assessment: A practical guide to the clinical interview. British Columbia Medical Journal, 45(4), 172-177

Sadock,  B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s  synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th  ed.). Philadelphia, PA: Wolters Kluwer.

Varghese, M., & Dahale, A. B. (2018). The Geropsychiatric Interview-Assessment and Diagnosis. Indian journal of psychiatry, 60(Suppl 3), S301

Parker, J. (2014). Adapting the psychiatric assessment for primary care. South African Medical Journal, 104(1).

Laracuente, R. (2019). Empathy in Psychiatry: Reflection on a Patient Interview. Arts and Culture,14(3),8.

In an interesting study I recently read about childhood obesity, a molecular marker in saliva was found to be associated with the emergence of childhood obesity in a group of preschool-aged Hispanic children. Crazy, isn’t it?! The investigators found that methylation of a gene called NRF1, which has roles in adipose tissue inflammation, was associated with childhood obesity. A child with the NRF1 methylation at baseline had a threefold increased odds of being obese three years later, after controlling for maternal BMI and other factors. What do you think would be helpful to families who find out their child has an increased disposition towards obesity? I would be interested in hearing your thoughts.