Ethical and Legal Implications

The response accurately and thoroughly explains in detail the ethical and legal implications of the scenario selected on all stakeholders involved.

The response includes accurate, clear, and detailed explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

The response explains the ethical and legal implications of the scenario selected on all stakeholders involved.

The response includes accurate explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

The response inaccurately or vaguely explains the ethical and legal implications of the scenario selected for all stakeholders involved.

The response includes vague explanations as to how these implications affect the prescriber, pharmacist, patient, and the patient’s family.

The response vaguely and inaccurately explains the ethical and legal implications of the scenario selected for all stakeholders involved, or the response is missing.

The response vaguely and inaccurately explains how these implications affect the prescriber, pharmacist, patient, and the patient’s family, or is missing.

An accurate, detailed, and clear description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes specific, detailed, and accurate reference to state laws related to the scenario.

An accurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes accurate reference to state laws related to the scenario.

A vague or inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided.

The response includes inaccurate or vague reference to state laws related to the scenario.

A vague and inaccurate description of strategies to address disclosure and nondisclosure as identified in the scenario selected is provided, or is missing.

The response includes vague and inaccurate reference to state laws related to the scenario, or is missing.

The response accurately and thoroughly explains in detail at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.

The response accurately and completely explains whether they would disclose the error, including an accurate, detailed, and clear justification for the explanation provided.

The response accurately explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario.

The response accurately explains whether they would disclose the error, including an accurate justification for the explanation provided.

The response inaccurately or vaguely explains at least two strategies that an advanced practice nurse would use to guide decision making in the scenario, or only explains one strategy.

The response inaccurately or vaguely explains whether they would disclose the error, including a justification that is vague, inaccurate, or misaligned to the explanation provided.

The response inaccurately and vaguely explains only one strategy that an advanced practice nurse would use to guide decision making in the scenario, or is missing.

The response inaccurately and vaguely explains whether they would disclose the error, with no justification provided, or is missing.

The response provides an accurate, detailed, and thorough explanation of the process of writing prescriptions, including detailed strategies to minimize medication errors.

The response provides an accurate explanation of the process of writing prescriptions, including some strategies to minimize medication errors.

The response provides an inaccurate or vague explanation of the process of writing prescriptions, including inaccurate or vague strategies to minimize medication errors.

The response provides an inaccurate and vague explanation of the process of writing prescriptions, including inaccurate and vague strategies to minimize medication errors, or is missing.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

Uses correct grammar, spelling, and punctuation with no errors

Contains a few (1–2) grammar, spelling, and punctuation errors

Contains several (3–4) grammar, spelling, and punctuation errors

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

Scenario below:
Advanced knowledge of pharmacotherapeutics is essential for an advanced practice nurse. The patient’s age, genetics, and metabolism are a few factors that influence how the patient may respond to the medication. When planning care for any patient population, understanding pharmacokinetics and pharmacodynamics is a critical component in effectively developing a patient-focused drug therapy plan. Pharmacokinetics is the study of drug movement throughout the body, and this includes how the drug is absorbed, metabolized, distributed, and excreted. Pharmacodynamics is how the body responds to the drug and the mechanisms of their actions (Rosenthal &Burchum, 2018).

Description of the Patient Case James was a 69 year-old African- American male, escorted into the emergency department (ED) by police for acute psychosis and manic behavior. James was picked up off the streets, handcuffed, and appeared to be homeless. The initial assessment of James was extremely agitated, combative, hyperverbal, and was hallucinating as well. The ordering physician ordered a combination medication of Lorazepam, Haldol, and Benadryl. After receiving the IM injection, James appeared to be more relaxed and less aggressive; he was placed on direct observation and assigned a safety companion. An hour after being medicated, his behavior escalated, and restraints were used due to his increasing agitation and combative behavior. James’s case is unique because, at the time that he presented to the ED, the staff or the police were aware of his medical history. Searching in the belongings, I was able to find a phone number.

James was an Alzheimer’s (AD) patient that manage to hitchhike from Chicago. James was reported missing six months before showing up in Florida. The patient was in a locked unit but managed to elope in hopes of finding his wife, whom he buried in Sarasota. The kidneys excrete most medications; pharmacokinetics in patients sixty-five or older is altered by the loss of kidney function (Aymanns, Keller, Maus, Hartman &Czock, 2010; Rosenthal &Burchum, 2018). Due to the complexity of comorbidities, polypharmacy, and age‐related changes in liver/kidneys, pharmacotherapy is challenging, and drug interactions or toxicity can occur ( Boparai&Korc-Grodzicki, 2011). The personalized plan of care for James would be a modified confusion assessment method (mCAM-ED) and a reality orientation. Behavioral symptoms change and evolve throughout dementia; agitation, restlessness, and hallucinations are frequent in these patients, reduction in agitation rather than sedation is a goal of treatment in most cases ( Casey, 2015). Instead of using Lorazepam, the first drug of choice would be Haldol, which has a shorter halflife, causes less sedation, respiratory depression, and has minimal effects on BP (Calver&Isbister, 2013).

References:

Aymanns, C., Keller, F., Maus, S., Hartman, B., &Czock, D. (2010). Review on pharmacokinetics and pharmacodynamics and the aging kidney. Clinical Journal of American Society of Nephrology, 5(2). doi: 10.2215/CJN.03960609

Boparai, M., &Korc-Grodzicki, B. (2011). Prescribing for older adults. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 78(4), 613–626. doi: 10.1002/msj.20278

Calver, L., &Isbister, G. K. (2013). Parenteral sedation of elderly patients with acute behavioral disturbance in the ED. The American Journal of Emergency Medicine, 31(6), 970-3. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.ajem.2013.03.026

Casey D. A. (2015). Pharmacotherapy of neuropsychiatric symptoms of dementia. P & T: a peer reviewed journal for formulary management, 40(4), 284–287.

Hasemann, W., Grossmann, F. F., Stadler, R., Bingisser, R., Breil, D., Hafner, M., &Kressig, R. W. (2018). Screening and detection of delirium in older ED patients: performance of the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). A two-step tool. Internal and Emergency Medicine, (6), 915. https://doiorg.ezp.waldenulibrary.org/10.1007/s11739-017-1781-y

Rosenthal, L. D., &Burchum, J. R. (2018). Lehne’spharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Uses correct APA format with no errors

Contains a few (1–2) APA format errors