K E TA M I N E I N F U S I O N C L I N I C S & T R E AT M E N - PowerPoint PPT Presentation

K E TA M I N E I N F U S I O N C L I N I C S & T R E AT M E N T- R E S I S TA N T C O N D I T I O N S A U G U S T 2 4 , 2 0 1 8 K N O X V I L L E , T N

A B O U T U S K AT H RY N WA L K E R Masters of Science in Nursing-Anesthesia J E N N I F E R Advanced Practice Registered Nurses Certified Registered Nurse Anesthetists H U LT Z

W E O F T E N G E T A S K E D “ H O W ? ” A N D “ W H Y ” K E TA M I N E C L A S S I C A L LY U S E D A N E S T H E T I C M E D I C AT I O N S A F E LY U S E D I N P E D I AT R I C S , A D U LT S , G E R I AT R I C S , O B S T E T R I C S C A N H AV E A D V E R S E E F F E C T S AT H I G H E R D O S A G E S T H AT R E Q U I R E A D VA N C E D M E D I C A L T R A I N I N G W I T H C A R D I A C A N D R E S P I R AT O RY S Y S T E M S

B A C H E L O R S I N N U R S I N G M E N TA L H E A LT H T R A I N I N G R E Q U I R E M E N T S F O R L I C E N S U R E A B U S E / N E G L E C T B E H AV I O R A L I N T E R V E N T I O N S C H E M I C A L A N D O T H E R D E P E N D E N C I E S C O P I N G M E C H A N I S M S C R I S I S I N T E R V E N T I O N C U LT U R A L D I V E R S I T Y / C U LT U R A L I N F L U E N C E S O N H E A LT H E N D O F L I F E C A R E FA M I LY D Y N A M I C S G R I E F A N D L O S S M E N TA L H E A LT H C O N C E P T S R E L I G I O U S A N D S P I R I T U A L I N F L U E N C E S O N H E A LT H S E N S O RY / P E R C E P T U A L A LT E R AT I O N S S T R E S S M A N A G E M E N T S U P P O R T S Y S T E M S T H E R A P E U T I C C O M M U N I C AT I O N T H E R A P E U T I C E N V I R O N M E N T

N U R S E A N E S T H E S I A : M E N TA L H E A LT H R E Q U I R E M E N T S F O R L I C E N S U R E A N AT O M Y, P H Y S I O L O G Y, A N D PAT H O P H Y S I O L O G Y O F C E N T R A L N E R V O U S S Y S T E M I N C L U D I N G : N E U R O D E G E N E R AT I V E D I S E A S E S M Y E L I N D I S E A S E S C E R E B R O VA S C U L A R D I S E A S E S N E U R O PAT H I E S A N D M Y O PAT H I E S P S Y C H I AT R I C D I S O R D E R S S P I N A L C O R D D I S O R D E R S I N T R A C R A N I A L T U M O R S C O N G E N I TA L A N O M A L I E S S E I Z U R E D I S O R D E R S G E N E T I C N E R V O U S S Y S T E M D I S O R D E R S I N T R A C R A N I A L H Y P E R T E N S I O N T H E R M O R E G U L AT I O N

N U R S E A N E S T H E S I A : M E N TA L H E A LT H R E Q U I R E M E N T S F O R L I C E N S U R E S U B S TA N C E A B U S E T R A U M A P H A R M A C O L O G Y P H A R M C O D Y N A M I C S , P H A R M A C O K I N E T I C S , D R U G - D R U G I N T E R A C T I O N S P S Y C H O P H A R M A C O L O G I C T H E R A P Y S S R I , T C A , M A O I , L I T H I U M , S E R O T O N I N A N TA G O N I S T S C H E M I S T RY, B I O C H E M I S T RY, P H Y S I C S

C R N A S I N T H E O U T PA T I E N T S E T T I N G : H O W C A N W E H E L P ?

C O L L A B O R AT I O N

T H E M E D I C A L W O R L D I S C H A N G I N G S P E C I A LT I E S C O L L A B O R AT E I N T H E H O S P I TA L H O S P I TA L S TAY S A R E B E C O M I N G L E S S A N D L E S S I N S U R A N C E C O M PA N I E S A R E N ’ T PAY I N G F O R PAT I E N T S T O S TAY I N H O S P I TA L S N O W I S T H E T I M E F O R C O L L A B O R AT I O N I N T H E O U T PAT I E N T S E T T I N G

C O L L A B O R AT I O N I S A N E C E S S A RY C O N C E P T F O R PAT I E N T S T H AT H AV E C O M P L E X C O N D I T I O N S I N C L U D I N G T R E AT M E N T - R E S I S TA N T C O N D I T I O N S

R A N D O M I Z E D C L I N I C A L T R A I L - J A M A P E D I A T R I C S , N O V E M B E R 2 0 1 6 The Costs and Cost-effectiveness of Collaborative Care for Adolescents With Depression in Primary Care Settings Findings A randomized clinical trial conducted at 9 primary care clinics in Washington State suggests that collaborative care results in an increase of 0.04 quality-adjusted life-year over usual care at $883 above usual care, for a mean incremental cost-effectiveness ratio of $18, 239 per quality-adjusted life-year gained. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2553826

W H AT I S A T R E AT M E N T- R E S I S TA N T C O N D I T I O N ? T R E AT M E N T- R E S I S TA N T I S A C L I N I C A L T E R M C O I N E D I N 1 9 7 4 T H AT I S U S E D T O D E S C R I B E A S I T U AT I O N W H E R E T H E PAT I E N T ’ S C O N D I T I O N D O E S N ’ T R E S P O N D T O A P R E S C R I P T I O N M E D I C AT I O N A S E X P E C T E D . ~ 3 0 % O F PAT I E N T S W I T H M D D H AV E A FA I L E D R E S P O N S E T O A N T I D E P R E S S A N T M E D I C AT I O N S O R P S Y C H O T H E R A P Y A N D A R E R E F E R R E D T O A S “ T R E AT M E N T- R E S I S TA N T D E P R E S S I O N ” ( J A M A P S Y C H I AT RY, J A N U A RY 2 0 1 7 ; V O L 7 4 ( 1 ) ) T R E AT M E N T- R E S I S TA N C E O C C U R S I N A VA R I E T Y O F M O O D D I S O R D E R S I N C L U D I N G D E P R E S S I O N , B I - P O L A R D I S O R D E R A N D E V E N S C H I Z O P H R E N I A ; A S W E L L A S M A N Y A N X I E T Y S Y N D R O M E S , S U C H A S O B S E S S I V E C O M P U L S I V E D I S O R D E R ( O C D ) . A N Y M E D I C A L C O N D I T I O N M AY P R E S E N T W I T H T R E AT M E N T- R E S I S TA N C E , S U C H A S A P N E U M O N I A T H AT FA I L S T O R E S P O N D T O F I R S T- L I N E A N T I B I O T I C S . https://drbrucekehr.com/treatment-resistant/

Q U E S T I O N S T O A S K W H E N PAT I E N T S S E E M T R E AT M E N T- R E S I S TA N T A R E T H E Y C O M P L I A N T ? H AV E T H E Y B E E N D I A G N O S E D C O R R E C T LY ? A R E W E M I S S I N G S O M E T H I N G ?

H O W C A N Y O U S O LV E A P U Z Z L E I F S O M E P I E C E S A R E M I S S I N G ?

T H E C O M P L E X I T Y O F T R E A T M E N T- R E S I S TA N T C O N D I T I O N S

M E D I C A L N E W S T O D AY, A P R I L 2 0 1 4 1 in 20 American adults 'misdiagnosed in outpatient clinics each year.’ A new study reveals that around 12 million people in the US are misdiagnosed in outpatient clinics each year - the equivalent to 1 in every 20 adults. According to the study researchers, the findings pose a "substantial patient safety risk." https://www.medicalnewstoday.com/articles/275565.php

T H E W O R L D I S C H A N G I N G A N D S O S H O U L D W E R E S I S TA N T C O N D I T I O N S A N D K E TA M I N E

K E TA M I N E U S E S : A N E S T H E T I C , PA I N M A N A G E M E N T, A N D N O W… B R A I N R E T R A I N I N G

K E TA M I N E K E TA M I N E I S A M E D I C AT I O N T H AT WA S M A D E I N T H E 1 9 6 0 S T O B E U T I L I Z E D I N T H E A N E S T H E S I A F I E L D . F I R S T A P P R O V E D B Y T H E F D A I N 1 9 6 3 . F I R S T M A J O R U S E WA S I N V I E T N A M A S A F R O N T L I N E A N E S T H E T I C . T O D AY, I T S M A J O R U S E I S I N O P E R AT I N G R O O M S A N D P R O C E D U R E F I E L D S A L L O V E R T H E W O R L D .

YA L E ’ S A C C I D E N TA L D I S C O V E RY I N T H E Y E A R 2 0 0 0 , YA L E WA S P E R F O R M I N G A N E X P E R I M E N T W I T H R O D E N T S W H E N T H E Y N O T I C E D T H E R O D E N T S W E R E A C T I N G L E S S D E P R E S S E D W H I L E U S I N G L O W D O S E I N T R AV E N O U S K E TA M I N E .

YA L E YA L E C O N T I N U E D T O P E R F O R M H U N D R E D S O F E X P E R I M E N T S T O U N D E R S TA N D T H E “ W H Y " T O T H E “ H O W ” . YA L E D I S C O V E R E D T H AT K E TA M I N E , W H E N G I V E N AT L O W D O S E S I N T R AV E N O U S LY, D I R E C T LY S T I M U L AT E S A P R O C E S S T H AT A L L O W S T H E B R A I N T O R E G R O W Q U A L I T Y PAT H WAY S , A L S O K N O W N A S B R A I N R E T R A I N I N G .

T H E N E U R O L O G I C A L T H E O R I E S A R E C H A N G I N G

A C C O R D I N G T O P S Y C H O L O G Y T O D AY ( 2 0 1 3 ) , “ O U R B R A I N C O N T I N U E S T O G R O W AT A N Y A G E . K N O W N A S N E U R O G E N E S I S O R B R A I N P L A S T I C I T Y, T H I S N E W K N O W L E D G E I S S H O W I N G U S T H AT T H E B R A I N H A S T H E A B I L I T Y T O C H A N G E T H R O U G H O U T L I F E B Y F O R M I N G N E W C O N N E C T I O N S B E T W E E N B R A I N C E L L S , A N D T O A LT E R F U N C T I O N . F O R A L O N G T I M E , I T WA S A S S U M E D T H AT A S W E B E C O M E O L D E R , T H E C O N N E C T I O N S I N T H E B R A I N B E C A M E F I X E D , A N D T H E N I T WA S J U S T A M AT T E R O F T I M E T H AT W E S TA RT E D “ L O S I N G ” B R A I N C E L L S . H O W E V E R , T H I S A S S U M P T I O N I S B E I N G A G G R E S S I V E LY C H A L L E N G E D B Y R E C E N T S T U D I E S S H O W I N G T H AT T H E B R A I N N E V E R S T O P S C H A N G I N G . ”