HNN215 Quality use of Medicines

Running head: CASE STUDY
HNN215 Quality use of Medicines
Name of the Student
Name of the University
Author note

1CASE STUDY
Answer 1
Upon analysing the medication charts, it was found that Mr Coleman had been
prescribed most medicines for addressing his presenting complaints of chest pain,
hypertension, and heart failure due to angina. He had been prescribed atenolol that is
commonly known as a beta blocker and used for the management of heart associated pain in
the chest. In addition, the drug also helps in treatment of heart beat irregularities (Wiysonge,
Bradley, Volmink, Mayosi & Opie, 2017). In contrast, the medication ramipril is also
administered for the treatment of heart failure, high blood pressure, and diabetic renal disease
(Bull et al., 2015). However, both of these drugs are associated with significant adverse
effects. Hypotension was the major risk factor associated with the administration of both of
these drugs. The drugs affect the responses to the nerve impulses that are present in the heart
that makes the heart beat slower, thereby reducing the increased blood pressure. However,
under circumstances when the blood pressure gets lowered, the amount of oxygen and blood
is increased to the cardiac muscles. Nonetheless, both atenolol and ramipril might decrease
the cardiac output (CO) that commonly refers to the product of heart beats per minute and
stroke volume (Briasoulis, Silver, Yano & Bakris, 2014). In addition, the drugs might also
bring about an inhibition of the renin-angiotensin-aldosterone system. Owing to the fact that
angiotensin II plays an important role as an arteriole vasoconstrictor and also results in a
constriction in the afferent arterioles, thereby increasing arteriolar resistance, an inhibition of
the RAAS would be responsible for the onset of hypotension (Rajgopal, Rajan, Sapru & Paul,
2014). Furthermore, the risk for hypotension can also be accredited to the potassium retaining
activity of the drugs.
Mr Coleman has also been administered enoxaparin sodium that is a potent
anticoagulant and primarily prescribed for the treatment and prevention of deep vein
thrombosis (DVT). The drug binds to antithrombin with the aim of forming a complex that

2CASE STUDY
results in an irreversible inactivation of clotting factor Xa. However, this drug has the
possibility of causing bleeding in the patient. Accumulation of the anticoagulant in the patient
will increase his likelihood of suffering from bleeding (Bourdoumis et al., 2014). Owing to
the fact that the drug prevents the formation of blood clots in the vessels and the heart, an
overdose of the drug might increase the risk of haemorrhage. This is in accordance to
findings from research studies that have provided evidence for increased bleeding rates
among atrial fibrillation patients, who have been subjected to anticoagulant therapy (Louis et
al., 2014). In addition, the advancing age of Mr Coleman and prevalence of hypertensive
symptoms would also make him more susceptible to bleeding risks due to enoxaparin
administration.
Answer 2
The first risk identified is hypotension that is marked by a significant decrease in
blood pressure in the arteries, particularly participating in systemic circulation. Owing to the
fact that sudden decrease in blood pressure due to the action of drugs can deprive the
patient’s brain of the necessary nutrients and oxygen, there lies a possibility of life-
threatening condition. Hence, effective nursing strategies must be adopted for management of
hypotension. Nursing intervention should focus on the addition of electrolytes to the patient’s
diet with the aim of relieving the symptoms of low blood pressure. Mr Coleman should be
made to lie on his back, or in dorsal decubitus position, following which his legs would be
lifted (Ricci, De Caterina & Fedorowski, 2015). This intervention would prove effective in
increasing his venous return and would also increase the availability of blood to the critical
organs such as the brain and the heart. Another important strategy would be to perform
volume resuscitation with the use of crystalloids that would help in replenishing the body
fluids that have been lost (Carrick, Leonard, Slone, Mains & Bar-Or, 2016). A vasopressor
such as, epinephrine, noradrenaline, angiotensinamide, and hydrocortisone will also be used

3CASE STUDY
for increasing the blood pressure and would also help in attaining the mean arterial pressure
(MAP). The patient will also be subjected to tissue perfusion with the use of dobutamine that
will facilitate maintenance of SvO2 >70 (Gupta & Donn, 2014).
Bleeding can also be managed by monitoring the haemoglobin count, in order to
determine the need for blood transfusion. The patient can be administered intravenous
vitamin K with the aim of reducing the extent of internal bleeding. In addition, there is a need
to administer intravenous fluids that contain a high content of electrolytes to prevent bleeding
(Kozek-Langenecker et al., 2017). Depending on the bleeding severity, there might also be a
need of conducting surgery for repairmen of the blood vessel and removal of excess blood.
Some essential behavioural modifications that would also form a crucial part of nursing care
plan include encouraging the patient to show adherence to lifestyle changes such as, cessation
from smoking and refraining from alcohol consumption in order to lessen the likelihood of
suffering from further internal injuries. Mr Coleman will also be educated about the essential
precautionary measures that he must adopt for preventing the disruption of normal clotting
mechanisms. In addition, restrictions will also be imposed on straining with bowel
movement, coughing, sneezing or nose blowing.
Answer 3
Medication regimen for the treatment of chronic disorders demands the administration
of long-term drugs and their accurate follow-up. Time and again it has been proved that
failure in treatment due to poor adherence to the prescribed medications lead to recurrent re-
hospitalizations, poor health outcomes, and augmented health care costs (Lam & Fresco,
2015). One of the potential reason that might have contributed to non-compliance to
medications include patient-related factors that encompass lack of understanding on the
illness, poor involvement in the clinical decision making process, and suboptimal health