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Case Study Pharmacology Reasoning, Bradycardia, Suggested Answer Guidelines : Marilyn Fitch is a 78-year-old Caucasian woman with a history of hypercholesteremia, hypertension, and heart failure and has$10.99
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Case Study Pharmacology Reasoning, Bradycardia, Suggested Answer Guidelines : Marilyn Fitch is a 78-year-old Caucasian woman with a history of hypercholesteremia, hypertension, and heart failure and has
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Course
NUR 325
Institution
NUR 325
Case Study Pharmacology Reasoning, Bradycardia, Suggested Answer Guidelines : Marilyn Fitch is a 78-year-old Caucasian woman with a history of hypercholesteremia, hypertension, and heart failure and has
Medication Categories: Concepts/Content:
Antidysrhythmics Assessment
ACE Inhibitors Drug-drug interactions
Beta Blockers Evaluation of desired outcomes
Statins Monitoring for adverse effects
Oral Anticoagulants Emergency treatment of dysrhythmias
Diuretics Client education
Electrolytes Psychosocial support
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
• Management of Care 17-23% X
• Safety and Infection Control 9-15% X
Health Promotion and Maintenance 6-12% X
Psychosocial Integrity 6-12% X
Physiological Integrity
• Basic Care and Comfort 6-12%
• Pharmacological and Parenteral Therapies 12-18% X
• Reduction of Risk Potential 9-15% X
• Physiological Adaptation 11-17% X
,I. Initial Presentation:
Marilyn Fitch is a 78-year-old Caucasian woman with a history of hypercholesteremia, hypertension, and heart
failure and has NKDA. She was brought in by her daughter after Marilyn complained of feeling dizzy several
times this morning and then almost passed out at home. Marilyn has a six-month history of paroxysmal atrial
fibrillation. Her heart rate has been regular and she has had no episodic dizziness since she had a synchronized
cardioversion one week prior to this visit. Her initial VS in triage were: T: 98.9 F/37.2 C (oral) P: 52 R: 16 BP:
94/52 and O2 sat: 98% room air.
Personal/Social History:
Marilyn is a widow and lives alone in her own home. She denies smoking and admits to drinking one glass of
wine with her dinner.
1. What data from the histories are RELEVANT and must be NOTICED as clinically significant
by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential)
RELEVANT Data from Present Clinical Significance:
Problem:
• Hypercholesterolemia • All of these are risk factors (especially when
Hypertension combined) for heart attack and stroke
Heart failure • Concerning signs of heart rhythm changes
• Dizziness/ almost passing out • Vitals of low HR and Low BP, usually if one of
• 6-month paroxysmal A fib these two vitals changes, the other will increase to
• Synchronized cardioversion compensate.
• Pulse of 52, BP 94/52
RELEVANT Data from Social History: Clinical Significance:
• Widow and lives alone • Shows the pt doesn’t have much of a support
system, and there could be psychosocial aspects to
• Drinking wine with dinner include in
her care
• Drinking 1 glass of wine with dinner is usually ok, in a
healthy individual. Since she has heart problems,
cholesterol issues and hypertension, she should restrict
alcohol use.
As the nurse responsible for this patient, you promptly review the medical
history and current home medications in the medical record:
2. What is the RELATIONSHIP of the past medical history and current medications? Why is your
patient receiving these medications? (Which medication treats which condition? Draw lines to connect)
Medical History (PMH): Home Medications:
Hypercholesteremia Apixaban 2.5 mg po bid
Hypertension Captopril 100 mg po BID daily
Heart failure Amiodarone 100 mg po bid
Atrial fibrillation Hydrochlorothiazide 50 mg po daily
Atorvastatin 10 mg po daily
Carvedilol 6.25 mg po bid
Applying your knowledge of pharmacology, to provide safe
patient care, answer the following essential information:
, 3. List each home medication from the scenario and answer the following:
(NCLEX Pharmacologic and Parenteral Therapies)
Home Pharm Indication(s): Mechanism of Body Common Nursing
Medication . Action In OWN Syste Side Effects: (1- Assessments:
3)
: Class: WORDS: m
Impacte
d
Apixaban Anticoagulant It’s a highly selective and CV, HEMA -Bleeding. Assess patient
2.5 mg Decreases risk of reversible inhibitor of factor Xa. for symptoms o
stroke/systemic Symptoms may stroke or
po bid
embolism It prevents the conversion of include: peripheral
associated with prothrombin to thrombin. nosebleeds vascular disease
nonvalvular atrial bruising more periodically
fibrillation easily during therapy.
heavy menstrual Assess for
bleeding increased
bleeding of your bleeding due to
gums when you anticoagulant
brush your teeth therapy
Captopril Antihypertensive Hypertension, HF, Supresses RAAS, inhibits ACE CNS, CV, GI, -Dizziness, Monitor blood
150 mg LVD after MI, but preventing Angiotensin I from GU, HEMA, lightheadedness, or studies (platelet
diabetic converting into angiotensin II INTEG, loss of taste may WBC,
po daily nephropathy, RESP occur as your body neutrophils
proteinurea adjusts to the etc..), monitor
medication. BP, check or
- Dry cough may Orthostatic
also occur. hypotension,
monitor for HF
(dyspnea, jugula
vein distension,
weight gain,
edemas, lung
sounds), monito
renal studies
(protein, BUN,
creatinine) and
renal symptoms
polyurea,
oliguria,
potassium.
Establish a
baseline before
studies begin.
Amiodaron Class III Used for • Mainly blocks potassium CNS, CV, -Cough. Monitor:
antidysrhythmic ventricular channels in the heart, EENT, -dizziness, -electrolytes
e 100 mg affecting the action
dysrhythmias ENDO, GI, lightheadedness, or -Thyroid
po bid potential and cardiac GU, INTEG, fainting. function tests
rhythm. MS, RESP. -fever (slight) -CNS symptom
• Can also affect -numbness or (confusions,dep
sodium/calcium channels tingling in the esssion)
and A & B fingers or toes. -hypothyroidism
adrenergic receptors. -painful breathing. symptoms
-sensitivity of the -hyper-
skin to sunlight. thyroidism
symptoms
-pulmonary
toxicity
-monitor cardiac
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