Question

Chapter 4 -Case Study Questions This activity contains 3 questions. Joan Pender is a 67-year-old diagnosed with an irregular heart rhythm. For the past month, she has been taking the following medications for management of her heart condition: digoxin 0.25mg once daily and warfarin (Coumadin) 5mg once daily. During her follow-up visit, the nurse notes that Mrs. Pender has developed purpura on her arms and lower legs. When the nurse asks the patient about these "purple spots," the patient states that she started noticing them about a week ago. The healthcare provider requested for serum liver function and renal function tests. Based on the knowledge of drug pharmacokinetics, how should the nurse explain to the patient the possible cause of the purpura? 2. Mrs. Pender's renal function test results show mild kidney impairment. What changes can the nurse anticipate regarding the patient's medication regimen? The patient asks the nurse, "Why did you have to check the function of my liver?" What is the most appropriate response by the nurse? (77%

Answer 1

1. The possible cause of purpura is warfarin drug side effect which is caused in the process of preventing the blood clots, small capillaries may breakdown and bleeding may occur under the skin ,which appears as purpura or purple spots.

2. The nurse expects changes in the dosage of warfarin , or search for other better alternative , because purpura and renal function test abnormalities indicate the compromised renal function which worse the functioning of heart ultimately.

3. Liver function test is done to know the SERUM BILIRUBIN and SERUM ALBUMIN levels and other enzymes involved in the breakdown of RBC which indicates the presence of bleeding in the internal organs , and further desition can be taken to continue or stop the warfarin .