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Quality Use of Medicines-Nursing Case Study

HNN215: Quality Use of Medicines-Nursing Case Study Assignment

Case Study:

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On 27th April, Mr Johann Buchanan, aged 75 years, was admitted to the ward with a chest infection. He began feeling unwell with a productive cough about a week earlier for which he started taking ‘Lemsip Max’ 4 times a day. On the morning prior to his admission, he noted chills and a fever. Mr Buchanan has a past history of hypertension, an acute myocardial infarction (15 years ago) and mild left ventricular failure. Mr Buchanan has also stated that he takes either ‘Nurofen’ or ‘Panamax’ for his sore knee and would like the doctor to write them up on the medication chart.His blood test results are all within normal limits except for the following:
Urea: 10.2 mmol/L (normal range 2.0- 8.5 mmol/L)
Creatinine: 0.11 mmol/L (normal range 0.06 – 0.11 mmol/L for males)

As a result of his chest infection, Mr Buchanan has been commenced on ceftriaxone, azithromycin and hydrocortisone. It is now two days since his admission, and Mr Buchanan has developed a rapid, irregular heart rate. He was given a stat dose of intravenous amiodarone at 1600hrs, to be followed by a regular dose as per his medication chart tomorrow morning. Mr Buchanan’s observations are presently:
Temperature: 38 0 C (tympanic)
Pulse: 112 bpm irregular
Respiration 22 bpm
Blood pressure: 115/74 mmHg
SpO2: 97% on 4 L/min oxygen via nasal prongs
Height: 172 cm
Weight: 80 kg

Question:

Q1. Assess Mr Buchanan’s medication chart. Identify and explain three significant risks that may be associated with the use of the medicines (home or inpatient use) for Mr Buchanan.

Q2. Describe the strategies a nurse may take to prevent/manage the specific risks you have identified in Question 1. Your answer should focus on Mr Buchanan’s needs rather than a discussion on the actual medicines.

Q3. Briefly explain the importance of providing education to Mr Buchanan in relation to over-the-counter (OTC) medications.

Q4. The doctor has ordered an initial intravenous dose of amiodarone in the STAT medicine order section, then to continue with oral dosing. Explain why Mr Buchanan has been ordered this regime. Your answer should include relevant pharmacokinetic concepts.

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