1 Respond to 2 people. Heidi and Pearl, by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described. In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure. Heidi  Week 1 Discussion Top of Form It is important when prescribing medication to consider a patient’s medical history and current medication regimen.  The way that a patient responds depends on numerous factors that all need considered to provide safe care.  Patient Case At a previous job I worked in the surgical department of a rural, critical access hospital.  We had an orthopedic surgeon who performed numerous joint replacements each week.  As with almost any surgery, patients need to stop anticoagulation therapy at least five days prior to the procedure unless otherwise indicated by the cardiologist.  We had a female patient with a history of atrial fibrillation and pulmonary embolism, taking coumadin, scheduled for a knee replacement.  Our protocol in surgery was to have patients hold anticoagulants five days prior to surgery after consulting the cardiologist, getting cardiac clearance, and orders for holding anticoagulants if permitted to do so.  Pharmacokinetic/Pharmacodynamic Processes             Coumadin is quick to be absorbed and has a half life of 1.5-2 days (Rosenthal & Burchum, 2018, p. 460).  The way that coumadin works in the body is by blocking the vitamin k dependent clotting factors (RxList, n.d.).  The patient described needed to be on anticoagulant therapy for prevention of blood clots, but for surgical purposes could be dangerous to continue.  The patient was relatively healthy with no comorbidities other than the atrial fibrillation and history of a prior pulmonary embolism.  The patient’s kidney function was good, her PT/INR were in therapeutic range, and she was in her mid 50’s.  This patient did have decreased mobility, which is why she was undergoing a total knee replacement, which put her at risk postoperatively for a DVT or embolism.  Personalized Plan of Care             The first plan of care that I would address is to obtain cardiac consultation and clearance by the patient’s cardiologist.  I would plan care based on their recommendations on how long to hold anticoagulant therapy.  One option would be to dose the patient with a Lovebox bridge, that is short acting, so that they can still have some type of anticoagulant in their system and it won’t affect the surgical procedure.  Atrial fibrillation is a major factor that increases the risk for a blood clot (Douketis & Lip, 2019). Interruption of anticoagulant therapy could be dangerous for a person with atrial fibrillation. Collaboration with anesthesiologist, cardiologists, and surgeons is needed for best practice consideration for holding anticoagulant.

1. 1
Respond to 2 people. Heidi and Pearl, by suggesting additional
patient factors that might have interfered with the
pharmacokinetic and pharmacodynamic processes of the patients
they described. In addition, suggest how the personalized plan
of care might change if the age of the patient were different
and/or if the patient had a comorbid condition, such as renal
failure, heart failure, or liver failure.
Heidi
Week 1 Discussion
Top of Form
It is important when prescribing medication to consider a
patient’s medical history and current medication regimen. The
way that a patient responds depends on numerous factors that
all need considered to provide safe care.
Patient Case
At a previous job I worked in the surgical department of a rural,
critical access hospital. We had an orthopedic surgeon who
performed numerous joint replacements each week. As with
almost any surgery, patients need to stop anticoagulation
therapy at least five days prior to the procedure unless
otherwise indicated by the cardiologist. We had a female
patient with a history of atrial fibrillation and pulmonary
embolism, taking coumadin, scheduled for a knee replacement.
Our protocol in surgery was to have patients hold anticoagulants
five days prior to surgery after consulting the cardiologist,
getting cardiac clearance, and orders for holding anticoagulants
if permitted to do so.
Pharmacokinetic/Pharmacodynamic Processes
Coumadin is quick to be absorbed and has a half life of
1.5-2 days (Rosenthal & Burchum, 2018, p. 460). The way that

2. coumadin works in the body is by blocking the vitamin k
dependent clotting factors (RxList, n.d.). The patient described
needed to be on anticoagulant therapy for prevention of blood
clots, but for surgical purposes could be dangerous to continue.
The patient was relatively healthy with no comorbidities other
than the atrial fibrillation and history of a prior pulmonary
embolism. The patient’s kidney function was good, her PT/INR
were in therapeutic range, and she was in her mid 50’s. This
patient did have decreased mobility, which is why she was
undergoing a total knee replacement, which put her at risk
postoperatively for a DVT or embolism.
Personalized Plan of Care
The first plan of care that I would address is to obtain
cardiac consultation and clearance by the patient’s cardiologist.
I would plan care based on their recommendations on how long
to hold anticoagulant therapy. One option would be to dose the
patient with a Lovebox bridge, that is short acting, so that they
can still have some type of anticoagulant in their system and it
won’t affect the surgical procedure. Atrial fibrillation is a
major factor that increases the risk for a blood clot (Douketis &
Lip, 2019). Interruption of anticoagulant therapy could be
dangerous for a person with atrial fibrillation. Collaboration
with anesthesiologist, cardiologists, and surgeons is needed for
best practice consideration for holding anticoagulants. A
decrease in mobility is another consideration. Patients who
undergo joint replacement are less mobile than others.
Anticoagulants should be started as soon as they can be safely
administered after the procedure to reduce the risk of clot
formation. Other non-pharmacological interventions are SCD
sleeves during surgery and starting physical therapy quickly
after surgery.
References
Douketis, J. D., & Lip, G. Y. (2019, May 21). UpToDate.
Retrieved from
https://www.uptodate.com/contents/perioperative-management-
of-patients-receiving-anticoagulants

3. Rosenthal, L. D., & Burchum, J. R. (2018). Lehne's
Pharmacotherapeutics for advanced practice providers. St.
Louis, MO: Elsevier.
RxList. (n.d.). Coumadin (Warfarin sodium): Uses, dosage, side
effects, interactions, warning. Retrieved from
https://www.rxlist.com/coumadin-drug.htm#clinpharm
1 day ago
PEARL E
Discussion 1
COLLAPSE
Top of Form
Pharmacodynamics and
Pharmacokinetics
Healthcare providers need to know pharmacokinetics and
pharmacodynamics of medications and the effects they have on
patients. Drugs can have many effects reaction to the body. The
relationship between the drug and the body is that the body
affects the drugs and the drug affects the body.
Pharmacodynamics is how the drug initiates its therapeutic or
toxic effects at the cellular and systemic levels and
pharmacokinetic is the process through which the drug is
absorbed, distributed and eliminated from the body (Arcangelo,
Peterson, Wilburg, & Reinhold, 2017).
Scenario of selected patient
Mrs. Fisher, an 80-year-old patient was admitted to the hospital
for a fall. Prior to the fall, she has been having diarrhea from a
course of antibiotics for urinary tract infection treatment. Pt
was unable to rest at night due to her frequent diarrhea. Her
caregiver stated that Mrs. Fisher took one tablet of Benadryl to
help her sleep at night and requested for more sleeping
medication be given to her at night. Ambien 5mg one tablet by
mouth, at bedtime was prescribed by the provider. Patient was
also given hydrocodone 5/325 mg to help with her pain from
fall. Ambien was given the first night it was ordered. On the

4. second night of taking the medication, patient started showing
some side effects which may be from the medicine. Mrs. Fisher
became agitated, confused and combative. The provider was
notified of the patient’s confusion and agitation and all
medication patient took while in the hospital. The provider
ordered Ativan 0.5mg to be given intravenously to help with
agitation. Mrs. Fisher after getting the Ativan 0.5mg ordered
seems like it made her agitation worse.
Factors influencing pharmacokinetics and pharmacodynamics
Healthcare providers need to apply the knowledge of
pharmacokinetics to drug therapy which will help to maximize
beneficial effects while minimizing harm (Rosenthal &
Burcham, 2018). Many factors influence the pharmacodynamics
and pharmacokinetics of medications, including the patients
age, gender, and actions. The Food and Drug Administration
recommends the dose of Ambien for geriatric women to be 5mg
for immediate release and 6.25mg for Ambien CR extended
release (Ulrich, 2009). Side effects from Ambien can present as
sleepwalking, sleep driving, increased falls, disorientation,
anxiety, and delirium which is most common with elderly
(Rosenthal & Burcham, 2018). Mrs. Fisher took both
hydrocodone, Ativan and Ambien. The interaction between
these medications could have easily caused her increased
confusion and agitation. According to Markota, Rummans,
Bostwick, and Lapid (2016), the American Geriatrics Society
has placed all benzodiazepines in the list of drugs that should
be discouraged in patients over the age of 65. This is due to
older adults have increased sensitivity to benzodiazepines and
reduced metabolism of long acting agents, resulting in an
enhanced danger of cognitive impairment, delirium, falls,
fractures and car accidents. American Geriatric society also
recommends long acting benzodiazepines such as Xanax instead
of short acting such as Ativan if they must be prescribed
(Markota et al., 2016).
Plan of care. Nonpharmacological techniques such as removing
background noise should be encouraged to relieve anxiety and

5. encourage sleep in the elderly. Pain management should be
adequately treated to reduce discomfort. Arcangelo et al.
(2017), recommends Haldol over any benzodiazepines due to
drugs such as valium could have a half-life of about 70 hours in
the elderly. It is recommended to give psychoactive medications
for the behavioral disturbance resulting from the somatic
conditions, such as aggressiveness only for a limited time.
Home medications also needs to be considered in other to
address polypharmacy which is very common with the older
population.
Conclusion
When caring for the elderly, the providers needs to understand
the physiological changes that occur in the body. It is important
to review medications that are prescribed to the patient before
prescribing anything new. Patient education is key to providing
care. The patient and family must understand the need to
bringing all their medications or list of all patient’s medications
to all medical appointments. Teaching must also be provided
for the patient to report any changes, signs or symptoms that
can be seen in new medications.
References
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 & Wilkins.
Markota, M., Rummans, T. A., Bostwick, J. M., & Lapid, M. I.
(2016). Benzodiazepine use in
Older adults: Dangers, management, and alternative
therapies. Mayo Clinic Proceedings,
91(11), 1632-1639.
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s
pharmacotherapeutics for advanced practice
Providers. St. Louis, MO: Elsevier.
Ulrich, K. (2009). Pharmacokinetics and drug metabolism in the
elderly. Drug Metabolism

6. Reviews, 41(2), 67-76.
Bottom of Form
NR328 Pediatric Nursing
RUA: Ethical Dilemma Assignment Guidelines
1
Purpose
For this assignment, you will examine an ethical dilemma that
exists in pediatric settings. You will examine the ethical
dilemma from two opposing positions and consider ethical
principles, conflict between the principles and the
relationship of the ANA Code of Ethics in relation to both
positions. You will also discuss potential resources,
possible outcomes of both positions and develop a plan for
resolving the issue (for patient, family and the nurse).
Your team will then present this information in class with a
PowerPoint grounded in scholarly sources. You will also
submit individual speaker notes describing your assigned part
and reflection on your values.
Course outcomes: This assignment enables the student to meet
the following course outcomes:
1. Provides individualized comprehensive care for children and
their families with multiple health problems in
institutions and community care settings from birth through
adolescence. (PO 1)
4. Utilizes critical thinking skills in clinical decision making in

7. the care of pediatric clients. (PO 4)
6. Utilizes legal, ethical, and professional standards and
principles, including those related to child abuse recognition
and intervention, as a basis for pediatric clinical
decision‐making. (PO 6)
8. Utilize research findings as a basis for nursing interventions
in pediatric healthcare settings and the development of
professional nursing papers. (PO 8)
Preparing the assignment
Follow these guidelines when completing this assignment.
1) An ethical dilemma with opposing positions of Organ
Donation. (You are presenting both sides of the dilemma.
Then tell in the final slide about what your resolution would
be.)
2) A PowerPoint will be created with rule of 7 (No more than 7
words per line and no more than 7 lines per slides).
And then write a little speech to go along with each slide in the
note section.
3) Although you may not agree with one of the positions, reflect
on your views, respect other perspectives, and
examine scholarly literature on both positions.
a. Description of the dilemma
• Performs preliminary research on the assigned ethical dilemma
and describes the dilemma. Clearly
identifies both positions grounded in scholarly literature.
b. Ethical Principles and ANA Code of Ethics Provisions
• Determines the ethical principles that apply to each position,
possible conflicts in principles, and

8. components of the ANA Code of Ethics that apply using three
(3) Provisions. Supports ideas with scholarly
literature.
c. Resources to resolve the dilemma
• Describes resources to resolve the dilemma and describes how
each resource could help to resolve the
dilemma. Supports ideas with scholarly literature.
d. Possible outcomes and plan for resolving the issue
• Discusses possible outcomes of both positions. Presents a plan
for resolving the issue (for patient, family
and the nurse). Supports ideas with scholarly literature.
4) Include citations and references. Make sure to put citations
on your slides as well.
5) Complete and submit speaker notes and a reflection of own
values and morals as it relates to the ethical dilemma.
6) Use this link to take you directly to the ANA website to
access the Code of Ethics. When prompted, choose “No I
do not wish to register at this time. Take me to the Code now.”
https://www.nursingworld.org/practice-
policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
7) For APA, formatting, or grammar assistance visit the APA
Citation and Writing page in the online library.
8) Adhere to the time limit of 15 minutes.
Instructions:
_Topic for this group project is Organ Donation.
_There are 9 required criteria for the team presentation. but
please work on 5 and 9 only (Please see the
Required Criteria on page 4, under the Grading Rubric for more

9. details). Do not forget to incorporate
references for each section.
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2
• Description of the dilemma is clear and includes statistical
significance to Pediatric nursing.
• Both positions of the dilemma are presented crediting
supporting scholarly sources.
• Appropriate ethical principle(s) to support each position are
used.
• Consideration of which, if any, ethical principles are in
conflict with the opposing positions.
• Three (3) provisions of the ANA Code of Ethics that apply to
the ethical dilemma are used.
• Present all pertinent resources available to resolve the
dilemma.
• Explain how resources could help in resolving the dilemma.
• Discuss possible outcomes of each position.
• Present a plan for resolving the issue.
• APA citations throughout.
a. References are submitted with assignment.
b. Uses current APA format and is free of errors.
c. At least three (3) scholarly, nursing, peer reviewed, primary
sources from the last 5 years, excluding the
textbook, are provided

10. d. One (1) scholarly source must be the ANA Code of Ethics
Provisions and each position must be supported by a
scholarly source.
https://www.nursingworld.org/practice-policy/nursing-
excellence/ethics/code-of-ethics-for-nurses/
https://www.nursingworld.org/practice-policy/nursing-
excellence/ethics/code-of-ethics-for-nurses/
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NR328 Pediatric Nursing
RUA: Ethical Dilemma Assignment Guidelines
4
Grading Rubric

11. Criteria are met when the student’s application of knowledge
demonstrates achievement of the outcomes for this assignment.
Assignment Section and Required
Criteria
(Points possible/% of total points available)
Highest Level
of
Performance
High Level of
Performance
Satisfactory
Level of
Performanc
Unsatisfacto
ry Level of
Performanc
Section
not
present
Professionalism
(5 points/5%)

12. 5 points 4 points 3 points 2 points 0 points
Required criteria
1. Team members are professionally dressed.
2. Team is introduced and assigned roles are identified prior
to starting the presentation.
3. Full group participation.
4. Respectful and professional language is used throughout
the presentation.
5. Adhere to the time limit of 15 minutes.
Includes no fewer
than 5
requirements for
section.
Includes no fewer
than 4
requirements for
section.
Includes no less
than 3 requirement
for section.
Includes no
less than 2
requirement
for section.
Includes 1 or no
requirements
for section.

13. Team Presentation
(50 points/50%)
50 points 40 points 30 points 20 points 0 points
Required criteria
1. Description of the dilemma is clear and includes statistical
significance to Pediatric nursing.
2. Both positions of the dilemma are presented crediting
supporting scholarly sources.
3. Appropriate ethical principle(s) to support each position
are used.
4. Consideration of which, if any, ethical principles are in
conflict with the opposing positions.
5. Three (3) provisions of the ANA Code of Ethics that apply
to the ethical dilemma are used.
6. Present all pertinent resources available to resolve the
dilemma.
7. Explain how resources could help in resolving the dilemma.
8. Discuss possible outcomes of each position.
9. Present a plan for resolving the issue.
Includes no fewer
than 9
requirements for
section.
Includes no fewer
than 8
requirements for

14. section.
Includes no fewer
than 7 requirements
for section.
Includes no
fewer than 6
requirements for
section.
Includes 5 or
fewer
requirements
for section.
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NR328 Pediatric Nursing
RUA: Ethical Dilemma Assignment Guidelines
5
Team Presentation (15 points/15%) 15 points 10 points 7 points
5 points 0 points
Required criteria
1. Full names of all team members included and team

15. member initials are present in the assigned sections.
2. Content is presented clearly and scholarly.
3. Citations included for each section.
4. PowerPoint includes sections for title, dilemma
description, Statistical significance, Ethical principles,
Applicable ANA Code of Ethics Provisions, Resources
to resolve dilemma, Potential outcomes of the
dilemma, Plan for resolving the dilemma, Key Points,
and References.
Includes no fewer
than 4
requirements for
section.
Includes no fewer
than 3
requirements for
section.
Includes no fewer
than 2 requirements
for section.
Includes no less
than 1
requirements for
section.
No
requirements
for this section
presented.
Speaker Notes and Reflection

16. (20 points/20%)
20 points 15 points 10 points 5 points 0 points
Required criteria
1. Title page with assigned individual part identified.
2. Citations throughout.
3. Ideas presented clearly.
4. At least two (2) sources used to support work.
5. Reference page.
6. Reflection of own values and morals.
Includes no fewer
than 6
requirements for
section.
Includes no fewer
than 5
requirements for
section.
Includes no fewer
than 4 requirements
for section.
Includes no fewer
than 3
requirements for
section.
Includes 2 or
fewer
requirements
for section.

17. Poster APA Style and Organization
(10 points/10%)
10 points 8 points 6 points 4 points 0 points
1. References are submitted with assignment.
2. Uses current APA format and is free of errors.
3. Grammar and mechanics are free of errors.
4. At least three (3) scholarly, peer reviewed, primary
sources from the last 5 years, excluding the textbook,
are provided
5. One (1) scholarly source must be the ANA Code of Ethics
and each position must be supported by a scholarly
source.
Includes no fewer
than 5
requirements for
section.
Includes no fewer
than 4
requirements for
section.
Includes no fewer
than 3 requirements
for section.
Includes 1‐2
requirements for
section.
No

18. requirements
for this section
presented.
Total Points Possible = 100
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