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

Running head: RISK MANAGEMENT
Risk management
Name of the student:
Name of the University:
Author’s note

1RISK MANAGEMENT
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

2RISK MANAGEMENT
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