Nursing: Pharmacology Assignment Case Study Example

Pathophysiology and Quality Use of Medicines

Question 1:1- Diagnosis and rationale
The possible diagnosis is syncope due to heart failure and low blood pressure. The low blood pressure could be related to a combination of digoxin and other antihypertensive medications. Syncope is caused by low blood flow to the brain due to low blood pressure. It is characterized by a sudden quick onset, brief and spontaneous recovery (Gaynor, 2011). These were the signs and symptoms manifested by Mr. Morrison. My rationale for congestive cardiac failure relates to syncope because syncope is usually associated with some underlying cause. Patients react to hypertensive medications and congestive cardiac failure intensifies reactions. Digoxin lowers the heart rate. Systolic dysfunction is a significant characteristic. Digoxin interacts with the heart to produce alterations in both systolic and diastolic function (Bui, Horwich & Fonarow, 2011).

Question 1:2 – Reasons for medication usage

Digoxin
This is a purified cardiac glycoside. It is used for atrial fibrulation. Digoxin reduces the ventricular rate by adjusting AV node stimulation simultaneously reducing its refractory period. It is alos used in hert failure which cannot be controlled by any other medication (Hallberg, Lindbäck, Lindahl, Stenestrand & Melhus, 2007). Mr. Morrison was diagnosed with heart failure and atrial fibrulation. Notable side effects are confusion, depression, dizziness, insomnia, loss of appetite, blurred vision and fainting (Hallberg et.al, 2007).

Enalapril

This is an antihypertensive medication found in the angiotensin – converting – enzyme inhibitor (ACE). Besides, hypertension it is also used for chronic heart failure as in Mr. Morrison’s condition. ACE coverts angiotensin 1 to 11 in the blood, which causes vasoconstriction and increases blood pressure. Enalapril prevents this interaction. Common side effects are dizziness, low blood pressure and dry cough (He, 2013).

Warfarin

.
This drug is also known as Coumadin and found in the anti-coagulant drug category. It is used tom prevent blood clot in the blood vessels with patients prone to develop them due to hypertension, heart failure or diabetes. Adverse effects include hemorrhage, Warfarin necrosis, osteoporosis, purple toe syndrome and calcification of arterial valves (Hirsh, O'Donnell & Eikelboom, 2007).

Question 1: 3 – Nursing management of patient receiving Sodium Chloride 1000mls with 2 grams Potassium Chloride IV and Frusemide 40mg IV

Management must be as for a patient receiving IV medication regardless of the drug being infused.
Once an infusion is used for administering these drugs the bag must be carefully labeled
This is to avoid administration bolus.
Signs of volume overload must be monitored carefully
Intravenous site must be evaluated regularly to ensure that drug entered the vein
Sodium blood levels must be assessed accordingly based on doctors’ requests.
Monitor patient for intravascular fluid volume to avoid dehydration from IV Frusemide
Serum electrolytes must be monitored in evaluating hypervolemia symptoms
When Frusemide has the potential due to excrete fluid and sodium along with essential electrolytes from the body.
Patient must be assessed regularly for other symptoms of dehydration e.g. complaining of thirst and skin is taut

Heart rhythm must be monitored regularly 4 hourly

Excess potassium can create fatal heart rhythmic disturbances.
(Crowley, Brim & Proehl, 2011).

Question 1:1 most likely cause of Mrs. Janet’s increased seizure activity

There could be three most likely causes of Mrs. Janet’s increased seizure. First due to the development of Alzheimer’s disease where there is loss of memory she could have been missing her seizure medications. Secondly, with the introduction of the new medication for tye disease synergistic reactions could have developed with the seizure medications making them inactive. Thirdly Mrs. Janet could have been experiencing insomnia.
Question 1:2 – Explanation of why Mrs. Janet was given phenytoin as an intravenous infusion in the ED.
Phenytoin is an anti convulsion medication and was given as an intravenous infusion in the ED because Mrs. Janet experiencing frequent uncontrolled tonic- clonic convulsive episodes. Oral medications would have taken much longer getting to the blood stream for immediate drug response, which was needed (Liley, Collins, & Synder, 2014).
Phenytoin is a hydrantion-derivative anti-consultant drug. It prevents seizures through a voltage-dependent block of voltage gated sodium channels mechanism. Besides, it is a class 1b antiarrythmic drug used in cardiac arrhythmias (Liley et.al, 2014).
Potential adverse effects of intravenous administration of this drug include severe low blood pressure, treatment to bring blood pressure to normal or lower the dosage. Double vision, slurred speech, tremor, cerebral ataxia are treated symptomatically (Clayton & Willihnganz, 2013).
Patient education regarding oral administration Phenytoin requires that a though review of the many serious side effects and how patients can learn to live with them. For example, sudden cessation of its use could trigger reactions similar to those experienced by Mr. Janet, more frequent convulsions and cardiac dysfunctions. If the patient develops any kidney conditions it should be reported because the drug intensifies it. Psychological alterations must also be discussed since persons may experience unexplained mood changes (Lehne & Rosenthal, 2014).
Question 2:3 - Galantamine 8mg daily for Mrs. Janet.
This disease presents a pathophysiology encompassing loss of neurons and synapses found in the nuclei degeneration follows. The degenerative process is initiated by aggregation of the es-amyloid peptide. The pathogenesis of AD is not clarified, but scientists believe that inflammatory processes involving interactions among cytokines may play an significant role in the pathology (Lambert, 2013).
Until more is discovered about Alzheimer disease it has been defined as neurological disorder whereby degeneration of neurons of occur. If this is true then, anticholinesterase medication is a relevant choice since it repairs nerve related. Current studies have proven its effective in relation to the pathology theory stating that neurofibrillary tangles are found inside of nerve cells and, there are extra-cellular deposition of beta-amyloid protein. Anticholinesterase medication prevents hydrolysis of acetylcholine (Lambert, 2013).
Nursing considerations specifically related to Galantamine during hospitalization relates its synergistic reactions with drugs which may be prescribed only due to a person’s hospitalization. Sleep patterns must be monitored because the drug induces extended sleep time ( Lambert,2013).

References

Bui, A. Horwich, T., & Fonarow, G. (2011). Epidemiology and risk profile of heart failure.
Nature Reviews Cardiology 8 (1): 30–41.
Clayton, B., & Willihnganz, M. (2013). Basic Pharmacology for Nurses. (16th ed). Mosby
Crowley, M. Brim, C., & Proehl, J. (2011). Clinical Practice Guideline: Difficult Intravenous
Access. JENR
Gaynor, D. (2011). Vasovagal syncope (the common faint): what clinicians need to know? The
Irish Psychologists 37(7); 176 -9
Hallberg, P. Lindbäck, J. Lindahl, B. Stenestrand, U., & Melhus, H. (2007). Digoxin and
mortality in atrial fibrulation: a prospective cohort study. European Journal of Clinical
Pharmacology 63 (10): 959–971
He, Y. (2013). Enalapril versus losartan for adults with chronic kidney disease: a systematic
review and meta-analysis. Nephrology (Carlton). 18(9):605-14.
Hirsh, J. O'Donnell, M., & Eikelboom, J. (2007). Beyond unfractionated heparin and Warfarin:
Lambert, J. (2013). Meta-analysis of74,046 individuals 11 new susceptibility loci for
Alzheimer disease. Nature Genetics 45 (12): 1452–8
Lehne, R., & Rosenthal, L. (2014). Pharmacology for Nursing Care (8th ed). Elsevier Health
Sciences
Liley, L. Collins, S., & Synder, J. (2014). Pharmacology and the Nursing Process (7th ed).
Elsevier Health Sciences