NURS 6521, Week 1 Assignment
NURS 6521, Week 1 Assignment
Directions: For each of the scenarios below, answer the questions using clinical practice guidelines. Explain the problem and explain how you would address the problem. If prescribing a new drug, write out a complete medication order just as you would if you were completing a prescription. Use at least 3 sources for each scenario and cite sources using APA format.
• A 52-year-old man PT was recently discharged from the hospital following treatment for atrial fibrillation. He was discharged on warfarin 5 mg po q day and amiodarone 200 mg tid. His INR is 8.8. What interaction has occurred with these 2 medications? What changes in his medications would you make?
• LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit. Past medical history includes HTN, Alzheimer’s disease, and diabetes. Her current medications include amlodipine 10 mg daily, donepezil 10 mg QHS, furosemide 40 mg QAM, glyburide 5mg BID, ketorolac 10mg daily, metformin 500mg daily. Physical exam shows bilateral 2+ edema to lower extremities and vitals include blood pressure of 177/82. Labs show K+ 3.3, glucose 101, BUN 42, Cr 1.6 and eGFR 45 mL/min. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?
• Name two drugs that are highly affected by the first pass effect. As a prescriber, what actions would you take in prescribing these drugs to counter the first pass effect?
• A 65-year-old man DH with liver cirrhosis is admitted to the medical-surgical unit with nausea and vomiting. He also has a diagnosis of heart failure. You note that his serum albumin (protein) level is low. The physician has written admission orders, and you are trying to make the patient comfortable. He is to take nothing by mouth except for clear liquids. An intravenous infusion of dextrose 5% in water at 50 mL/hr has been ordered, and the nurses have had difficulty inserting his intravenous (IV) line.
1. One of the drugs ordered is known to reach a maximum level in the body of 200 mg/L and has a half-life of 2 hours. If this maximum level of 200 mg/L is reached at 4 pm, then what will the drug’s level in the body be at 10 pm?
2. Describe how factors identified in the patient’s history would affect the following:
• Absorption
• Distribution
• Metabolism
• Excretion
3. This patient is also receiving digoxin (Lanoxin) for heart failure. This drug is known to have a low therapeutic index. Explain this concept.
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