Developing a Patient Case Study

This article discusses the development of a patient case study and the administration of medication. It provides information on the dosage, side effects, and interventions for the medication. It also explores two national health and safety quality standards that are relevant to the case study. The article concludes by discussing the importance of effective documentation and patient education in medication administration.

Running head: DEVELOPING A PATIENT CASE STUDY
DEVELOPING A PATIENT CASE STUDY
Name of the student:
Name of the university:
Author note:

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DEVELOPING A PATIENT CASE STUDY
Prescription:
Medication: Ipratropium bromide
Dose: 2 puffs four times daily
How often it is to be administered: 2 puffs four times daily, in case of more requirements the
medication can be also puffed for more times but it should not exceed 12 puffs a day
Presentation of the case study:
A patient named Jack Samuels of the age 45 had visited the healthcare center with
complaints like persistent mucus producing cough which remains most of the days in the month.
The patient stated that he often needs to clear the throat to feel comfortable. He also complained
of shortness of breath. The other subjective data apart from these were chest tightens as well as
wheezing. When vital signs were taken, his temperature was found to be slightly above the
normal residing around 38.5 Celsius. His blood pressure was found to be quite high around
170/90 mmHg and his respiration rate was about 21 breaths per minutes showing Tachypnea.
The primary analysis from the subjective and objective data showed that Jack was probably
suffering from chronic bronchitis which is one of the most concerning chronic disorder under
chronic obstructive pulmonary disorder. The patient is a worker of the cement industry for about
20 years and had been a heavy smoker who smokes around 20 cigarettes per day. He used to be
obese and often used to feel sleep apnea but he is trying to lose weight. He could not reduce his
smoking habits. He also suffers from blood pressure and gastro-esophageal reflux. He had no
past accidents. No allergy was reported by him as well. Chronic bronchitis results in the
bronchial tubes to get more inflamed as well as narrowed and the lungs also start producing more
and more mucus (WHO 2017). This mucus blocks the narrowed tubes of the lungs and causes

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development of chronic cough with an aim to clear the airways. Blockage by this cough makes it
difficult for the patients to breath. The patient named Jack faced the same issues and hence he
needed to be treated properly.
Medication administration:
Ipratropium bromide is a short acting bronchodilator which is used for preventing
wheezing, shortness of breath, chest tightness as well as coughing in people who suffer from
COPD. It mainly works by preventing bronchio-spasms mainly by causing relaxation and
opening of the airways to the lungs for making it easier for breathing (Li et al. 2017). Studies are
of the opinion that this medication is an anticholinergic bronchodialator that mainly helps in
inhibition of the reflexes that are mediated by the vagal nerve. This mainly takes place as it
causes blocking of the action of the acetylcholine which is a substance that gets released at the
neuromuscular junctions present in the lungs. These forms of bronchodilators mainly help by
preventing calcium ions from entering the muscle cells of the lungs and this causes relaxation of
the airways (Obeidat et al. 2016). This drug is mainly used for the maintenance of the treatment
of bronchospasm that associates with chronic obstructive pulmonary disorder as well as
including chronic bronchitis and even in emphysema. The main dosage for the treatment of
bronchospasm that remains associated with COPD is about 2 puffs for around 4 times daily.
Additional puffs can be suggested to the patients when required but these should not exceed 12
puffs each day. A number of side effects need to be mentioned to the patient to make him aware
of the complications and prevent him from getting anxious and accordingly coping with them or
to contact professionals immediately (Donohue et al. 2016). These are dry mouth, cough,
headache, nausea as well as dizziness and difficulty in breathing. It can also result in
bronchospasms that can be life-threatening. It can also cause rashes, and different serious allergic

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reactions, itching and even might get involved in the closure of the airways. Many of the studies
are of the opinion that because of this anti-cholinergic effect, it might worsen symptoms of
benign prostatic hyperplasia and even the narrow-angle glaucoma. The professional should be
careful about not using with other anticholinergic drugs as this might increase the occurrence of
the side effects. The main contraindication for the inhaled ipratropium bromide is
hypersensitivity towards atropine as well as related substances (Panahi et al. 2016). For mainly
oral administration, contraindications are found to be similar to that of the anticholinergics. They
are seen to include narrow angle glaucoma as well as obstructions in the gastrointestinal tract and
urinary system. Specific information needs to be provided to the patient in order to educate him
about the medication. The patient needs to reveal whether he is allergic to the medication by
taking a allergy test. He should also reveal whether he has urination problems or glaucoma as
this might have negative impacts. The patient should be educated to avoid getting the medication
in contact with the eyes and if this happens, it should be immediately washed with water (Sheng
et al. 2016). This medication has the capability of blurring the vision and might also impair any
thinking or reactions. In case of missed doses, the patient should be immediately taking it and if
the missed dosage time has already near to the next scheduled dose, then the dose should be
skipped. In case of overdose, the patient should immediately contact the healthcare professional.
The patients should be also taught the ways to manage the mild-side effects and in case of
complications, they should contact professionals.
3 interventions for the medication being administrated:
The nurse should first monitor for any form if complications arising from the drug
therapy. This is because the first dose might precipitate bronchospasms and may cause
anaphylactoid reaction. This is seen to include angioedema as well as bronchospasms and even

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laryngosspasm. The patient should therefore be instructed about the proper use of the metered
dose inhaler that would also include ways to self-administer medication and the ways to care for
the equipments (Zafari et al. 2017). The patient should be also educated to test the fire metered
dose inhaler three times before taking the first inhalation.
The nurse should be very careful in using the medication cautiously in elderly men who
have benign prostatic hypertrophy as well as in all patients with glaucoma.. This is because the
drug might cause worsening the symptoms (Braido et al. 2015). The patient named Jack has not
revealed any form of such information to the nurse. Therefore, the nurse should take the
initiative of first revealing if they have such issues and then would instruct the patient in
reporting any difficulties with the urination as well as any vision changes.
The nursing professional should try to monitor the common side effects like that of
hoarseness, and throat irritation, cough, dry mouth, urinary retention, nosebleeds, constipation,
headache and rhinitis. These might cause additional suffering to the patient as well as threatening
situations (Calzetta et al. 2017). The patients should instruct the patients of identifying signs and
symptoms of side effects, in reporting side effects to the different health providers and even
using the medication only when directed. The patient should be told that increased use might
cause increase in side effects.
Two national health and safety quality standards:
One of the national health and safety quality standards that need to be met for Jack is
ensuring medication safety that remains included under the standard 4. Within this standard,
there is another important sub section as 4.3 called partnering with consumers. It is stated here
that nurses would need to use the organizational process for partnering with consumers for

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ensuring medication safety (Stanford et al. 2019). The clinicians would also need to actively
involve patients in their own care and should also meet the information needs of the patient and
also involve in shared decision making. While caring for the patient named Jack, the professional
would try to make him participant in this own care and listen actively to the needs of the patient.
Developing therapeutic relationship with patient and engaging them in their own care make
patient feel empowered and their compliance with treatment increases. This approach would help
in increasing adherence of Jack to the medication
Another important standard is the standard action number 4.7 belonging to the
medication safety. This action plan described the importance of the healthcare organization in
documenting the history of the medicine allergies as well as adverse drug reactions in the
healthcare records on the presentation (NSQHS Standards 2017). This step is important as it
helps in reduction of the medicine related risks for the patients and is minimized by the
documentation as well as for referring to the history of the medicine allergies and adverse drug
interaction. It has been found in case of Jack, that he had no history of medicine allergies and
hence the drug could be prescribed to him. This standard mainly guides professionals in
preventing threatening situation from drug-drug interaction and other medication errors
occurring due to poor reporting.
Information gained from this case study that can be applied to others:
This case study helped in understanding the various important aspects that remain
associated in prescribing and administering medication to patients. One of the most important
aspects of medication administration is effective documentation of the patient’s history and the
different allergies the patient has the medications they already take. Documenting and evaluating

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this information is important while prescribing medication to prevent any form of drug-drug
interaction or to result in exacerbation of allergic situations or other threatening issues. This form
of medication errors not only result in suffering of the patients but also results in readmission to
hospitals, increase in length of stays in the hospitals, increased financial constraints, expenditure
of healthcare resources and poor quality lives (Vinjamuri et al. 2017). Nurses should therefore
take in consideration of all the information to ensure that medicine do not reach with the other
mentioned factors and cause threatening situations. It has been also found that different
medications might have different side effects that might impact the health of the patient and
make them strenuous and nervous. The professionals need to conduct a cost-benefit analysis to
find out if the positive outcomes of the medication overdo the mild side-effects that arise with
this. Accordingly, nurses need to provide medications and they should also educate the patients
about how to manage the side-effects successfully. Patient education about different aspects of
medication can help in increasing not only the adherence of the patients to the medicine but also
reduces the risks of taking wrong dosage, at wring tines and others. Effective participation with
the consumers and making them active members of the care process enable them to feel
empowered and their adherence to treatment increases.

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