Documentation of their treatment data and laboratory values will need to be passed along to whatever facility is found in the community to take on such a high-risk patient.


Please respond to both students discussion. Use APA format and 3 APA sources no older than 5 years. 
Student 1 
Andrea Long 
 
Patient involvement in their treatment plan is extremely important. Evidence-based medicine should begin and end with the patient. ​(Hoffmann et al., 2014)​ Decision aids are distinct from patient education programs in that they serve as tools to enable patients to make an informed, value-concordant choice about a particular course of action based on an understanding of potential benefits, risks, probabilities, and scientific uncertainty. (Schroy et al., 2011)
A patient in custody came in hypertensive.  The patient’s blood pressure was running 185/100-195/110.  The gentleman refused medication and insisted he would walk, decrease salt intake, lose weight, and drink plenty of water.  He explained to me his dad had hypertension and managed it just fine without any medications.  I educated him on the risk, of stroke, heart attack, and possible death from refusing the medications.  He verbalized understanding but insisted on trying his treatment plan without medications for one week.  The provider on call was notified of the situation and stated we had to respect his decision and to take BP every day for one wk. Although this particular patient was not making the best decision for his health, in my opinion, I respected it.  After a week, his BP did not come down despite his lifestyle changes.  He then agreed to try the medication which bought it down.  I explained to him all the things he wanted to try in his treatment plan are great and will lower his BP if he continued over a longer period of time, however, while in custody my job was to make sure he was safe and educate him about the consequences of not taking medication.
The decision aid, High Blood Pressure: Should I Take Medicine? (A to Z Summary Results – Patient Decision Aids – Ottawa Hospital Research Institute, 2022)   Would have been helpful to me and to the patient during this time.  I will utilize this in the future as it is giving the patient all the tools to make an informed decision regarding their healthcare. He would have the ability to see, this was not my opinion this was something recommended by the pateint decision aid as well.  This tool could have assited him in making a better healthcare deciasion from day one.  Although there was no conseuence to his decision, he could have suffered from a stroke or worse.  If this aid was utilized in the beginning, he may have made a better treatment plan choice for the beginning.  
References
A to z summary results – patient decision aids – ottawa hospital research institute. (2022, September 7). The Ottawa Hospital Patient Decision Aides. Retrieved November 8, 2022, from https://decisionaid.ohri.ca/AZsumm.php?ID=1012
Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA, 312(13), 1295. Retrieved November 4, 2022, from https://doi.org/10.1001/jama.2014.10186
Schroy, P. C., Mylvaganam, S., & Davidson, P. (2011). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. Retrieved November 8, 2022, from https://doi.org/10.1111/j.1369-7625.2011.00730.x
Student 2 
Heather Cross
 
Patient Choices
            This week I had a patient who is of the Jehovah’s Witness faith. They were showing the signs of late chronic kidney disease, and their laboratory data confirmed that their kidneys were no longer adequately filtering out the toxins in their blood. They were also very anemic with levels as low as 5.7g/dL prior to administration of iron and darbepoetin where they settled around 6.5g/dL. The patient refused blood products as it went against their religion so it will need to be managed medicinally instead. Regarding their kidney function, they were given a choice of hemodialysis or peritoneal dialysis. The patient was educated on both types of dialysis and given the pros and cons. With hemodialysis, the blood enters a circuit, is filtered through an artificial kidney, then is returned to the patient, and the cycle continues for several hours whereas with peritoneal dialysis fluid is introduced into the peritoneal cavity dwells for some time, then is drained to be repeated several times the same day (Healthwise, 2022).
            When trying to educate the patient on the different types of dialysis, it was also important to address their anemic status. While anemia can make treatments dangerous for either option, the mortality rate for patients with anemia in peritoneal dialysis was greater than for those on hemodialysis (Tao Li et al., 2021). With the different modalities the patient thought that peritoneal dialysis would be more in line with their faith, but they did not want to chance the increased mortality rate associated with their very low hemoglobin, so they chose hemodialysis after consulting with their religious leader.
Trajectory of Care
            With the patient selecting hemodialysis, several things had to occur to get them started. They needed signed consents for hemodialysis treatment, a central venous catheter access placed to run dialysis from, and aggressive medicinal anemia management. The patient had a line placed and treatment began for a short run to see how they tolerated treatment. The patient was crying by the end of treatment because they said they felt like they were betraying their faith, but also did not want to die. A mental health consult was placed to ensure that the patient had the support they needed moving forward. Additionally, this patient will remain admitted in the hospital longer than most new start patients because we must prove that they are able to tolerate hemodialysis treatments even with low hemoglobin and a full treatment time. Documentation of their treatment data and laboratory values will need to be passed along to whatever facility is found in the community to take on such a high-risk patient.
Value of Education
            While it is the goal of the nephrology department to educate all their patients, this patient needed to be thoroughly educated on the process of hemodialysis as it related to their faith. The decision aid that I selected holds information on both hemodialysis and peritoneal dialysis that the patient was able to read and understand quite easily. Even though initiation of dialysis with anemia had a lower mortality rate in hemodialysis versus peritoneal dialysis, it was still important to stress the importance of correcting their low hemoglobin to improve their survival chances (Karaboyas et al., 2020). This patient was given approval from their spiritual leader to proceed with hemodialysis, but they still had moral issues to work through. The mental health provider that was consulted will need to be educated on the entire background of the patient to give them the supportive care they need. The community clinic that ends up accepting this patient will also need to be educated on this patient’s circumstances because when it comes time to do monthly labs, they will not be able to give any “waste” blood back to the patient, due to their religious beliefs, so the minimum amount necessary should be taken. The decision aid I selected is useful in putting treatment options into terms that the patient can understand and allows for another source of information for healthcare workers to offer their patients. Education does not stop with just the patient; all involved parties need to be educated on how to treat this patient to the best of their ability.
References
Healthwise. (2022, May 4). Kidney failure: What type of dialysis should I have?. Healthwise. https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=tb1248
Karaboyas, A., Morgenstern, H., Waechter, S., Fleischer, N. L., Vanholder, R., Jacobson, S. H., Sood, M. M., Schaubel, D. E., Inaba, M., Psioni, R. L., & Robinson, B. M. (2020). Low hemoglobin at hemodialysis initiation: An international study of anemia management and mortality in the early dialysis period. Clinical Kidney Journal, 13(3), 425–433. https://doi.org/10.1093/ckj/sfz065
Tao Li, P. K., Man Choy, A. S., Bavanandan, S., Chen, W., Foo, M., Kanjanabuch, T., Kim, Y.-L., Nakayama, M., & Yu, X. (2021). Anemia management in peritoneal dialysis: Perspectives from the Asia Pacific region. Kidney Medicine, 3(3), 405–411. https://doi.org/10.1016/j.xkme.20201.01.011

Documentation of their treatment data and laboratory values will need to be passed along to whatever facility is found in the community to take on such a high-risk patient.


Please respond to both students discussion. Use APA format and 3 APA sources no older than 5 years. 
Student 1 
Andrea Long 
 
Patient involvement in their treatment plan is extremely important. Evidence-based medicine should begin and end with the patient. ​(Hoffmann et al., 2014)​ Decision aids are distinct from patient education programs in that they serve as tools to enable patients to make an informed, value-concordant choice about a particular course of action based on an understanding of potential benefits, risks, probabilities, and scientific uncertainty. (Schroy et al., 2011)
A patient in custody came in hypertensive.  The patient’s blood pressure was running 185/100-195/110.  The gentleman refused medication and insisted he would walk, decrease salt intake, lose weight, and drink plenty of water.  He explained to me his dad had hypertension and managed it just fine without any medications.  I educated him on the risk, of stroke, heart attack, and possible death from refusing the medications.  He verbalized understanding but insisted on trying his treatment plan without medications for one week.  The provider on call was notified of the situation and stated we had to respect his decision and to take BP every day for one wk. Although this particular patient was not making the best decision for his health, in my opinion, I respected it.  After a week, his BP did not come down despite his lifestyle changes.  He then agreed to try the medication which bought it down.  I explained to him all the things he wanted to try in his treatment plan are great and will lower his BP if he continued over a longer period of time, however, while in custody my job was to make sure he was safe and educate him about the consequences of not taking medication.
The decision aid, High Blood Pressure: Should I Take Medicine? (A to Z Summary Results – Patient Decision Aids – Ottawa Hospital Research Institute, 2022)   Would have been helpful to me and to the patient during this time.  I will utilize this in the future as it is giving the patient all the tools to make an informed decision regarding their healthcare. He would have the ability to see, this was not my opinion this was something recommended by the pateint decision aid as well.  This tool could have assited him in making a better healthcare deciasion from day one.  Although there was no conseuence to his decision, he could have suffered from a stroke or worse.  If this aid was utilized in the beginning, he may have made a better treatment plan choice for the beginning.  
References
A to z summary results – patient decision aids – ottawa hospital research institute. (2022, September 7). The Ottawa Hospital Patient Decision Aides. Retrieved November 8, 2022, from https://decisionaid.ohri.ca/AZsumm.php?ID=1012
Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA, 312(13), 1295. Retrieved November 4, 2022, from https://doi.org/10.1001/jama.2014.10186
Schroy, P. C., Mylvaganam, S., & Davidson, P. (2011). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. Retrieved November 8, 2022, from https://doi.org/10.1111/j.1369-7625.2011.00730.x
Student 2 
Heather Cross
 
Patient Choices
            This week I had a patient who is of the Jehovah’s Witness faith. They were showing the signs of late chronic kidney disease, and their laboratory data confirmed that their kidneys were no longer adequately filtering out the toxins in their blood. They were also very anemic with levels as low as 5.7g/dL prior to administration of iron and darbepoetin where they settled around 6.5g/dL. The patient refused blood products as it went against their religion so it will need to be managed medicinally instead. Regarding their kidney function, they were given a choice of hemodialysis or peritoneal dialysis. The patient was educated on both types of dialysis and given the pros and cons. With hemodialysis, the blood enters a circuit, is filtered through an artificial kidney, then is returned to the patient, and the cycle continues for several hours whereas with peritoneal dialysis fluid is introduced into the peritoneal cavity dwells for some time, then is drained to be repeated several times the same day (Healthwise, 2022).
            When trying to educate the patient on the different types of dialysis, it was also important to address their anemic status. While anemia can make treatments dangerous for either option, the mortality rate for patients with anemia in peritoneal dialysis was greater than for those on hemodialysis (Tao Li et al., 2021). With the different modalities the patient thought that peritoneal dialysis would be more in line with their faith, but they did not want to chance the increased mortality rate associated with their very low hemoglobin, so they chose hemodialysis after consulting with their religious leader.
Trajectory of Care
            With the patient selecting hemodialysis, several things had to occur to get them started. They needed signed consents for hemodialysis treatment, a central venous catheter access placed to run dialysis from, and aggressive medicinal anemia management. The patient had a line placed and treatment began for a short run to see how they tolerated treatment. The patient was crying by the end of treatment because they said they felt like they were betraying their faith, but also did not want to die. A mental health consult was placed to ensure that the patient had the support they needed moving forward. Additionally, this patient will remain admitted in the hospital longer than most new start patients because we must prove that they are able to tolerate hemodialysis treatments even with low hemoglobin and a full treatment time. Documentation of their treatment data and laboratory values will need to be passed along to whatever facility is found in the community to take on such a high-risk patient.
Value of Education
            While it is the goal of the nephrology department to educate all their patients, this patient needed to be thoroughly educated on the process of hemodialysis as it related to their faith. The decision aid that I selected holds information on both hemodialysis and peritoneal dialysis that the patient was able to read and understand quite easily. Even though initiation of dialysis with anemia had a lower mortality rate in hemodialysis versus peritoneal dialysis, it was still important to stress the importance of correcting their low hemoglobin to improve their survival chances (Karaboyas et al., 2020). This patient was given approval from their spiritual leader to proceed with hemodialysis, but they still had moral issues to work through. The mental health provider that was consulted will need to be educated on the entire background of the patient to give them the supportive care they need. The community clinic that ends up accepting this patient will also need to be educated on this patient’s circumstances because when it comes time to do monthly labs, they will not be able to give any “waste” blood back to the patient, due to their religious beliefs, so the minimum amount necessary should be taken. The decision aid I selected is useful in putting treatment options into terms that the patient can understand and allows for another source of information for healthcare workers to offer their patients. Education does not stop with just the patient; all involved parties need to be educated on how to treat this patient to the best of their ability.
References
Healthwise. (2022, May 4). Kidney failure: What type of dialysis should I have?. Healthwise. https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=tb1248
Karaboyas, A., Morgenstern, H., Waechter, S., Fleischer, N. L., Vanholder, R., Jacobson, S. H., Sood, M. M., Schaubel, D. E., Inaba, M., Psioni, R. L., & Robinson, B. M. (2020). Low hemoglobin at hemodialysis initiation: An international study of anemia management and mortality in the early dialysis period. Clinical Kidney Journal, 13(3), 425–433. https://doi.org/10.1093/ckj/sfz065
Tao Li, P. K., Man Choy, A. S., Bavanandan, S., Chen, W., Foo, M., Kanjanabuch, T., Kim, Y.-L., Nakayama, M., & Yu, X. (2021). Anemia management in peritoneal dialysis: Perspectives from the Asia Pacific region. Kidney Medicine, 3(3), 405–411. https://doi.org/10.1016/j.xkme.20201.01.011

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