Effective Risk Management Strategies for Medication-related Risks in Patients: A Case Study Analysis

In this answer we will discuss about risk management and below are the summaries point:- Mr. Michael Coleman, a patient with chest pain and shortness of breath, is taking multiple medications including aspirin, atenolol, ramipril, and sublingual glyceryl trinitrate. Long-term use of aspirin poses a significant risk of gastrointestinal bleeding for Mr. Coleman, as it is associated with ulceration and increased bleeding risk. The combination of ramipril and atenolol increases the risk of hypotension for Mr. Coleman, which can be concerning for a patient with cardiovascular disease and hypertension.

Running head: RISK MANAGEMENT
Risk management
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Author’s note

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Answer 1:
Mr. Michael Coleman, a 56 year old patient with symptoms of mild chest pain and
shortness of breath has been given atenolol, ramipril, aspirin, sublingual glyceryl trinitrate post
admission to the emergency department. As per his medication chart, it has been found that Mr.
Coleman has been taking 100 Aspirin once daily for 5 years, Atenolol 50 mg twice daily for 10
years, Ramipril 10 mg for 10 years and 1 tab GTN for 1 year.
Based on the long term use of these medications, one significant risk identified for Mr.
Coleman is risk of gastrointestinal bleeding. This is said because use of aspirin is associated with
side effects of gastrointestinal ulceration and long term use of such drug can further increase the
risk of bleeding. Research evidence shows that long term use of aspirin is associated with use of
gastrointestinal bleeding and the risk is more stronger because of dose instead of use of aspirin.
Although aspirin is most commonly prescribed to patient with cardiovascular disease for
prevention of cardiovascular events, however meta-analysis of studies has revealed that there is
two-fold higher risk of gastrointestinal bleeding in persons who regularly use aspirin compared
to those who do not use the drugs (Huang et al., 2011). A systematic review of observational
studies has also revealed that aspirin increases risk of major bleeding events (Rodríguez et al.,
2016). Hence, as Coleman has been using aspirin since 10 years, there is high possibility that Mr.
Coleman is also likely to suffer bleeding in the future.
Another possible risk identified for Mr. Coleman with the use of multiple medications
includes the risk of hypotension because of the use of Ramipril and atenolol. Mr. Coleman has
been using 10 mg Ramipril for 10 years. One of the side effects of Ramirul includes dizziness
due to low blood pressure. Low blood pressure is also the side effect of Atenolol. Hence, taking

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both these drugs at the same time can further increase the risk of hypotension for patient. As Mr.
Coleman is a patient with cardiovascular disease and history of hypertension, he has been
prescribed Ramipril for the treatment of hypertension and reducing risk of cardiovascular event.
It is an angiotensin-converting enzyme (ACE) inhibitor. However, apart from high blood
pressure, very low blood pressure can also increase the risk of stroke and heart attack for patients
with cardiovascular disease. Mossello et al. (2015) indicates the need to consider the effects of
antihypertensive drugs on patients because of effects of low blood pressure. Hence, it is
necessary to consider the use of these two drugs for patient and manage the risk of hypotension.
Answer 2:
To prevent the risk of gastrointestinal bleeding, the strategy that a nurse can adapt
includes decreasing the dose of aspirin drug for Mr. Coleman. This strategy is important because
research has shown that adverse effect of aspirin therapy is seen due to dose of drug instead of
duration of drug (Huang et al., 2011). In addition, aspirin drug cannot be discontinued as it is
recommended not to discontinue the drug for patient with high risk of cardiovascular disease
(Strate & Gralnek, 2016). Hence, the most effective nursing strategy for minimizing the risk of
bleeding can include lowering the most effect dose for Mr. Coleman so that the purpose of
medicine usage is served and risk is prevented too. Apart from lowering the drug dose, the nurse
should also focus on conducting hemodynamic status assessment of Mr. Coleman so that it can
be identified whether the patient is at high or low risk of adverse outcomes.
As intensive use of antihypertensive medications can increase the risk of hypotension for
Mr. Coleman, it is necessary for nurse to engage in routine blood pressure monitoring of patient
so that any risk of hypotension is immediately identified (Mossello et al., 2015). Automated

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blood pressure monitoring at fixed interval everyday can be used as a strategy to identify the risk
of hypotension and immediately take steps to minimize the risk. The nurse can also increase the
volume of fluid intake for Mr. Coleman as this can increase blood volume and prevent risk of
dehydration and hypotension. Pellicori, Kaur and Clark (2015) argue that ACE inhibitors reduce
the circulating blood volume as well as the venous and arterial pressure. Hence, managing fluid
intake can help to control the risk of hypotension for patient.
In addition, after routine blood pressure monitoring, if patient is found to have
hypotension, then this can be managed by increasing salt intake in food. Benetos et al. (2015)
gives the argument that when multiple blood pressure medication is given to elderly patient, it is
associated with risk of hypotension. Hence, diet modification can help to minimize the effects of
the medication.
Answer 3:
It has been mentioned in the case study that Mr. Coleman does not adhere to his
medication regimen. There might be three factors contributing to decreased adherence to
medication:
1. Firstly, lack of knowledge about the reasons for each medication might be the reason for
not continuing with the scheduled medication regime. This is because without proper
education regarding the purpose of each medication, Mr. Coleman might not understand
the significance of taking it for his health and recovery. Hence, such patient’s take less
interest in their medication regimen. Yap, Thirumoorthy and Kwan (2016) supports that
lack of interest or knowledge is a major barrier to taking medications and this aspect
should be considered while prescribing medications to patient.

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2. The second cause of non-adherence to medication might include polypharmacy or use of
more than three medications (Tavares et al., 2013). Mr. Coleman has been found to take
more than three medications like given atenolol, ramipril, aspirin, sublingual glyceryl
trinitrate. Hence, this might have contributed to extra burden for Mr. Coleman and non-
adherence to medication. Marcum and Gellad (2012) reports that 50% of all older adults
do not adhere to their chronic medications and polypharmacy presents many unique
challenges that contribute to non-adherence.
3. Another cause behind non-adherence to medication for Mr. Coleman might include side
effects and cost of medication and poor communication between health care provider and
patient. This communication gap might have lead to unawareness about side effects of
medication and ways to management. Hence, no communication between patient and
provider regarding the value of medication regimen and not taking any steps to make te
regimen simple might be the reason for missing the daily medication dose. Customizing
the medication regimen according to Mr. Coleman’s lifestyle and level of knowledge
would have helped him to follow the regimen (Gelaw et al., 2014).
Answer 4:
After admission to the hospital, Mr. Coleman has been prescribed atorvastatin. While
preparing patient for discharge, the nurse should give the following education to Mr. Coleman
regarding the use of this medication:
1. As Mr. Coleman had experienced chest pain and shortness of breath, he
has been prescribed atorvastatin to reduce the risk of heart attacks (Groves et al., 2016).
Before discharge, the nurse should educate Mr. Coleman regarding the purpose of using

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this medication and the appropriate dose that needs to be followed. The patients must be
instructed to follow the medication dose for the drug as prescribed. In case he forgets to
take the medication, he should be advised not to double up on the missed dose and follow
the usual schedule with the next dose. This form of education will help to prevent any
medication dose related errors for patient (Mulchandani et al., 2018). In addition to this
information, the nurse must also educate the patient regarding any changes to diet or
lifestyle while having this medication
2. The nurse should also inform Mr. Coleman regarding the side effects of
atorvastatin. Some of the adverse reactions or side effects that can be experienced by
patient while using the drug include dizziness, fatigue, abdominal pain and nausea,
hyperkalemia and hot flushes. Mr. Coleman should be advised to immediately notify
health care provider if unexplained pain or weakness accompanied by fever occurs after
taking the medication. Any signs of liver problems like loss of appetite and yellowing of
skin or eyes should also be notified (Mulchandani et al., 2018)..
3. Another vital education that the nurse needs to provide Mr. Coleman regarding the use of
atorvastatin is that he must follow many diet restrictions and lifestyle changes while
using this medication. For example, he needs to take low fat and low cholesterol diet and
avoid foods rich in carbohydrates. In addition, he should also abstain from smoking and
alcohol as it may help Mr. Coleman to achieve better health benefits while having this
medication (Vallerand, 2018).
Following the above three mentioned advice in relation to the use of Atorvastatain will
help Mr. Coleman to understand the rationale for use of medication and develop positive

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perspective regarding the reason for its use. Education regarding dosage information and side
effects will also prevent any safety issues for Mr. Coleman while taking the medication.

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Treatment with multiple blood pressure medications, achieved blood pressure, and
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Gelaw, B. K., Mohammed, A., Tegegne, G. T., Defersha, A. D., Fromsa, M., Tadesse, E., ... &
Ahmed, M. (2014). Nonadherence and contributing factors among ambulatory patients
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Mulchandani, R., Lyngdoh, T., Chakraborty, P., & Kakkar, A. K. (2018). Statin related adverse
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