Pbl 5 : A Bad Interaction

This paper will demonstrate the author’s ability to prescribe safely from the Nurse Prescribing Formulary (NPF 2009-2011). A prescribing situation undertaken by myself while supervised by my mentor will be discussed. The patients name, address, date of birth and GP details have been changed to ensure patient confidentiality in accordance with the Nursing and Midwifery Council (NMC)(2004). The patient therefore will be referred to under the pseudonym Prince Charming.

As our population ages, patients are living longer as a result of advances in medical technology, surgical procedures, and drug development(Bressler MD & Bahl PhD, 2003). The average older person is taking two to five prescription medications daily and one in five of this age group has a medication related hospitalization annually (McLean & LeCouteur, 2004). In my eighteen years of nursing, I have taken care of many patients being treated with anticoagulant medications for various reasons, and I have found that most of these patients are not educated about the risks, benefits, and adverse reactions associated with anticoagulants.

In the last decade, the number of prescriptions for antibiotics has increases. Even though, antibiotics are helpful, an excess amount of antibiotics can be dangerous. Quite often antibiotics are wrongly prescribed to cure viruses when they are meant to target bacteria. Antibiotics are a type of medicine that is prone to kill microorganisms, or bacteria. By examining the PBS documentary Hunting the Nightmare Bacteria and the article “U.S. government taps GlaxoSmithKline for New Antibiotics” by Ben Hirschler as well as a few other articles can help depict the problem that is of doctors prescribing antibiotics wrongly or excessively, which can led to becoming harmful to the body.

Coumadin (non specific name: warfarin) is an anticoagulant, or blood diminishing drug, that is endorsed to numerous patients who are at danger for creating blood clusters that could bring about heart assaults or strokes. Warfarin is near the most astounding purpose recently and simultaneous investigations of medications that provoke ER visits and occurring an expansion in healing center based offices with the affirmation of patients. Anticoagulation treatment stances perils to patients and over and over prompts unfavorable solution events in light of complex dosing, fundamental ensuing watching, and clashing patient consistence. As a result, various patients who meet current evidence based principles for warfarin treatment are not being managed

Your white blood count (lab test) was 16.6, computed axial tomography (test) of the neck showed mild edematous (swelling) and enlargement of the right tonsil without abscess (pocket of infection). You received intravenous treatment (through the vein) fluid bolus (fast) in the amount of 2 liters, Morphine (pain medicine) for pain, Decadron (medicine that decreases swelling), Clindamycin (antibiotic) and Unasyn (antibiotic) all intravenous (through the vein) stat (immediately). Your blood cultures showed no growth. You were admitted with intravenous (through the vein) fluid at 60 an hour (rate), Zosyn (antibiotic) intravenous (through the vein) every 6 hours, Heparin (medicine to thin blood) and Tylenol. You were seen by an Infectious disease (specialist) for a consultation and continued on intravenous (through the vein) antibiotics. Based on the Interqual guideline criteria (a decision based program to determine medical need) for infection, the clinical guidelines were not met because there was no documented failed outpatient anti-infective treatment; you were not Immunocompromised (body not able to fight infection or gets infection easily) and your temperature was not greater than 99.4

In the context of the War on Drugs, physicians must balance many different competing and contradictory interests when determining how to prescribe in treating a patient. The physician's first interest is in maintaining his duty to properly

A study performed by Alex Broom found that in multiple Australian hospitals contained a culture that perpetuated the ideology of using antibiotics in a reckless manner. In fact the study epitomized the global issue of misuse with the statistic of, “On any given day in Australia, approximately 40% of hospital in-patients will receive antibiotics with up to 50% of those deemed sub-optimal in current best practice terms” (Broom 81). Not only is this an important statistic for the argument that there is an issue, the journal discusses an insight as to why the misuse is happening in some medical quarters. Broom highlights the “social world” of hospitals that make doctors inclined to suppress immediate complications of an illness much more than looking to prevent a catastrophe that takes years to develop. Broom goes on to say, “We conclude that understanding the habitus of the hospital and the logics underpinning practice is a critical step toward developing governance practices that can respond to clinically ‘sub-opitmal’ antibiotic use” (Broom 81). The habitus, or a sort of social constitution among doctors, is one that includes a fear of undertreating as compared to over treating. The inconsideration for over treating patients could possibly be deemed inexplicably

Developing and enforcing dosing and monitoring guidelines for all anticoagulation therapy will increase awareness of drug reactions and allow for medical records verification among all hospital professional. With verification of medications and patient records will result in less drug reactions. (Franco, Maxwell, Green & Barthol, 2009) Medication reactions can been minimize even more with proper handling, patient care and medical records management.

clotting in vessels. This makes the person more vulnerable if when cut for the blood flow to cease in

Preventing errors relating to commonly used anticoagulants. (2008). Joint Commission perspectives. Joint Commission on Accreditation of Healthcare Organizations, 28(11), 13-15.

The main concerns regarding treating a patient with AF are rhythm control, rate control, and anticoagulation (Zak, 2010). For patient X, he was started on Metoprolol (beta blocker), Amiodarone (anti-dysrhythmic) and Warfarin (anticoagulation). Due to Warfarin’s ability to alter the INR of the blood, it is imperative to monitor the INR frequently to ensure that the level is therapeutic (Shea and Sears, 2008). Patient X had a full time job though making minimum wage. He was unable to take time off of work to get his blood drawn monthly for INR levels at his doctor’s office. This would result in sub therapeutic levels of anticoagulation and therefore noncompliance. He suffered a pulmonary embolus from the sub therapeutic anticoagulation and was hospitalized. After speaking with his cardiologist regarding other means of anticoagulation, the decision was made to change his medication from Warfarin to Pradaxa, an anticoagulant of a different

Health care practitioners that are licensed using these prescription drugs in ensuring that the injured or sick person receives the most appropriate treatment. The last decade has experienced some significant transformation in the health care, and this can be accorded with the relevant advances that have been gained in the pharmaceutical therapies. As a result, significant advances in how diseases are managed, prevented, or cured have been achieved with reference to the prescription drugs identified (Hamric, Hanson, Tracy, & O'Grady,

According to Zeuthen, Lassen, and Husted (2003), the theoretical possibility of a transient hypercoaguable state “emerges from a decline in plasma levels of protein C and S, at a time when factors X and II levels are still high due to a longer half life, [which] may lead to a transient hypercoaguable state within the first 12 to 60 hours” of warfarin initiation. In this study, 40 patients who had atrial fibrillation lasting longer than 48 hours were enrolled, and were randomized to receive either warfarin or a LMWH as antithrombotic treatment. Patients with ulcer disease, a gastrointestinal bleed within the past five weeks, uncontrolled hypertension, pregnancy, thrombocytopenia, renal insufficiency, or blood coagulation disorders were excluded (Zeuthen et al., 2003). The study specified that two patients dropped out voluntarily, 21 patients received LMWH and 17 patients received warfarin with a goal international normalized ratio (INR) in the range of 2.0 to 3.0. According to Zeuthen et al. (2003), the method of measuring the possibility of a hypercoaguable state involved assessing markers that reflected the protein and factor activity during the initiation of warfarin and the initiation of a LMWH. The patients in the study were randomly treated with warfarin or LMWH, as discussed previously, for three consecutive days, and biochemical markers were measured at

Warfarin is a prescription drug used to prevent damaging blood clots from forming or growing bigger. Useful blood clots try to prevent or stop bleeding, but dangerous blood clots can cause a stroke, heart attack, deep vein thrombosis, and/or pulmonary embolism in the body. Because warfarin conflicts with the forming of blood clots, it is called an anticoagulant. Many people indicate anticoagulants as “blood thinners”; but, warfarin does not thin the blood. Instead warfarin causes the blood to take longer to form a clot. Warfarin lowers the body’s ability to make blood clots by blocking the formation of vitamin K–dependent clotting factors. Vitamin K is needed to make clotting factors and stop bleeding. Whereas, by giving a medication that

Warfarin is an anticoagulation that is metabolized in the liver and removed through the kidneys. The proper metabolism of his warfarin is being inhibited by the cimetidine. The effect of warfarin is increased due to the interaction between these two medications. According to Miller (2010), wafarin is a drug that needs to be carefully considered for a patient in terms of interactions. A second issue entails issues pertaining to his signs of bleeding and indication of slow clotting. The patient is having epistaxis, ecchymosis, and an increased international normalized ratio (INR). The normal INR range of warfarin is 2.0-3.0. According to Barta, Nutescu, and Johnson (2015), the patient needs to remain in the accepted range for as long as possible which indicates a stable level. The laboratory results indicated an elevated INR of 4.8. This indicates he is at risk for bleeding due to the rate that his blood is clotting. A third problem pertains to his abnormal digoxin level of 1.6 ng/ml. digoxin is an antiarrhythmic that is metabolized in the stomach and liver. The normal range for this medication is 0.5 to 0.8ng/ml. According to Niemeijer et al. (2015), digoxin can result in sudden death and must be carefully