Nursing Pharmacology: Situation Mrs Ramsden - Assignment Example

Running head: NURSING PHARMACOLOGY CASE STUDY: MRS. RAMSDEN CASE TITLE: CASE STUDY; PHARMACOLOGY IN NURSING PRACTICE NAME: 27TH APRIL 2014. SUBJECT: SUPERVISOR: INSTITUTION: Question 1 Answer. Mrs. Ramsden, 68 years of age, has been taking Tipton (an herbal medicine at home) as painkiller. In addition, a junior medical officer prescribed ramipril due to her blood pressure. These beside the drug prescribed at the hospital as an inpatient. The two line of medication may place Mrs. Ramsden in risk of several implications as follows: 1. There is Risk of Home Medication Changing the Effect of Prescribed Medication The painkiller taken from home can synergize the effect of the antidepressant given as an inpatient or it can also reduce the effectiveness of the antidepressant given making the patient be in more pain. These is through the pharmacokinetics of the drug where one can antagonize one by sharing or covering the receptor that the drugs act on. These can be so dangerous in nursing care of the patient since addition of more painkillers intoxicate the patient. The home medication can also interact with the prescribed medication and come up with a totally newer substance that may be toxic or ineffective of acting on the intended purpose (Lehne, 2012) 2. Risk of Home Medications Masking Symptom of Disease and Resistance Development When home medication is used for long they can completely get rid of the symptoms that warn of more serious medical problem. For example, the painkiller taken at home can hide or mask the signs of inflammation that in turn lead to more severe infection such as bacteremia where blood is fully loaded by bacteria hence making it harder for the diagnosis of the disease through examination done by the doctor therefore worsening the situation. In addition to masking of the symptom, home medicine can be inadequate hence killing only the susceptible bacteria or disease causing agent leaving the rest with strong immunity against the prescribed medication (Fugh-Berman, 2000; Katzung et al., 2001). 3. Risk of Drug Overdose Home medication especially when taken in high doses for too long and/or combined with prescribed medication may lead to overdose. The herbal taken by Mrs. Ramsden can have same components of the prescribed medicine and these can lead to overdose of drug that come with dire consequence. With the advanced age of 68 years, she is considered a geriatric patient where renal function might not be that effective. Most of these drugs she is taking they are being cleared by kidney hence the drug clearance might have been compromised therefore toxicity is foreseeable for this patient (Adams and Koch, 2010). Question two answers. MANAGEMENT/ PREVENTION OF THE RISKS ABOVE FOCCUSSED ON MRS RAMSDEN NEEDS Managing of aforementioned risks calls for implementation of nursing care plan fully so that every aspect of the patient are catered. Prevention of the risk also may involve the nursing care plan to capture most of the patient information so that before anything is done the information regarding the patient is at hand. The following guidelines will be employed as approaches  preventing  risk of harm to patient (Hansten and Horn, 2007; Mallet et al., 2007). First and foremost, the nurse in charge need to perform nursing process to as the only solution and strategy to prevent the risks or otherwise prevent them to happen at all. In the nursing process, the following steps will be followed all through to implementation and evaluation and if not effective the process has to be re-done until the solution is reached (Delafuente, 2003). Assessment of Mrs. Ramsden Upon admission, the nurse admitting the patient must do a complete assessment of the patient. The nurse should do perform a thorough head to toe physical examination to capture any hidden compromised part of the patient. Mrs. Ramsden had sustained injury on her left leg and the pain caused by the injury was being managed using herbal medicine at home which can only be known through physical examination of the patient. On to do list of nurse, under assessment is taking a very complete history of the patient. Concerning the risk posed by taking the home medication and/or prescribed medication, the nurse will concentrate on past medical history of the patient. So history will involve questions such as having been on medication before coming? Were they prescribed medication or over the counter drugs? with this information, the nurse is able to know in prior if at all the patient have been on medication before coming to the hospital. It will help if the nurse takes name of exact drugs taken while at home and even the prescription of another hospital she attended before coming to the current hospital thus enabling the collaborative team that takes care of the patient to identify possible interaction to expect if the drugs were taken recently or there is slow clearance given that the patient is geriatric. Coming Up with Nursing Diagnosis of the Patient The nurse should come up with the nursing diagnosis that will capture the risks posed with the home and prescribed medication. The risk aforementioned above will be captured in these diagnoses. In relation to the risk posed by various medications, the following could be the diagnosis of nurse to work upon (Kee and Hayes, 1997). Nursing Diagnosis Risk of drug overdose due to many medications and old age. Risk of disease symptom masking due to home and inpatient medication. Risk of ineffective response to medication due to multiple drugs taking. Then Nurse should come up with Plan of Action The nurse should advise the patient to stop all other medication if they compromise the current medication. The termination of the medication should be a collaborative decision of the hospital care team and not personal decision of the nurse. Nurse should do a research to check for the renal function and liver function test to check the clearance of the medication given the advanced age of the patient. It is effective since the medication taken long time ago at home could have some residual effect to the body in case of clearance that is impaired. The nurse should also monitor the response of the patient to the currently prescribed medication closely by taking the vital sign frequently. Any abnormal result that is unexpected from the normal side effect should be managed separately and collaboratively by the health care team. The nurse should also advise the patient the danger of taking over the counter medication or home medication without prescription. This will fill the knowledge gap and prevent future recurrence of the same (Bergman-Evans, 2006; Curry et al., 2005; Mallet et al., 2007b; Pinnell and Pinnell, 1996) Implementation Here the nurse implements the plan of action fully and wait for the result following the implementation. Everything done should then be documented for the continuity of care. Evaluation The nurse here evaluates the effectiveness of his or her plan of action. If the implementation were not effective then the nurse should review the plan of action collaboratively to ensure there is no effect as result of home and/or prescribe medication. Question three answers. THREE DOSES OF HYDROCORTISONE ARE ORDERED IN STAT- WHY IS IT THAT THE PATIENT IS ORDERED IN MUTIPLE DOSES OVER 24 HRS Hydrocortisone is a glucocorticoid and synthetic form of endogenously produced cortisol. Glucocorticoid is one of the steroids usefuk in intermediary metabolism, immunity functioning, musculoskeletal and connective tissuefunctions as well as brain functioning. It has diverse use. Cortisol is the main glucocorticoid produced by adrenal cortex. Considering Mrs. Ramsden, she is 68 years of age where there is expected to be inadequate adrenal function that produces cortisone a naturally occurring glucocorticoid (Katzung et al., 2001). The multiple doses of hydrocortisone may serve to provide for the insufficient adrenal function of the patient. The three stat doses may be intended to raise the level of cortisol. Secondly, and perhaps more importantly, the patient has history of high blood pressure. High and supra-physiological doses of hydrocortisone have been proved to have effect of elevation of blood pressure, salt and water retaining property. Therefore, a single high stat dose of hydrocortisone may elevate the blood pressure when she already have hypertension (Katzung et al., 2001). Question 4 answers. STRATEGY THAT REDUCES DEVELOPMENT OF ANTIBIOTIC RESISTANCE First nurse should ensure that responsible prescribing is done by the doctors. Her the antibiotic are only indicated when there is clinical evidence of bacterial infection. On documentation nurse should ensure that the clinical indication, duration of review date, route and dose on the patient’s drug chart is shown. Nurse in addition may take part in education of the patient on antimicrobial resistance by encouraging compliance to medicine until the dose is completed to ensure complete eradication of the bacteria (Burke, 1998). These prevent partial elimination of susceptible bacteria living the rest to mutate and becoming resistant. Thirdly nurse should also advise the patient to stop using over the counter medication or home medication or even the left over medication of the relatives especially if they are antimicrobial. These non-prescribed medication can eventually cause resistance from developing. Nurses should also have a sound referral medical notes and re-admission alert system to know the medication profile well (Carling et al., 2003). In case of a recurrence of same infection, culture and sensitivity investigation should be done to know the specific microbe causing the assault to the body. Finally, nurse should embrace proper screening methods that can identify the bacteria which is causing the assault in the body. In doing these nurses can significantly reduce spread of antibacterial resistance (Nicolle et al., 1996). References Adams, M., Koch, R.W., 2010. Pharmacology: Connections to nursing practice. Pearson Prentice Hall. Bergman-Evans, B., 2006. Evidence-based guideline. Improving medication management for older adult clients. J. Gerontol. Nurs. 32, 6–14. Burke, J.P., 1998. Antibiotic resistance—squeezing the balloon? Jama 280, 1270–1271. Carling, P., Fung, T., Killion, A., Terrin, N., Barza, M., 2003. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect. Control Hosp. Epidemiol. 24, 699–706. Curry, L.C., Walker, C., Hogstel, M.O., Burns, P., 2005. Teaching older adults to self-manage medications: preventing adverse drug reactions. J. Gerontol. Nurs. 31, 32–42. Delafuente, J.C., 2003. Understanding and preventing drug interactions in elderly patients. Crit. Rev. Oncol. Hematol. 48, 133–143. Fugh-Berman, A., 2000. Herb-drug interactions. The Lancet 355, 134–138. Hansten, P.D., Horn, J.R., 2007a. The Top 100 Drug Interactions: A guide to patient management. 2007 Edition. Free. WA HH Publ. LLP 235–6. Hansten, P.D., Horn, J.R., 2007b. Drug interactions: analysis and management. Wolters Kluwer Health. Katzung, B.G., Masters, S.B., Trevor, A.J., 2001. Basic & clinical pharmacology. Lange Medical Books/McGraw-Hill Toronto: Kee, J.L., Hayes, E.R., 1997. Pharmacology: A nursing process approach. WB Saunders. Lehne, R.A., 2012. Pharmacology for nursing care. Elsevier Health Sciences. Mallet, L., Spinewine, A., Huang, A., 2007a. The challenge of managing drug interactions in elderly people. The Lancet 370, 185–191. Mallet, L., Spinewine, A., Huang, A., 2007b. The challenge of managing drug interactions in elderly people. The Lancet 370, 185–191. Nicolle, L.E., Strausbaugh, L.J., Garibaldi, R.A., 1996. Infections and antibiotic resistance in nursing homes. Clin. Microbiol. Rev. 9, 1–17. Pinnell, N.L., Pinnell, N.N., 1996. Nursing pharmacology. WB Saunders Company. Read More