I need a one page conclusion for a “Total Knee Replacement – Stand Pivot Transfer” essay ,  font  Time New Romas,  size 12, and double spacing.

APA  format 1.5 pages Masters program Due March 8,2018 by 8pm 3 references 1 from Walden University Library

Case Study

            C.S. was a 49 year old female with severe peripheral arterial disease (PAD) who had underwent numerous operations to reestablish circulation in her legs. I was taking care of her every few months or so when her stent would clot off or she would need another bypass in her legs. She took her Plavix and aspirin daily and could not understand why she was continuing to have problems.

Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

            Clopidogrel (Plavix) is a prodrug, meaning is must be converted by the liver into its active form using the cytochrome P-450 enzyme system (Arcangelo, Peterson, Wilbur & Reinhold, 2017).  The most active enzyme in the metabolism of this drug is the CYP2C19 enzyme (Polasek, 2011). After conversion, it works to decrease platelet activation and subsequent aggregation and is commonly used in stroke, cardiac, and PAD patients. The binding of the active metabolite is not reversible and continues for the lifespan of the platelet (7-10 days), therefore it is important to stop the drug 7-10 days before procedures like surgery (Drugs.com, 2012).

Pharmacogenetics is the study of how an individual’s genotype effects how they respond to the drug (Arcangelo, Peterson, Wilbur & Reinhold, 2017).  As a drug that relies on the body to produce the active metabolite, Clopridogrel depends upon a “healthy” or un-mutated CYP2C19 enzyme. Some populations carry an allele that decreases or even stops the activity of the CYP2C19 enzyme and subsequently makes drugs like Clopidogrel much less effective (Han et al., 2015).  This can account for up to a 70% variability in the response to Clopidogrel and may be the reason C. S. is experiencing repeated stent thrombosis (Polasek, 2011). The availability of genetic testing can help practitioners individualize drug regimens to optimize care for patients like C.S. (Scott, 2012).

Plan of Care

For C.S., genetic testing might benefit her if it is available and affordable on her insurance plan. I would see if her family history includes PAD and if her family had issues with stent thrombosis as well. If genetic testing is not an option, changing her medication regime to something that does not rely on the CYP2C19 enzyme, such as ticagrelor (Brilinta), would be recommended. With any platelet inhibitor, she must be educated on the risk of bleeding and bleeding precautions for home. To reduce the risk of drug-herb interactions on bleeding time, I would screen her home med list for over the counter supplements such as Omega-3, garlic, ginger, etc. that may interact with the medication and increase bleeding risk (Arcangelo, Peterson, Wilbur & Reinhold, 2017). 

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.

Drugs.com. (2012). Plavix. Retrieved from https://www.drugs.com/pro/plavix.html

Han, Y., Lv, H., Liu, X., Dong, Q., Yang, X., Li, S., & … Xu, J. (2015). Influence of genetic polymorphisms on clopidogrel response and clinical outcomes in patients with acute ischemic stroke CYP2C19 genotype on clopidogrel response. CNS Neuroscience & Therapeutics, 21(9), 692-697. doi:10.1111/cns.12426

Polasek, T. M. (2011). Beyond CYP2C19–A new chapter in Clopidogrel pharmacogenomics. Journal of Pharmacy Practice & Research, 41(1), 14-16.

Scott, S. A. (2011). Personalizing medicine with clinical pharmacogenetics. Genetics in Medicine, 13(12), 987–995. http://doi.org/10.1097/GIM.0b013e318238b38c

 

This Assignment will serve as the Course Level Assessments for:

 

Course Outcome 1: Examine the history, transition theories, and emerging role of the Doctor of Nursing Practice in serving the needs of specific populations across the continuum.

 

Course Outcome 2: Analyze the characteristics of the interprofessional team in relation to communication skills, role delineation, conflict management, and consultative and leadership skills.

 

Directions:

 

Before writing the document you will review these scholarly writing resources in the Kaplan Writing Center:

 

·         Formal vs. Informal Writing

 

·         Honing Word Choice: Tips for College-Level Diction

 

·         Basic Citation Guidelines

 

For this Assignment you will create a document:

 

·         a minimum of 5 pages in length (excluding title page and references);

 

·         supported with a minimum of five scholarly, peer review sources external to those assigned in class for this unit;

 

·         follow the conventions of Standard American English (correct grammar, punctuation, etc.);

 

·         well ordered, logical, and unified, as well as original and insightful;

 

·         display superior content, organization, style, and mechanics; and;

 

·         use APA 6th edition format.

 

The content for this document will include:

 

1.     Describe the role of the DNP prepared nurse in relationship to the interprofessional health care team.

 

2.     Analyze the skills essential for effective and efficient interprofessional collaboration, including:

 

a.     communication;

 

b.     conflict management;

 

c.     negotiation; and

 

d.     consultative and leadership skills.

 

3.     Provide a self-inventory of your strengths and areas in need of improvement. For example, you may have strong, effective communication skills but you may face challenges in negotiating or conflict management. What might you do to improve your skills?

 

4.     Conclude with a strategic plan to improve skills and competencies.

 

Before finalizing your work, you should:

 

·         be sure to read the Assignment description carefully (as displayed above)

 

·         consult the Grading Rubric (under the Course Home) to make sure you have included everything necessary; and

 

·         utilize spelling and grammar check to minimize errors.

 

Consideration for grading:

 

Described the role of the DNP prepared nurse in relationship to the interprofessional health care team.

 

The discussion included history and transition theories relevant to the emerging role of the DNP when working with specific populations

 

Description was thorough, relevant to the topic and illustrated critical analysis.

 

At least 5 scholarly peer reviewed articles were utilized to support the content not older than 5 years .

 

Analyzed the skills essential for effective and efficient interprofessional collaboration, including: communication; conflict management; negotiation; and consultative and leadership skills.

 

Analysis was thorough, relevant to the topic and illustrated critical analysis

 

Completed a self-inventory of strengths and weaknesses.

 

The self-inventory was thorough, relevant to the topic and illustrated critical analysis.

 

Create a strategic plan to improve in areas designated as weaknesses. 

 

The strategic plan was thorough, relevant to the topic and illustrated critical analysis.

 

Discussion post and medication home work.

Assignment 1: Discussion Questions

Directions:

Discussion Question Response: By Friday, October 7, 2016, post your response to the assigned discussion questions in the appropriate threads in theDiscussion Area.

Participation Responses: No later than Saturday, October 8, 2016, review and comment on the discussion question responses posted by at least two of your peers.

Guidelines: Support your responses with scholarly academic references using APA style format. Assigned course readings and online library resources are preferred. Weekly lecture notes are designed as overviews to the topic for the respective week and should not serve as a citation or reference.

In your discussion question response, provide a substantive response that illustrates a well-reasoned and thoughtful response; is factually correct with relevant scholarly citations,references, and examples that demonstrates a clear connection to the readings.

In your participation responses to your peers, comments must demonstrate thorough analysis of postings and extends meaningful discussion by building on previous postings.

Note: Review South University’s Substantive Participation Policy Criteria, Helpful Tips, and Late Policy available by clicking on the South University Policy and Guidelines navigation tab. The late policy applies to late discussion question responses.Grading Criteria Maximum Points Discussion Question Responses: Displays an understanding of the course materials and the underlying concept discussed. Includes course materials and additional scholarly resources to support important points.15Participation Responses: Displays an understanding of topic under discussion by affirming statements, asking a related question, or making an oppositional statement. Position must be supported with related evidence.  Responds to a minimum of two peers per question.10Professional Practice Connection: Demonstrates reflective thought pertaining to personal perspectives and professional development. Reflective statements include a theoretical rationale.10Quality of Academic Writing: Written responses are free of grammatical, spelling or punctuation errors. Citations and references are included and written in the correct APA Style.10Total: 45  

    Select a discussion question  from the drop down menu below and click Go to begin. Use the  Respond  link to post responses and materials that pertain to that question. To respond to an existing posting use the Respond  link beneath it.

TopicsTopicDiscussion Question 1Discussion Question 2Discussion Question 3Discussion Question 4

 Discussion Question 1

Debate the utility of the knowledge of nursing theories and associated theoretical concepts in the process of assessing patient’s needs and implementing appropriate care.   Discussion Question 2

Analyze the effectiveness of contemporary nursing theories in relation to your healthcare setting and comment whether theories shape your practice. 
Discussion Question 3

Theory critique and development serve as the underpinning for the progress of professional nursing. Justify.  Discussion Question 4

Do you think that theories need to be further operationalized and simplified so as to make them more usable and applicable to clinical settings? Substantiate your viewpoint with appropriate examples.