Patient care, effect

Hillson SD, Dowd B, Rich EC, Luxenberg MG. Call night and patient care effects on inpatients at one teaching hospital. J Gen Intern Med 1992 7 405 110. 

The nursing process is a framework for nursing action consisting of problem-solving steps that help members of the health care team provide effective patient care. It is both a specific and orderly plan used to identify patient problems, develop and implement a plan of action, and then evaluate the results of nursing activities, including the administration of drug . 

Anxiety disorders are common in the population of opioid-addicted individuals however, treatment studies are lacking. It is uncertain whether the frequency of anxiety disorders contributes to high rates of illicit use of benzodiazepines, which is common in methadone maintenance programs (Ross and Darke 2000). Increased toxicity has been observed when benzodiazepines are co-administered with some opioids (Borron et al. 2002 Caplehorn and Drummer 2002). Although there is an interesting report of clonazepam maintenance treatment for methadone maintenance patients who abuse benzodiazepines, further studies are needed (Bleich et al. 2002). Unfortunately, buspirone, which has low abuse liability, was not effective in an anxiety treatment study in opioid-dependent subjects (McRae et al. 2004). Current clinical practice is to prescribe SSRIs or other antidepressants that have antianxiety actions for these patients. Carefully controlled benzodiazepine prescribing is advocated by some practitioners. 

The file Is used routinely In the laboratory at the National Institutes of Health In an attempt to explain abnormal test results The resident physicians affiliated with the Clinical Chemistry Service discuss the results with the patient-care physicians and determine If the results were due to the patient s clinical state or to a drug effect This close monitoring of test results has led to recognition of deficiencies In what Is believed are specific enzymatic procedures for the measurement of glucose and uric acid Likewise, the gualac procedure for occult blood In feces was found to yield false negative results under certain circumstances This has prompted the development of a more specific procedure (Jaffe et al unpublished) ... 

Elsewhere, it was found that errors by physicians and others is often not reported to patients, and surprisingly, 23% of physicians and 11% of patients in one study did not feel that physicians should report such errors to patients.15 Clinicians in the future will be expected to interact more, and more effectively, with patients. These expectations for improved interaction with patients will help both clinicians and patients to reach their therapeutic goals. The authors of the chapters in this text have worked through patient care problems that are commonly seen in practice, and the reader will benefit by using similar tactics to help their patients. 

After selection and initiation of antimicrobial regimen, there are a number of additional patient care and monitoring considerations that should be addressed to improve the likelihood of a successful outcome. Patient education, deescalation of antimicrobial therapy based on culture results, monitoring for clinical response and adverse effects, and appropriate duration of therapy are important. 

Recent advances in the treatment of cancer of the colon and rectum now offer the potential to improve patient survival, but for many patients, improved disease- and progression-free survival represent equally important therapeutic outcomes. In the absence of the ability of a specific treatment to demonstrate improved survival, important outcome measures should include the effects of the treatment on patient symptoms, daily activities, performance status, and other quality-of-life indicators. Individualized patient care to balance the risks associated with treatment with the benefits of a specific treatment regimen is necessary to optimize patient outcomes. 

Other patient care services provided by independent community pharmacies as a group are shown in Table 4. One of the strengths of the pharmacies in this group is the wide range of services provided. It should be noted that special knowledge is required to effectively deliver many of these services, and some areas such as herbal medicine have grown very dramatically. 

Patients on other oral antidiabetic agents - No transition period is necessary when transferring patients to the extended-release tablets. Observe patients carefully (1 to 2 weeks) when being transferred from longer half-life sulfonylureas (ie, chlorpropamide) to the extended release tablets due to potential overlapping of drug effect. 

The rate of dose escalation may be slowed if a patient is intolerant to the recommended titration schedule. However, it is not advisable to accelerate the dose incrementation plan. Following initiation of therapy, or any dosage increase, observe patients carefully for adverse effects. Take between meals whenever possible however, if minor Gl upset occurs, take with meals to improve tolerability. Taking tacrine with meals can be expected to reduce plasma levels approximately 30% to 40%. 

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