Ka Nānā ʻana i ka Lāʻau Lapaʻau ma nā Halemai
ʻO ka nānā ʻana i ka lāʻau lapaʻau ma nā haukapila he hana ʻōnaehana ia e hōʻoia i ka loaʻa ʻana o ka lāʻau lapaʻau kūpono i nā mea maʻi, ma ka nui kūpono, ma ke ala kūpono, i ka manawa kūpono, a ke nānā mau ʻia nei no ka pane a me nā hopena ʻaoʻao. Ma ke kaiapuni haukapila, ʻo ka paʻakikī o nā kūlana o ka mea maʻi, ka nui o nā lāʻau lapaʻau i hāʻawi ʻia, a me nā loli lapaʻau wikiwiki e hoʻolilo i ka nānā ʻana i ka lāʻau lapaʻau i mea koʻikoʻi o ka palekana o ka mea maʻi a me ka maikaʻi o ka mālama. Me ka nānā ʻole ʻana, hiki ke piʻi aʻe ka pilikia o nā hewa lāʻau lapaʻau, nā pilina lāʻau lapaʻau, nā hanana ʻino koʻikoʻi, a me ka hāʻule ʻole o ka lāʻau lapaʻau.
Ka Wehewehena a me ke Kumu o ka Nānā ʻana i ka Lāʻau Lapaʻau
ʻO ka nānā ʻana i ka lāʻau lapaʻau ka hana o ka loiloi ʻana a me ka hahai ʻana i ka hoʻohana ʻana i nā lāʻau lapaʻau ma muli o ke kūlana lapaʻau o ka mea maʻi, nā hopena o ka hale hana, nā palena koʻikoʻi, a me nā hoʻopiʻi i ʻike ʻia e ka mea maʻi. ʻO ka pahuhopu nui ka hoʻokō ʻana i nā hopena lapaʻau kūpono a me ka hoʻēmi ʻana i nā pilikia. Ma ke kikoʻī hou aku, ʻo ka pahuhopu o ka nānā ʻana i ka lāʻau lapaʻau: (1) e hōʻoia i nā hōʻailona lāʻau lapaʻau e kūlike me ka hōʻailona, (2) e loiloi i ka pono o ka lāʻau lapaʻau, (3) ʻike a hoʻokele i nā hopena ʻaoʻao a me nā hopena lāʻau lapaʻau maikaʻi ʻole, (4) pale i nā pilina lāʻau lapaʻau weliweli, (5) e hōʻoia i ka mālama ʻana i nā alakaʻi lapaʻau a me nā formularies haukapila, a (6) e hoʻonui i ka hoʻohana ʻana i nā kumuwaiwai no ka lāʻau lapaʻau ʻoi aku ka maikaʻi.
No ke aha he mea nui ka nānā ʻana i ka lāʻau lapaʻau ma nā haukapila?
Loaʻa pinepine i nā maʻi haukapila nā maʻi koʻikoʻi a i ʻole nā maʻi maʻi me nā pilikia. Loaʻa i nā maʻi he nui ka hui pū ʻana o ka lāʻau lapaʻau, me nā antibiotics, nā lāʻau cardiovascular, nā anticoagulants, nā analgesics, nā lāʻau diabetes, a me nā sedatives. ʻO nā kūlana e like me ka hōʻino ʻana o ka puʻupaʻa a i ʻole ke akepaʻa, nā loli i ke kūlana wai, a i ʻole ka ʻelemakule hiki ke hoʻololi i ka pharmacokinetics a me ka pharmacodynamics o nā lāʻau lapaʻau. ʻO ka hopena, hiki ke kiʻekiʻe loa a haʻahaʻa paha nā dosis "maʻamau". Eia kekahi, ʻo ka hoʻohana ʻana i nā mea lapaʻau, nā kaʻina hana ʻoki, a me nā hoʻololi ʻana i ka meaʻai hiki ke hoʻopilikia i ka lāʻau lapaʻau.
He mea koʻikoʻi nō hoʻi ka nānā ʻana i ka lāʻau lapaʻau no ka mea, ʻo nā haukapila nā wahi e loli ai ka neʻe ʻana o ka hoʻololi ʻana, ka hoʻoili ʻana o nā lumi, a me nā hoʻololi mālama (e laʻa, mai ka lumi pilikia a i ka lumi mālama a i ʻole mai ka ʻāpana mālama koʻikoʻi a i ka mālama maʻi). I loko o kēia mau hoʻololi ʻana, hiki ke hana ʻia nā hewa hoʻopaʻa lāʻau, ka hana pālua ʻana o ka lāʻau lapaʻau, a i ʻole ka hoʻōki ʻana i nā lāʻau lapaʻau me ka manaʻo ʻole. Me ka nānā pono ʻana, hiki ke hoʻemi ʻia kēia mau pilikia.
Nā ʻĀpana Koʻikoʻi o ka Nānā ʻana i ka Lāʻau Lapaʻau
ʻO ka nānā ʻana i ka lāʻau lapaʻau ma nā haukapila ma ke ʻano laulā e komo pū me kēia mau ʻāpana nui.
1. Hoʻoponopono Lāʻau Lapaʻau
Hana ʻia ka hoʻoponopono ʻana i nā lāʻau lapaʻau ma ke komo ʻana i ka haukapila, ka hoʻoili ʻana i kahi keʻena hou, a ma ka hoʻokuʻu ʻia ʻana. Hoʻohālikelike kēia kaʻina hana i ka papa inoa lāʻau lapaʻau o ka mea maʻi ma mua o ka haukapila me nā lāʻau lapaʻau i kuhikuhi ʻia i ka wā o ka mālama ʻana. ʻO ka pahuhopu ka pale ʻana i nā lāʻau lapaʻau i hala ʻole, nā hana pālua, a i ʻole nā pilina ʻino paha. Pono ka hoʻoponopono pono ʻana i ke kamaʻilio ʻana me ka mea maʻi/ʻohana, ka nānā ʻana i nā kauoha mua, a me ka nānā ʻana i nā maʻi allergies a me nā hopena lāʻau.
2. Ka Nānā ʻana i ke Kauka Lapaʻau a me ke Kūpono o nā Hōʻailona
Pono kēlā me kēia lāʻau lapaʻau i kuhikuhi ʻia e loaʻa kahi hōʻailona maopopo. Na nā kauka lāʻau lapaʻau lapaʻau a i ʻole nā kauka lāʻau lapaʻau haukapila ke kuleana no ka nānā ʻana i nā kuhikuhi e hoʻoholo ai inā ʻaʻole pono kekahi mau lāʻau lapaʻau, inā loaʻa nā koho ʻē aʻe palekana, a inā kūlike ka lāʻau lapaʻau me nā alakaʻi. No ka laʻana, pono e kuhikuhi ʻia nā antibiotics ma muli o ka hōʻailona a, inā hiki, kākoʻo ʻia e ka moʻomeheu a me ka hoʻāʻo ʻana i ka ʻike.
3. Ka Nānā ʻana i ka Pono
Ua loiloi ʻia ka pono ma o ka hoʻomaikaʻi ʻana i nā hōʻailona lapaʻau, nā palena koʻikoʻi, ka hoʻokolokolo kino, a me nā hopena hoʻokolohua. No ka laʻana, ua nānā ʻia ka lāʻau antihypertensive ma o ke koko; insulin ma o nā pae glucose; antibiotics ma o ka hoʻohaʻahaʻa ʻana i ke kuni, ka helu leukocyte, a me ka hoʻomaikaʻi ʻana i ke kikowaena o ka maʻi; a me nā anticoagulants ma o nā palena coagulation a i ʻole nā hōʻailona o ke kahe koko/thromboembolism.
4. Ka Nānā ʻana i ka Palekana a me nā Hopena ʻAoʻao
Loaʻa i kēlā me kēia lāʻau lapaʻau nā hopena ʻaoʻao. I loko o nā haukapila, pono e hana mua ka nānā ʻana i ka palekana. ʻO kekahi mau hiʻohiʻona o nā palena palekana i nānā pinepine ʻia: ka hana o nā puʻupaʻa (creatinine, eGFR) no nā lāʻau nephrotoxic; ka hana o ke akepaʻa (AST/ALT) no nā lāʻau hepatotoxic; nā electrolytes (potassium, sodium) no nā diuretics a i ʻole nā lāʻau lapaʻau cardiac; a me ka nānā ʻana no nā hōʻailona o nā allergies a me ka anaphylaxis. ʻO ka hōʻike ʻana i nā hopena lāʻau ʻino (ADRs) he ʻāpana koʻikoʻi o ka pharmacovigilance.
5. Ka Nānā ʻana i nā Hana like a me ka Hana Pālua
Hoʻonui ka Polypharmacy i ka pilikia o ka launa pū ʻana o ka lāʻau lapaʻau a me ka lāʻau lapaʻau-meaʻai. Hiki i nā pilina ke hoʻonui i ka ʻawahia a hōʻemi paha i ka pono. No ka laʻana, ʻo ka hui pū ʻana o nā anticoagulants me nā NSAID e hoʻonui i ka pilikia o ke kahe koko; hiki i kekahi mau antibiotics ke hoʻolōʻihi i ka wā QT, e pono ai ke akahele i ka wā e hoʻohana ʻia me nā lāʻau ʻē aʻe me nā hopena like. He mea maʻamau nō hoʻi ka hana pālua ʻana o ka lāʻau lapaʻau, no ka laʻana, ka hoʻohana pono ʻole ʻia o ʻelua mau lāʻau me ke ʻano like.
6. Nā Hoʻoponopono Hana Kūikawā
Pono nā lāʻau lapaʻau he nui i nā hoʻoponopono dosage e pili ana i ka makahiki, ke kaumaha, ka hana o nā puʻupaʻa, ka hana o ke akepaʻa, a i ʻole nā kūlana kikoʻī e like me ka hāpai ʻana. Ma ka ICU, hiki koke mai nā loli i ka hana o nā ʻōkana, e koi ana i ka loiloi pinepine ʻana i ka dosage. Hōʻoia ka nānā ʻana i ka Therapy i ka dosage palekana a maikaʻi hoʻi, me nā lāʻau lapaʻau me kahi helu therapeutic haiki e like me digoxin, phenytoin, a me warfarin.
7. Ka Nānā ʻana i nā Lāʻau Lapaʻau (TDM)
ʻO TDM ke ana ʻana o nā pae lāʻau i loko o ke koko e hōʻoia i ko lākou komo ʻana i loko o ka pae therapeutic. He mea nui ka TDM no nā lāʻau me ka loli nui o ka pane a me ka pilikia nui o ka ʻawahia, e like me aminoglycosides, vancomycin, phenytoin, a me valproate. Kōkua nā hopena TDM i ka hui lapaʻau e hoʻoponopono i nā dosis pākahi no ka lāʻau lapaʻau pololei.
Ke Kuleana o ka Hui Ola ma ka Nānā ʻana
He hana hui multidisciplinary ka nānā ʻana i ka lāʻau lapaʻau. Na nā kauka ke kuleana no ka hoʻoholo ʻana i ka maʻi a me ke ʻano hoʻōla, a me ka loiloi ʻana i ka pane lapaʻau. Loiloi nā kauka lāʻau lapaʻau i ke kūpono o ka lāʻau, ka nui, a me nā pilina, a hāʻawi i nā ʻōlelo paipai i hoʻokumu ʻia ma muli o nā hōʻike. He kuleana koʻikoʻi ko nā kahu maʻi i ka lawelawe ʻana i ka lāʻau, ka nānā ʻana i nā hōʻailona koʻikoʻi, ka nānā ʻana i nā hopena ʻaoʻao, a me ka hoʻonaʻauao ʻana i ka mea maʻi. Kōkua nā mea lapaʻau i ka loiloi ʻana i nā pilina lāʻau-meaʻai a me ka hoʻoponopono ʻana i nā meaʻai. He mea nui ka laulima maikaʻi, me ke kamaʻilio maopopo ma waena o nā ʻoihana, no ka nānā pono ʻana.
Nā Pilikia i ka Hoʻokō ʻana
ʻO kekahi mau pilikia i loaʻa pinepine i nā haukapila, ʻo ia ka nui o nā hana, nā palapala piha ʻole, nā ʻōnaehana ʻike palena, a me nā mākaukau limahana like ʻole. Eia kekahi, ʻaʻole ʻike nā mea maʻi i kekahi manawa i nā lāʻau lapaʻau a lākou e lawe nei a poina paha i kā lākou mau dosages, e paʻakikī ai ka hoʻoponopono ʻana i nā lāʻau lapaʻau. ʻO ke komo palena ʻana i kekahi mau hoʻokolohua hale hana hiki ke hoʻopilikia i ka nānā ʻana. No laila, pono nā haukapila i nā kaʻina hana maʻamau (SOP) no ka nānā ʻana i ka lāʻau lapaʻau, kahi ʻōnaehana hōʻike maʻalahi, a me ke aʻo mau ʻana.
Hoʻolālā no ka hoʻomaikaʻi ʻana i ka maikaʻi o ka nānā ʻana i ka Therapy
No ka hoʻomaikaʻi ʻana i ka maikaʻi o ka nānā ʻana i ka lāʻau lapaʻau, hiki ke hoʻokō ʻia kekahi mau hoʻolālā: ka hoʻohana ʻana i nā moʻolelo lapaʻau uila me ka launa pū ʻana o nā lāʻau lapaʻau a me nā hiʻohiʻona makaʻala allergy; ka hoʻokō ʻana i nā ala lapaʻau a me nā alakaʻi therapy; nā loiloi hoʻohana lāʻau lapaʻau; nā papahana mālama antibiotic; a me ka hōʻike ʻole ʻana i nā hanana palekana o ka mea maʻi e hoʻohilahila i nā limahana mai ka hōʻike ʻana iā lākou. He mea nui nō hoʻi ka hoʻonaʻauao ʻana i ka mea maʻi ma mua o ka hoʻokuʻu ʻia ʻana e hōʻoia i ka hoʻomau pono ʻana o ka therapy ma ka home.
Pani
ʻO ka nānā ʻana i ka lāʻau lapaʻau ma nā haukapila he hana koʻikoʻi ia e hōʻoiaʻiʻo ai e hāʻawi nā lāʻau lapaʻau i kuhikuhi ʻia i ka pōmaikaʻi nui loa me ka liʻiliʻi o ka pilikia. Me ka hoʻoponopono pono ʻana i nā lāʻau lapaʻau, ka loiloi pono a me ka palekana, nā hoʻoponopono dosage kūpono, a me ka laulima ʻana ma waena o nā ʻoihana, hiki ke hoʻomaikaʻi nui ʻia ke ʻano o ka mālama. I waena o ka paʻakikī o nā lawelawe haukapila, ʻaʻole wale ka nānā ʻana i ka lāʻau lapaʻau he kaʻina hana hoʻomalu akā he hana lapaʻau e pili pono ana i ka palekana a me ka hoʻōla ʻana o ka mea maʻi. Me nā ʻōnaehana ikaika a me kahi moʻomeheu palekana ikaika, hiki i nā haukapila ke hāʻawi i ka lāʻau lapaʻau palekana a ʻoi aku ka maikaʻi, e kuhikuhi ana i nā hopena lapaʻau maikaʻi loa.
