General Practice Surgery

Part A (Arial. 2)

Part B (Arial. 2)

In healthcare, consultation is the key opportunity in which the clinicians and nurses are able to explore the problems of the patients and their concerns leading them to identify the cause of their illness. It helps in determining the nature of intervention to be provided so that effective clinical governance can be reached (Ahmed et al., 2018). In this study, initially the consultation process of the patient is to be analysed. Thereafter, the pharmacological actions of the drug and clinical governance in care is to be analysed and discussed. On admission of Mr Jones in the hospital, effective care consultation was executed for him to explore his health condition and the reason behind the symptoms so that effective care delivery and prescribing of medication can be executed. Mr Jones was admitted to the hospital for reporting of lower abdominal pain along with dysuria, increased urine frequency and smelly urine production. In the consultation process, initial rapport building with Mr Jones was essential for the prescribing approach. This is because good rapport between patients and nurses assist in creating close and harmonious therapeutic relationships with one another. It also assists the nurse to effectively understand the feelings of the patients and develop communication that shows value towrads the patients making them reveal their health needs without hiding anything (Ulrich et al., 2019). As argued by Cho et al., (2017), negative rapport with the patients leads the nurses fail to elicit information from the patients. It makes them develop hindered clinical decision and prescriptions for the treatment of the patients leading to hindered patient outcomes. The way to develop good rapport involves making compassionate and empathetic open communication along with active listening (Carthon et al., 2019). Similar nature of open communication was performed with Mr Jones, which led to enhanced development of rapport with him by the nurse. During the consultation process, the development of trust was another element that was important to be present in achieving effective prescribing episode. This is because enhanced trust of the patient towards the nurses leads them to feel comfortable and be honest in sharing information. It helps in strategic use of consultation time to reach informed consent and decision regarding intervention and prescribing approach (Conroy et al., 2017). As criticised by Desborough et al. (2018), hindered trust of patient towrads nurses makes them avoid revealing major secrets regarding their health in the consultation process. It leads the nurses and clinicians to have partial information regarding the health history of the patient which makes them deliver hindered care at times due to lack of availability of detailed health prospect of the patient. The NMC Code of Conduct also mentions that trust and effective rapport with the patients are to be built by the nurses to determine their care needs and demands to be fulfilled (NMC, 2018). In case of Mr Jones, effective trust as well as rapport was able to be developed in the consultation process which led to smooth understanding of his needs and demands in care without any delay.

In the consultation process, identifying the key concerns and problems of the patient is one of the key elements to be achieved which is important for prescribing episode. This is because without identification of the main issues in the patient’s health, the diagnosis required to be made and care required for the patient cannot be decided by the clinicians or nurses (Moore et al., 2019). In this context, detailed health analysis and health history of Mr Jones is identified. The NMC Code of Conduct mentions that care in the best interest of the patient is to be provided to them (NMC, 2018). In this context, the determination of health concerns and problems of the patients in the consultation process is essential so the best interventions can be provided to them. The trust and rapport development in consultation improves care concordance. This is because it promotes enhanced revelation of patients’ health details based on which definitive diagnosis of the health problem is reached leading to take enhanced care decision that fulfils the aim of satisfactory care delivery. The hindered problem identification of patients leads to create wastage of care resources due to hindered care consultation and identification (Burgener, 2020). Thus, efficient problem identification led the nurses to avoid wastage of resource and reach the ultimate care goal for M Jones. (LO3 and LO4) The health consultation of Mr Jones mentions that he is suffering from lower urinary tract infection (UTIs) and he is prescribed Nitrofurantoin to be administered to treat the UTI. The study by Huttner et al. (2018) mentions that Nitrofurantoin is effectively absorbed in the gastrointestinal tract of the most patients with its major absorption occurring in the proximal small bowel to be gradually moved to the lower areas. Mr Jones is mentioned to be suffering from lower UTI and thus the administration of the medication is effective for him. This is because it is properly absorbed in the proximal area of the urinary tract to reach the lower urinary tract in reacting to kill the bacteria and treat his UTI. According to Mahboob and Rahman (2021), Nitrofurantoin is considered to be relatively safe medication compared to other dugs for UTI such as ciprofloxacin and trimethoprim-sulfamethoxazole. This is because the use of trimethoprim-sulfamethoxazole creates more side-effects such as vomiting, nausea, diarrhoea and others than Nitrofurantoin in treating UTI in patients (Mottaghizadeh et al., 2020). In addition, Nitrofurantoin is better than ciprofloxacin because though the later is a cheaper drug and create effective removal of bacterial infection, but adversely interacts with some foods and show greater side-effects than the Nitrofurantoin due to the which the initial is preferred over the latter for UTI treatment (da Silva Ribeiro et al., 2020). The mechanism of action of Nitrofurantoin informs that it mainly works by damaging the DNA of the bacteria in the urinary tract since it is reduced from a highly reactive stage. Its action is made possible through the rapid reduction of the medication within the bacterial cell by the action of flavoproteins also known as nitrofuran reductase. It acts to create multiple reactive intermediates which attack the ribosomal proteins, pyruvate metabolism, cellular respiration, and the DNA in the bacteria (Ten Oever, 2020). The study by Sharma et al., (2021) informs that Nitrofurantoin creates higher effects on the bacterial cell than the mammalian cells as the bacterial cells are more rapidly and highly activated by the drugs. However, the primary actions responsible for making Nitrofurantoin create bacterial activity is unknown. The broader mechanism of the drug to act in the body is responsible for the reduced development of resistance to its activity because the medication may affect different process which are essential for the living ability of the bacterial cells (Mahboob and Rahman, 2021). Nitrofurantoin is mainly concentrated in the urine and reaches higher efficiency in the urinary tract compared to other tissue compartments leading is the most effective drug to treat bacterial infection in the urinary tract. It is evident as the typical plasma level of the medication in the body is 1 µg/ml which reached 200 µg/ml when it is in the urine (Leuin et al., 2021). Mr Jones has UTI which is caused by E.coli bacteria due to which the medication is effective to be administered in treating the condition.

The study by Maredia et al. (2020) informed that Nitrofurantoin could not be administered to individuals who are suffering from acute bacterial pyelonephritis. This is because it is unable to reach the upper urinary tract for creating therapeutic concentration in resolving bacteraemia which the key complication in the disease. The health diagnosis of Mr Jones revealed that he has no complication of bacterial pyelonephritis due to which the administration of Nitrofurantoin is effective as it would work to resolve his UTI. The study by Maredia et al. (2020) mentioned that the patients who have oliguria, anuria or any nature of significant renal function impairment for which their creatinine clearance is below 60 mL/min are not allowed to be prescribed with Nitrofurantoin. This is because Nitrofurantoin is released through the urine and bile and hindered kidney or renal function would led the medicine to be deposited in the body which would create adverse side-effects. Mr Jones express effective creatinine release more than 60 mL/min which ensures he is able to be provided Nitrofurantoin as excess of the medication can be easily excreted out of his body without causing any complication. (LO 1nad LO2) The clinical governance is referred to the framework used by the healthcare professionals and organisation to remain accountable for continuous quality improvement of the care services and safeguarding of the patients to deliver them high-quality care (White and Evans, 2019). In caring for Mr Jones, effective clinical governance in medication prescription and treatment is reached. In the prescribing decision, to reach effective clinical governance it is ensured most effective clinical and prescribing decision is established. This is because prescription of medication that ensure greater effectiveness on the health improvement of the patient leads timely patient recovery (Raja, 2019). The impact of the prescribing decision on Mr Jones is that it led him to experience less risk and side-effects of the medication and developed enhanced health in effective manner. This is because effective risk assessment of health condition and side-effects of the medication for Mr Jones is performed to determine best medication to be prescribed to him. It promoted effective clinical governance as the risk assessment of treatment provided to patients is one of the key pillars of establishing governance Sihra et al. (2018). The impact of the action for Mr Jones is that it led him to show increased compliance in care due to safe feeling and less experience of side-effects from the medication. As argued by Korbel et al., (2017), side-effects of medication make patients show noncompliance in care. This is because they are either unable to bear the side-effects or think the provided treatment is wring due to which they avoid compliance. The autonomy provided to Mr Jones in deciding his care and treatment through information shared by the nurse ensured effective care concordance and compliance from him. This is because the action made the patient feel valued and cared. As asserted by Veenstra et al. (2017), approval of patient’s opinion in care and allowing them to make informed decision makes them feel valued. This is because such action makes them feel respected for being an individual and not avoided for being burden of care. In the prescribing episode, as a nurse, the professional role is to ensure best and safe care to the patient. This role impacted in caring for Mr Jones is that it made me as a nurse to be more aware of the existing health complication of the individual to be identified so as to know if the determined medication on administration would compromise the safety of his health or not. Thus, the role of the nurse acted as in create beneficence for Mr Jones by ensuring beneficial care is provided to the patient under all context (Manda-Taylor et al., 2017).

The ethics in nursing ensures that non-maleficence in care is to be established indicating the medical action is to be weighted against all the risks, benefits and consequences to avoid any harm towards the patients (Jafari et al., 2019). In the care practice for Mr Jones, effective non-maleficence was established which impacted the prescribing episode to be non-harmful for the patient. The prescribing episode related with my practice area as in nursing it is often the responsibility of the nurse to make initial diagnosis and administer the medication prescribed by the clinicians to the patients. According to NMC, the nurse is to provide effective information in detailed manner regarding care to the patients to received informed consent from them (NMC, 2018). Thus, the current process related with my specific area of adult nursing by informing the way communication and informed consent from the patients is to be received while upholding beneficence, autonomy and non-maleficence in care. In future, the care in the similar context is to be developed by undertaking training in medication so that better medication delivery can be reached. (LO5 and LO6) `In conclusion, Mr Jones is found to be effectively informed regarding his care and informed consent in taken in all aspect to deliver him care. The mechanism of action of Nitrofurantoin informed it destroys the bacteria cell to react in treating UTI and it is best suited for Mr Jones because it creates less side-effects and is regarded as first-line of medication in resolving UTI. (LO1, LO3, LO4).

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