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1 Pharmacology case study Running head: Pharmacology case study Pharmacology Case Study Elizabeth Maimo Nursing 3191 professional Clinical Nursing RN 1 Fall, 2014 School of Nursing Columbus State University 2 Pharmacology case study Assuming the patient is a type @ diabetic, diet and exercise can be employed to manage diabetes. Alternative therapy for management of diabetes includes both diet therapy and physical activity. Diet therapy involves modifying the diet so that carbohydrates that are consumed would be of low glycemic value. Whole grain carbohydrates and low glycemic index carbohydrates cause a gradual and sustained release of glucose into the blood stream, as opposed to simple and processed carbohydrates which cause a ‘dumping’ of glucose into the bloodstream, resulting in hyperglycemia. ‘Diets based on carbohydrate foods that are more slowly digested, absorbed, and metabolized (i.e., low glycemic index [GI] diets) have been associated with a reduced risk of type 2diabetes and cardiovascular disease’ Marsh et al. (2011). Traditionally exercise is believed to improve the cells uptake of glucose improved sensitivity to insulin. According to Zanuso et al (2010), exercise has been shown to decrease HgA1c, when followed consistently. Given that the patient has limited resources, dietary modification and exercise would be affordable methods to improve her outcomes. The exercise that would need to be performed could be as simple as walking for up to 30 minutes a day, 4-5 days a week. In the same study by Zanuso et al (2010) it was found that cholesterol (LDL) levels and blood pressures were decreased in patients who consistently exercise. The patient has problems with her cholesterol levels and elevated blood pressure. Moderate fat, low sodium diet and exercise aid in lowering both cholesterol levels and blood pressure. As far as diet goes, emphasis will be placed on consuming non-starchy vegetables in the meals as well as complex carbohydrates, all of which do not cause an abrupt spike in blood glucose levels. The patient has problems with finances, since this is the case; it is obviously not a good idea for her to check her blood pressure while out shopping. Blood pressures are bound to be increased in instances of stress (emotional or physical). 3 Pharmacology case study Patient empowerment is a big factor in determining positive outcomes for patients. Patient empowerment enables informed decision-making by patients on matters concerning their own care. When patients are educated on their disease processes, they’re better able to participate in their care and offer relevant feedback on matters regarding their treatments. Patient safety is enhanced when patients participate in the decision-making concerning their health through the following ways: patients who actively involve themselves in their treatments will communicate better with their healthcare providers and thus reduce the likelihood of some health information being overlooked if they change healthcare providers. Medication safety is improved when patients are knowledgeable about their medications. It is not uncommon for patients to halt medication errors by alerting the nurse that the said medication has never been taken or in instances where the dosage is incorrect. Patients can also enhance safety by inquiring about the medications they’re being given and what the effects are. Conscientious nurses will pause when patients ask about their, potential errors might even be discovered when the nurse pauses to explain the medications to the patient. One of the factors that drive healthcare cost is diagnostic procedures that employ innovative medical equipment. Some Diagnostic procedures might be bypassed if the patient is able to provide a comprehensive history of their health condition. For patients who do not possess health insurance or primary care providers or who have problems affording medications, social workers often work with patients to get them situated. Active patient participation in healthcare could often be impaired by certain barriers on the part of the patients. Literacy levels play a role in how much patients are able to contribute to their healthcare. The more educated a patient is, the more likely they would understand instructions and directions about their health management. In addition to education, fear and awe of healthcare providers is a factor in how much patients participate in their healthcare. Hispanic 4 Pharmacology case study and African cultures often ‘look up’ to healthcare providers and believe that healthcare providers know best in matters of healthcare. This acquiescence on the part of some culture limits active participation in healthcare decision making. Ignorance on healthcare practices/processes limits patient contribution. Another barrier to active patient involvement is the healthcare professionals themselves; according to Boivin et al (2014), critics of patient involvement in healthcare ‘doubt that patients can actually influence professionals’ decisions and have an impact on collective healthcare’. Such thinking, and stereotyping of patients by some healthcare providers will limit patient participation in their healthcare. Knowledge plays a major part of patient empowerment. As the old phrase goes ‘knowledge is power’, patients who have been educated on the various aspects of their healthcare are better placed to make informed decisions. Given that nurses spend more time in physical proximity to patients, the duty of patient education should be integrated in nursing care. Most patients will ask questions when in doubt of treatments or procedures. As much as possible, nurses should strive to provide answers to patients’ questions, or channel the questions to the appropriate quarters. Healthcare providers need not assume a paternalistic stance when treating patients, patients should have autonomy and matters should be explained to them in terms that would be understood. McAllister et al (2012, p. 2) propose that patient empowerment promotes adherence instead of mere compliance. They define adherence as ‘the patient voluntarily agreeing with a healthcare plan developed through share decision-making’. For patients with chronic conditions like diabetes, hypertension, etc, adherence to the treatment plan will promote positive outcomes for the patient. Patients and families should be provided the necessary tools that would enable them be participants in their own care, instead of as passive consumers. 5 Pharmacology case study Reference: Boivin, A., Lehoux, P., Lacombe, R., Burgers, J., & Grol, R. (2014). Involving patients in setting priorities for healthcare improvement: a cluster randomized trial. Implementation Science, 9(1), 1-20. doi:10.1186/1748-5908-9-24 Marsh, K., Barclay, A., Colagiuri, S., & Brand-Miller, J. (2011). Glycemic index and glycemic load of carbohydrates in the diabetes diet. Current Diabetes Reports, 11(2), 120-127. doi:10.1007/s11892-010-0173-8 McAllister, M., Dunn, G., Payne, K., Davies, L., & Todd, C. (2012). Patient empowerment: the need to consider it as a measurable patient-reported outcome for chronic conditions. BMC Health Services Research, 12157. Zanuso, S., Jimenez, A., Pugliese, G., Corigliano, G., & Balducci, S. (2010). Exercise for the management of type 2 diabetes: a review of the evidence. Acta Diabetologica, 47(1), 1522. doi:10.1007/s00592-009-0126-3