limitations and Magnesium and Iron

APA format references with in five years. Please use evidence based practice
response to this paper about limitaions

For this week’s discussion, I would like to share an experience I had in this week’s clinical setting. I felt this scenario was both a challenge and limitation. In the intensive care unit, my preceptor and I were caring for a patient who was a 68-year-old Caucasian female who was admitted to the ICU for severe COPD exacerbation and hypoxic respiratory failure. The patient had a past medical history significant for COPD, heart failure, as well as obstructive sleep apnea. The patient initially was intubated due to her hypoxic respiratory failure and later was extubated and weaned to high-flow nasal cannula oxygen. After a day or so of doing well, the patient’s condition began to deteriorate. The patient had a new onset of rapid atrial fibrillation with heart rate up to 150s, worsening hypoxia, and increasing anxiety. The patient was given diltiazem push and started on diltiazem infusion, and she was placed on bipap. Unfortunately, there was no improvement in her condition. My preceptor later switched the patient from diltiazem to amiodarone in hopes to convert the patient to a normal sinus rhythm or at least to better control her rate to improve her cardiac output. Unfortunately, there was no improvement in the patient’s condition, and she began to worsen.
In this scenario, the patient was in end stage COPD on maximum therapies for her COPD. Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death with an illness trajectory characterized by a progressive and inexorable decline interlaced with acute exacerbations (Scheerens et. al, 2018). The stage of COPD this patient was in, defined as GOLD stage IV, is a stage of very low functioning in which the patient experienced symptoms such as dyspnea, pain, fatigue, and anxiety. I felt this patient case was a challenging one as the patient was already receiving maximum therapy to treat her COPD exacerbation with no improvement but worsening in her symptoms and condition. I felt this scenario was limiting due to the options we had to move forward in her care. This case was also very challenging because my preceptor decided to discuss end of life care with the patient, which I felt was very appropriate in terms of future intubation and resuscitative measures. The patient was informed by my preceptor that the odds of her making a meaningful recovery and coming off the ventilator a second time were unlikely. I later pondered that day why palliative care was not involved in her care sooner. In a study by Scheerens et. al (2018), it was concluded that there are several barriers in the early involvement of palliative care in those with COPD including the disease trajectory, patient attitudes, professional caregivers’ practices, and the lack of communication between health care and the palliative care teams. Perhaps if palliative care could have been involved sooner, the patient may have not been cured of her COPD but could have experienced a better outcome rather than a rapid decline in her condition facing end-of-life care unexpectedly.
Goals of treatment for the patient with COPD include reversing or reducing airflow obstruction, to control cough and secretions, to prevent and eliminate infection, and to control complications including heart failure such as in this patient’s case. Pharmacotherapy should be based on the severity of the disease and often include bronchodilators, anticholinergics, and corticosteroids (Buttaro et. al, 2017).
References
Buttaro, T.M., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A
collaborative practice. 5thed. St. Louis, MO: Elsevier.
Mantero M, Radovanovic D, Santus P, & Blasi F. (2018). Management of severe COPD
exacerbations: focus on beclomethasone dipropionate/formoterol/glycopyrronium bromide. International Journal of COPD, Vol Volume 13, Pp 2319-2333 (2018), 2319.

Iron

Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?
magnesium
Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

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