Case Study on Nursing Assignment 2022

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

1NURSING
Introduction
This nursing assignment is based on the case study of Mr Candice Tong who was
admitted to Deakin Hospital on 14th of July, 2019 with upper abdominal pain, vomiting and
nausea. The endoscopy and biopsy of her stomach showed that she is suffering from bacterial
peptic ulcer. On the next day, her discharge planning was done along with proper medication
planning. The following paper will highlight the prospective side-effects of the medications
upon the current physiological aetiology of Ms Tong followed by possible interventions for
the management of such risk factors. The paper will also highlight the over-the-counter
(OTC) medication used by Ms Tong, its side effects and patients’ education about OTC
medication.
Answer 1
Metroclopramide is used for the management of nausea and vomiting. According to
Hirmanpour et al. (2018), metroclopramide is used for slow emptying of stomach
(gastroparesis) among the patients. It works by increase the movements or smooth muscle
contraction of the stomach and intestines. The study conducted by Hirmanpour et al. (2018)
highlighted that administration of Metroclopramide leads to significant decrease in the
systolic and diastolic blood pressure arising out of dilation of the smooth muscles. During
hypertension, vascular resistance increases due to vasoconstriction arising out of thickening
of the diameter of the vascular muscles. The action is regulated by rennin-angiostesin-
aldosterone system, oxidative stress, and sympathethic nervous system. In smooth muscle
contraction, that pathophysiolgy reverses leading to decrease in the blood pressure. Mr Tong
is however, prescribed with two anti-hypertensive pills known as rampiprial (orally) and
felodipine (orally). The role of the anti-hypertensive pills is to reduce the blood pressure.
However, administration of Metroclopramide reduces the blood further (Adams & Urban,

2NURSING
2015). The case study reveals that Mr Tong is attributed to low blood pressure as evident
from her vital signs reported at the time of admission. This sudden reduction in the blood
pressure can cast threat to the health of Ms Tong.
Clarithromycin is an antibiotic that is used to control the infection of Helicobacter
pylori common among the peptic ulcer patients (Adams & Urban, 2015). Ms Tong was also
prescribed by Clarithromycin orally, twice daily for seven days. It is macrolide and
nevirapine in nature and acts through non-nucleoside reverse transcriptase inhibitor.
However, use of antibiotics are also associated with sudden side-effects like increase level of
stomach pain, indigestion, bloating and diarrhoea. In extreme cases, the use of this antibiotic
is also associated with increased level of heart beats along with unbearable pain in the
stomach (Adams & Urban, 2015). Taking into consideration of the age of Mr Tong (56 years
old), pain in the stomach can hamper the quality of life. Moreover, her medication chart has
no specific medication (antacids) targeted towards the management of the gastritis (treatment
of acidity) thus creating further discomfort along with the chances of constipation. The study
conducted by Neufeld et al. (2017) stated that use of Clarithromycin as an antibiotic can
increase neuropsychiatric complications. The ability of Clarithromycin to regulate the central
nervous systems leads to the generation of anxiety, stress and psychosis. Since Mr. Tong has
previous reported cases of depression and is also taking antidepressant (Citalopram),
Clarithromycin can induce neuro-psychological side-effects.
Answer 2
The first risk that can be associated with Ms Tong is sudden decrease in the blood
pressure under the action of two anti-hypertensive pills, Rampipril and Felodipine along with
the side effects of Metroclopramide. According to the Nursing and the Midwifery Board of
Australia (NMBA) (2016), Professional Code of Conduct, it is the duty of a nursing