Nursing- Pathophysiology and Pharmacology Essay Example

  • Category:
    Nursing
  • Document type:
    Case Study
  • Level:
    Undergraduate
  • Page:
    4
  • Words:
    2559

Nursing- Pathophysiology and Pharmacology

Scenario 1

  1. Mode of Action for Renitec 15mgs and Losec 20mgs

The two drugs have different modes of action based on the type of disorder that they alleviate. Renitec 15mgs prescribed to Mrs. Frienda is a group of drugs that are essentially utilized in treatment of hypertension as well as congestive heart failure. The mode of action is prevention of cardiovascular disorders, congestive heart failure, and hypertension left ventricular dysfunction and remedying nephropathy in diabetes mellitus. On the contrary, Losec 20mgs reduces gastric acid secretion through a unique mode of action. It inhibits the gastric proton pump in the parietal cells. In the same way, it produces reversible control of gastric acid release with daily dosage of one tablet. Furthermore, omeprazole present in the drug inhibit the gastric enzyme H+, K +-ATPase which is responsible of catalyzing the exchange of H+ and K + (Medscape, 2011)

  1. Desired Effects of Renitec 15mgs and Losec 20mgs

Based on the past history of Mrs. Frienda, Renitec 15mgs was administered with the hope of treat her hypertension so that the blood pressure attains a stable level. This was as well desired to reduce congestive heart failure resulting from hypertension. On the other hand, Losec 20mgs administered daily was supposed to reduce the secretion of gastric acid that apparently had resulted into her long history of GORD.

  1. Side Effects of Renitec 15mgs and Losec 20mgs

In this case where Mrs. Frienda is feeling vague and unable to pronounce her word properly, the most probable cause is that she might have developed stroke following the long history of hypertension. It is evident that after her husband’s death, Mrs. Frienda must have suffered post-traumatic stress which had an eventual result into stroke. On the other hand, it could be possible that long-term use of Renitec and Losec could have side effects that ultimately affected her speech. Pharmaceutical indications reveal that Losec has undesirable side effects on the central and peripheral nervous system. This may be the cause of her dizziness, paraesthesia and inability to pronounce words correctly. In addition, Mrs. Frienda may be experiencing vagueness as a result of overdose of the prescribed drugs. There have been reported cases of patients feeling dizziness and nervous disorders following overdose of both Renitec and Losec medication (Porth & Hannon, 2009, pg 37).

  1. Blood Tests and Their Significance

Based on the historical medical report of Mrs. Frienda, the doctor had to carry out a number of blood tests in order to ascertain the ultimate diagnosis of her hypertentic and GORD condition. Blood tests that were carried out on Mrs. Frienda include: Coag Studies, Liver function test-LFT, Troponin, and Erythrocyte Sedimentation Rate.

Coag Studies

These are a collection of blood tests including PT, PTT and INR and have different implications to the blood state of a patient. These kinds of blood test are carried out by doctors before carrying out surgeries on patients so that the level of their blood clotting can be established (Medscape, 2011). In the event results show that the patient’s blood can clot at a faster rate, alternative drugs are administered to slow the rate of blood clotting.

Prothrombin Time Blood Test- PT

This test is carried out to determine the possibility of blood to clot during surgery. When the test is carried out, normal blood clot level is expected to be 10-12 seconds. Any alteration to these results may be caused by deficiency in vitamin K. This blood test was carried out on Mrs. Frienda to ascertain whether her hypertension was caused by a blood clot within the heart or vein. This could aid in the establishment of which drug to administer in the event to find a remedy for her high blood pressure problem.

Partial Thromboplastin Time Blood Test- PTT

This kind of blood test was performed on Mrs. Frienda essentially to establish if heparin treatment is efficiency. The doctor carried out this test specifically to establish if there was a blood clotting disorder in Mrs. Frienda which caused her hypertension. The normal expected results were 30 to 45 seconds before blood could clot. Prolonged clotting to this period could have implied a complication in the liver of Mrs. Frienda. The test was imperative in the event Mrs. Frienda required surgery during her medication so that blood clotting complications could not hinder her safe treatment.

Liver Function Test- LFT

This in the case of Mrs. Frienda was an effective apparatus for screening blood so that efficient modality of detecting hepatic dysfunction could be established (Porth & Hannon, 2009, pg 17). This follows the fact that the liver is an organ that is used to perform a multiple of functions including blood purification. Failure of the liver could also indicate the possible cause of hypertension. This test was important in the establishment of the pattern of cholestatic disorders like the hypertension. Importantly still, the test done on Mrs. Frienda could reveal whether her liver was in position to metabolize some drugs prescribed to her so that the most effective drugs could be prescribed for her complications. The most imperative test included serum bilirubin. Normal result should indicate 17μmol/L in which case above this shows an underlying liver disorder. Results collected from the tests were normal hence as true indication that Mrs. Frienda’s cause of hypertension was stress following her husband’s death.

Troponin

This is a type of blood test that is carried out to investigate Troponin T and Troponin I proteins in any sample of blood. Such protein samples are identified whenever there is damage on heart muscles particularly after a patient undergoes a heart attack. Normal result anticipated after the blood test includes:

  • Troponin I : less than 10 µg/L

  • Troponin T : 0–0.1 µg/L

Alterations from these results imply that the heart has been damaged. The test was carried out on Mrs. Frienda to establish whether she had experienced a heart attack following her husband’s death which caused hypertension.

Erythrocyte Sedimentation Rate

This is a nonspecific test that is carried out on blood to establish a number of complications linked to acute and chronic inflammation on the heart as well as cancer issues. Most prevalently, the test is conducted to diagnose temporal arteritis and polymyalgia rheumatic. Based on Mrs. Frienda’s case, the test was ordered to confirm any possibilities of inflammation on the heart following hypertension.

  1. Types of CVAs

Generally, there two main types of strokes or cerebral Vascular Accident and these are ischemic and hemorrhagic. An ischemic stroke is as a result of an obstruction that develops within a patient’s blood vessel causing a shortage of blood to the brain. In addition, an ischemic stroke causes permanent damage to the brain paralyzing the patient’s movement abilities such as the one experienced by Mrs. Frieda after her first stoke (Porth & Hannon, 2009:1265). Whenever blood vessels become clogged with fats and cholesterol, blood clots form inside these vessels blocking the flow of blood to vital organs such as the brain resulting in an Ischemic stroke. In contrast, hemorrhagic stroke can be triggered by a sudden rupture of a weak blood vessel diverting the blood from its normal course spilling into or around the brain cavity. Furthermore, high blood pressure is attributed to causing weak blood vessels supplying blood to the brain to burst open causing a serious bleeding in the brain. In older individuals, the accumulation of protein amyloid inside arteries is another cause for hemorrhagic stroke.

  1. Why Medications Were Ordered

After diagnoses, Mrs. Frieda was given 1 litre of IVT-normal saline continuously for twelve hours to prevent dehydration since she could not swallow liquids and nutrients through her mouth. Nutrient supplements dissolved in the saline solution supplemented her nutritional needs since she could not eat or drink due to severe vomiting resulting in dehydration (Medscape, 2011:2). Neurological observations were also ordered by the doctor to ensure Mrs. Frieda’s vital signs were recorded in addition to papillary responses and limb assessment. This is because centers that control blood pressure, respiration, and heart rate are located in the brain stem and the midbrain thus any pressure build up in the brain will affect these centers causing changes in patient’s vital signs.

In addition, the doctor requested for her Blood Glucose levels to be monitored closely to track any normal or abnormal changes that may occur whilst the patient is receiving IVT-normal saline. Given that she had lost the ability to swallow, no pills of any form were administered to her. Moreover, the doctor ordered her to be given 1gm of Paracetamol IV TDS to relief the pain being caused by ulcers in her stomach and the effects of stroke (Medscape, 2011:2). Enalapril and aspirin were commenced 24 hours later after the speech therapist reviewed her to treat high blood pressure to allow healing to take pace effectively. Lastly, the doctor requested continual liver function tests to be carried out to assess any abnormalities in the measure of various chemicals present in the blood generated by the liver.

  1. Concerns about the Results

Looking at Mrs. Frienda’s current observations of P 122, BP 161/72, R 19, T 38.2, GCS 13, BGL 13.6mmol/l, it can be deduced that her blood pressure is still high and this raises a number of concerns about her health. Mrs. Frienda’s BP 161/72 shows that her heart strains so much to pump blood through the arteries. This could be as a result of blockage within the blood vessels most likely following cholesterol accumulation. On the other hand, the blood pressure could be persistent following a stressing life that she is undergoing.

Looking at her BGL which is 13.6mm0l/l, it can be deduced that Mrs. Frienda’s glucose level has gone up and therefore she requires a diabetic diagnosis to bring back her blood sugar level back to normal of 1.1mmol/l. It should be noted that Mrs. Frienda lost her husband 15years ago and this contributed to her hypertentic state (Medscape, 2011). Another concern arises considering the systolic pressure which indicates a clear increase. This shows that Mrs. Frienda has arterial hypertension which may lead to surgery to alleviate her condition. On the contrary, GCS 13 found with Mrs. Frienda shows that there is an impending danger in motor and verbal coordination. This might be an indication of an acute CVA.

  1. Why Observations Were Ordered

The neurological observations were ordered to check any developments in the patient’s vital signs. These included recording the patient’s blood glucose levels, heart rate, temperature changes, changes in speech, and lastly body mobility (Knights, Salerno & Bryant, 2010:47). A patient suffering from stroke needs keen attention to note any abnormalities in the above vital signs. In case of any change the doctor should be notified immediately to assess the patient’s recovery process.

  1. Why Mrs. Frienda Daughter’s Uncle was Able to Talk and Swallow

The possible explanation as to why Frieda’s daughter uncle was able to talk and swallow though he suffered a CVA is because his was mild. It is a warning sign of an impending Ischemic stroke that needs attention to treat the causative factors (Porth & Hannon, 2009:1264). However, Mrs. Frieda has suffered CVA for a long period of time especially after her husband’s death 15 years ago in which case such incidences paralyze a patient’s ability to talk and swallow after turning into an acute stroke.

  1. Why Mrs. Frienda was on Walfarin and had to see Her Doctor Every Two Days

The reason why Mrs. Frieda is on Walfarin is to prevent her blood from clotting as a result of the protein elements in her blood. The Liver Functional Test carried on her revealed that there was a dysfunction of her liver and considering the results seen during the above observations, she has hypertension which is possibly caused by blood clotting. This is the most preferred drug for patients suffering from CORD. Moreover, the drug is administered to patients of Ischemic stroke to prevent new clots from forming inside their veins and arteries. To ensure the patient is using the drug as prescribed by the doctor, he or she is required to visit the hospital for regular checkups. This is the reason why Mrs. Frieda was required to see her doctor every two days.

Scenario 2

Osteoarthritis is caused by an imbalance in the natural breakdown and repair process that occurs with cartilage. In a patient suffering Osteoarthritis, the damaged cartilages worn out by age and injury do not have the ability to repair themselves as required. The cartilage is made of water, collagen and, specific proteins that deteriorate over time (Knights, Salerno & Bryant, 2010:61). In a health person, the cartilage is supposed to continually breakdown itself and repair worn out parts. In Osteoarthritis, this natural process gets disrupted leading to deterioration of the cartilage and an abnormal repair response commences. The main reason behind this abnormal behavior exhibited by joint cartilages is because of an increase in its water content coupled with a high rate of protein makeup break down.

Osteoarthritis is a cartilage disorder that is caused by an imbalance between the natural processes responsible for destroying and repairing the cartilage. This cartilage disease triggers an abnormal multiplication of chondrocytes resulting to an excessive force being applied to the joint causing pain and discomfort to the patient (Knights, Salerno, & Bryant, 2010:301). On the other hand, Rheumatoid arthritis is an autoimmune disease responsible of causing chronic inflation of the patient’s joints. This condition affects people of all ages and is known to cause pain and discomfort to the patient’s joints whenever they move them. In addition, it can cause permanent damage to joints as well as deform the cartilage around the joints.

Paracetamol Osteo given to George is supposed to relief him from the pain caused by osteoarthritis. The right prescription is three daily doses each lasting 8 hours apart. This dosage is enough to relief the patient pain caused by osteoarthritis for 24 hours a day. In addition, Celecoxib was administered to George to relief pain, tenderness, stiffness, and swelling caused by osteoarthritis (Knights, Salerno, & Bryant, 2010:299). The drug is packed as a capsule that can be orally taken once or twice a day according to doctor’s instructions. Patients receiving doses lower than 200 mg can take the medication without food while those taking above 200 mg must eat before they take the drug.

20 mls of Mylanta given to George three times a day were administered to relief heartburns that caused him pain and discomfort. Mylanta drugs given to George did not affect prior medications given to him to treat osteoarthritis. This is because the medication only works to reduce the amount of acids that the stomach produces which must have been the cause of heartburns.

Excess gastric acid secreted in the stomach causes heartburns that in turn cause pain and discomfort to the patient. This is the reason why George felt pain accompanied with heartburns. To relief the pain, the doctor prescribed 20 mls of Mylanta to be taken on a daily basis.

Bibliography:

Knights, B., Salerno, E., Knights, M. K., & Bryant, B. 2010. Pharmacology for Health Professionals. Melbourne: Elsevier Australia.

Medscape. 2011. Medscape News. Retrieved September 08, 2011, from Gastroenterology: http://www.medscape.com/gastroenterology

Medscape. 2011. Pulmonary medicine. Retrieved September 08, 2011, from Medscape News: http://www.medscape.com/pulmonarymedicine

Porth, M. C., & Hannon, A. R. 2009. Porth Pathophysiology: Concepts of Altered Health States. Chicago: Lippincott Williams & Wilkins.