Question

Geriatric and Anticoagulants

Case Study

A 77-year-old female was brought to the emergency room after falling twice at her daughter’s home. The first fall was in the bathtub, where she slipped while rising from the shower chair. She fell a second time when leaving her daughter’s home to visit friends 2 hours later. Her daughter, who is present, states that her mother hit her head on the side of the house, and there is presently a large hematoma on the right side of her skull.

Recent history: The daughter states that her mother has been fatigued over the past 2 weeks and began taking an herbal remedy suggested by a friend. The daughter also states that her mother had complained about her arthritis “acting up.” When the mother is further questioned, she states that she added garlic capsules to her daily medications to help lower her cholesterol levels. The garlic is not on the list of home medications.

Home medications:

Aspirin 325 mg po daily

Furosemide 40 mg po daily

Metolazone 5 mg po daily

Metoprolol succinate 50 mg po daily

Potassium 20 mEq po daily

Rosuvastatin calcium 10 mg po daily

Warfarin 5 mg po daily

Now add: Garlic 2 capsules po every am

** Using a drug book or Pharmacology textbook, answer the following questions for each medication listed. Make your answers specific to this case study.

What do I know about these medications? What is the recommended dose, route, and time of day to give these? What lab results do you need regarding the medication? What is the therapeutic use, what are the most common diseases treated with this medication? Are there any off label uses for this medication?

Aspirin:

Furosemide:

Metolazone:

Metoprolol succinate:

Potassium:

Rosuvastatin calcium:

Warfarin:

Garlic Capsule:

Can I figure out the patient’s past medical history by looking at the medication list?

Allergies:

-Codein

-Morphine

What are codeine and morphine used?

What are the signs and symptoms of an adverse reaction to codeine and morphine________________________________ ______________________________________________________________________

Body Systems:

Place each medication under the body system that it commonly affects.

Neurological:

Cardiovascular:

Hematological:

Pulmonary Gastrointestional:

Nutrition:

Genitourinary/renal:

Musculoskeletal:

Endocrine:

Integumentary:

Immune:

Pain/Comfort:

Mechanism of Action

Does the patient's medical history have an effect on the pharmacokinetics of each drug?

What contraindications do I need to address regarding the medications and medical history?

Nursing Process

What nursing assessment will I perform regarding each medication? What is a priority nursing diagnosis regarding each medication? What planning, and implementation do I need to do for each medication? How do I evaluate each medication's effectiveness?

Aspirin:

Furosemide:

Metolazone:

Metoprolol Succinate:

Potassium:

Rosuvastatin Calcium:

Warfarin:

Garlic capsule:

Do I need to be concerned about geriatric considerations with this individual?

Physical Assessment Findings:

The patient is alert and oriented: no acute distress; reports headache; pupils equal, bilateral cataract removal noted; presently a large hematoma on the right forehead with bruising on the right side of the face; cranial nerves II-XII intact. No focal defects

Atrial fibrillation; 88 beats per monitor, no carotid bruits, no JVD, s1 s2 noted, mild edema to ankles, pulses intact to lower extremities, BP 90/60, cap refill @ 3 sec. T 99.6F, PT 80, INR 5 K+ 3.0, NA+ 128

Breath sounds clear RR even, unlabored

Dentures; eats without difficulty; small framed black woman; weight 110 lbs; colonoscopy last week;

Slightly incontinent; wears briefs; no noted trace hematuria in urinalysis

Mild osteoarthritis; reports being still but continues to work in her garden; slightly limited range of motion

No exophthalmos; no slow-heating wounds; no noted trace hematuria in urinalysis

Mild osteoarthritis; reports being still but continues to work in her garden; slightly limited range of motion

No exophthalmos; no slow-healing wounds; no goiter; skin warm and dry

Several areas of bruising appearing after admission to the emergency room (facial, hip and right shoulder)

No palpable lymph nodes

Noted headache and tenderness to right hip, right thigh

Physician Orders:

Stop garlic

Stop Warfarin

0.9% NS at 100mL/hr

Potassium chloride 40 mEq IV

Phytonadione 5mg IM now

CT scan

Consult to neurological

Why is the garlic stopped?

Why is the Warfarin stopped?

Why did the physician order the following medication for his patient?

Potassium chloride:

Phytonadione:

Nursing Process

What is going on with this patient and why? (be specific):

Answer 1

Aspirin: It is an anti-inflammatory drug.

• Recommended Dose:- For Adults-75-160 mg.
• Route of administration:- Oral
• Time:-With doctors consultation, take medicines as and when pain exists that is at least for 1 day. If self medicating, do not take medicine for more than 3 days.
• Lab results required regarding the medication:- Regular monitoring of temperature, ESR level.
• Use/ Indication:- Relieves mild to moderate pain, fever.
• Contraindications/Off Label use:-Allergies, Consult doctor in-case the patient has kidney disease, liver disease, aspirin sensitive asthama, certain enzyme defeciency like G6PD deficiency. Also take precaution when pregnant and lactating.

Furosemide:- It inhibites re-absorption of sodium and chloride ions at proximal and distal renal tubules and loop of Henle.

• Recommended Dose:- injectable solution-10 mg/ml, tablet- 20 mg, 40 mg, 80 mg
• Route of administration:- Oral, Injectable (IM /IV)
• Time:-With doctors consultation, 20-80 mg per oral once daily or 20-40 mg q6-8 hr;not to exceed 600 mg/day.
• Lab results required regarding the medication:-Check blood glucose level, renal functioning and blood pressure regularly.
• Use/ Indication:- Relieves edema, acute pulmonary edema, hyperkalemia, acute renal failure.
• Contraindications/Off Label use:-Avoid this medicine in case of lupus erythematous, hepatic coma, prolonged use in neonates.

Metolazone: It is a diuretic

• Recommended Dose:- 2.5 mg, 5mg, 10 mg
• Route of administration:- Oral
• Time:-With doctors consultation, take once a day. If taken before bedtime, better to take it 4 hrs before going to bed.
• Lab results required regarding the medication:-Check renal functioning and blood pressure regularly.
• Use/ Indication:- Relieves High blood pressure, reduces edema
• Contraindications/Off Label use:-Precaution to be taken if individual has heart disease, liver disease, kidney disease, Pregnant or lactating.

Metoprolol succinate: It is a beta blocker.

• Recommended Dose:- 25 mg- 100 mg/ day or 2 divided dose.
• Route of administration:- Oral, IV
• Time:-With doctors consultation, take once a day.
• Lab results required regarding the medication:-Check blood pressure, ECG and pulse regularly.
• Use/ Indication:- Angina, high blood pressure, heart failure.
• Contraindications/Off Label use:-Precaution to be taken if individual has heart disease, liver disease, kidney disease, Pregnant or lactating.

Potassium: It is a mineral as well as electrolyte.

• Recommended Dose:- 50-100 mEq/ .
• Route of administration:- Oral,
• Time:-With doctors consultation, take once a day.
• Lab results required regarding the medication:-Check blood pressure, potassium level regularly.
• Use/ Indication:- Hyperkalemia,
• Contraindications/Off Label use:-Precaution to be taken if individual has heart disease, liver disease, kidney disease, Pregnant or lactating.

Rosuvastatin calcium: It is a synthetic lipid lowering agent.

• Recommended Dose:- 5 - 40 mg of tablet.
• Route of administration:- Oral
• Time:-With doctors consultation, take once a day.
• Lab results required regarding the medication:-Check blood pressure, potassium level regularly.
• Use/ Indication:- Hyperlipidemia, dyslipedimia. hypertriglyceridemia
• Contraindications/Off Label use:-Precaution to be taken if individual gets myopathy which is a skeletal muscle effects.

Warfarin: It sis used to treat blood clots.

• Recommended Dose:- 1- 10 mg of tablet.
• Route of administration:- Oral
• Time:-10 mg per oral for 2 days.
• Lab results required regarding the medication:-Check clotting factor regularly.
• Use/ Indication:- stroke, thromboembolism,
• Contraindications/Off Label use:-Precaution to be taken if individual is allergic to the drug, has increased alcohol use, blood vessel disorders, pregnancy etc. Avoid getting this injection in the muscles.

Garlic capsules: It is herb which is used for treating heart related conditions.

• Recommended Dose:- Do not use more than what is recommended by a doctor or recommended on the products label.
• Route of administration:- Oral
• Time:-Take as per doctors advice
• Lab results required regarding the medication:-Check blood pressure, heart rate, ESR level regularly.
• Use/ Indication:- Atherosclerosis, diabetes, high cholesterol, high blood pressure.ringworm treatment.
• Contraindications/ Off Label use:- Avoid this capsule when any other medicines are taken in such as acetaminophen, birth control pills etc.Do not take his capsule along with other herbs.

Patients past history suggest that the patient has blood pressure, cardiac related disorders for which some of the following medications were given.