Mr. Jones, Mr. Nguyen, Mrs. Alensi, Miss Josepovic Case Study – Medical Science Assignment Help

Assignment Task

Task

Question 1:

Mr Jones is a 59-year-old man who was admitted 4 days ago following a motorcycle accident. He sustained a fractured R tibia and fibula. He underwent external fixation of the fracture 3 days ago. This morning he was complaining of some shortness of breath and chest pain. A 12 lead ECG showed non-specific ST segment and T wave changes, vital signs were Pulse: 110, B/P: 100/60, resp: 24, SaO2: 92. V/Q scan indicated pulmonary embolism. Past medical history: type 2 diabetes, peripheral vascular disease and impaired renal function GFR 60ml/min. He smokes 1 pack per day, but says he is going to give it up. Normally does little exercise and weighs 89kg.

He has been commenced on Dalteparin 200 U/kg/day.

Discuss the rationale for commencing Dalteparin and outline the mechanism of action and nursing care required while on this drug.

Question 2:

Mr Nguyen is an overweight 40 year old who has recently been diagnosed with type 2 diabetes. He has been started on Metformin but has been complaining of diarrhoea, some abdominal pain and loss of appetite. He continues to work as a taxi driver and often works the night shift as he has young school aged children. His HbA1c is 8%. The medical staff are considering adding Exenatide to his medication regime.

Outline the mode of action of Metformin and Exenatide and why these drugs may be prescribed together. Describe factors to be considered when administering each of these drugs.

Question 3:

Mrs Alensi returned to the ward 1 hour ago following a Left sided total knee replacement. She has a morphine infusion running at 1mg/hour for pain relief. 30 minutes ago her BP was 115/75 and her respirations were 16. You have just checked again and now her BP is 85/55 and her respirations are 10.

Describe what actions you would take and medications you anticipate administering and provide rationale.

Question 4:

Miss Josepovic (80 year old) was admitted yesterday following a fall at home. She did not sustain any serious injury but has been kept in for monitoring, medication review and further investigations. Her past medical history is:, Congestive Heart Failure (CHF), mild renal impairment, hypertension, type 2 diabetes. Since admission she has been diagnosed with Atrial Fibrillation (AF) Her medications are: Enalapril 10mg daily, Metformin 1g BD, Paracetamol 1g prn (max dose 4g in 24hors). She has commenced Dabigatran 150mg BD, Metoprolol 50mg BD.

Outline the mechanism of action of Dabigatran and Metoprolol and explain the rationale for commencing Miss Josepovic on these drugs.

Question 5:

Ward 8E is a rehabilitation unit with 25 beds. In order to encourage independence all patients eat their breakfast in a communal dining area. The very small medication room is situated at the other end of the ward and is approximately 30 metres from the dining area – all patient medications are kept here. The ward will be introducing an electronic drug chart next year, but currently paper based charts are still used and are kept at the end of each patient’s bed. Patients are dispensed their morning medications while they eat breakfast in the dining room.

Describe how medication errors may occur from this arrangement.

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