HNN215: Quality Use of Medicines - Case Study Assessment Answers

Question one

Polypharmacy creates the incidence of various health complications caused by unfavorable medication interactions that lead to adverse effects in patients and especially the elderly (Cooper, 2011). Ms. Kruzwoski is a typical victim of overmedication and prolonged drug use which puts her at risk of developing certain complications. The first possible risk is the development of digestive tract complications due the reduced efficiency of physiological functions like reduced muscle capabilities responsible for swallowing, absorbing, distribution and elimination.

According to Gebhart (2001), non-steroidal anti-inflammatory drugs (NSAIDS) cause problems in the digestion tract like diarrhea, ulcers, constipation, bowel disease and stomach bleeding when used together with medications like aspirin and anticoagulants like Warfin like in the patient’s case or when they have prolonged use. The complications happen because such drug interaction, cause increased vulnerability of the stomach wall to gastric acid which may lead to erosion of the walls , causing the development of ulcers and even bleeding of the stomach walls (Gebhart, 2001). According to Hongoltz-Hetling (2013), aging can reduce GI motility and GI flow which in turn affects the gastric pH which aids in the absorption of drugs leading to problems like vomiting which can cause deficiency of sodium and potassium mineral found in the stomach.

The implication is that some drugs are either over absorbed or under absorbed (Fishman, Ballantyne, Rathmell, & Bonica,2010). With increasing age also, the body water content is reduced further reducing the ability of the body to absorb and distribute the drugs. Most of the patient’s drugs are used orally and can, therefore, release inflammatory substances that burn off the digestive lining causing problems of ulcers, epiglottis distress due to mucous wall damage and reflux which is the leading factor of heartburns in elderly women (Fishman, Ballantyne, Rathmell,& Bonica, 2010).

Another risk of the Polypharmacy by Ms. Kruzowski is that there are psychiatric risks. Most drug interactions especially between NSAIDS like Voltaren Rapid, anticoagulants like Warfarin and antibiotics like Augmenting, reduce the cognitive abilities of a patient and cause memory loss making them confused and may fall from time to time (Fishman, Ballantyne, Rathmell, & Bonica,2010). When Ms Krakowski tripped on her cat and fell, she was exhibiting the side effects of cognitive impairment and confusion which are caused by over-medication.

According to Gebhart (2001), the prolonged use of hypertension medication like in the patient case causes Gray matter atrophy which is the reduction of the neurological function found in the brain function that causes cognitive thinking and integrity. Grey matter is responsible for planning, organizing, thinking and controlling impulses. If destroyed or reduced a patient may not be able to store and process information quickly and may, therefore, find it difficult to make logical assessments and decisions. This confusion is the reason why the patient finds it hard to carry out her routine activities on her own since her brain processing power has been reduced (Yamada, Chen, Yamada, Fahs & Fukawa, 2006).

Another risk that the overmedication and prolonged use of some of the drugs may bring about is Kidney distress which leads to kidney failure. The effects on Ms Kruzwoski can already be observed by the high concentrated urea which is an indication that her renal functions are not efficient. Prolonged use of medicines that reduce hypertension and chronic pain has been proved to have a contribution to kidney failure and kidney stones.

Polypharmacy causes electrolyte imbalance and inhibits the function of the kidney to get rid of excess substances in the blood stream or causes toxicity to the kidney. The long term effect is total kidney failure. A case study research by Hongoltz-Hetling, (2013), stated that in a certain patient once the overused medication on blood pressure was eliminated, there was an improvement in the kidney function. Kidney health in Ms Kruzwoski should be managed proactively before further adverse effects. The chronic pain relievers like Panadol osteo and antibiotics like Erythromycin used by the patient also cause toxicity to the Kidney and impair its functionality.

Question two

To develop and manage a healthy pharmacotherapeutic plan for the elderly, it is paramount to study and understand their pharmacokinetics with regard to how different drugs are absorbed, metabolized, distributed and eliminated. A discerning analysis of the patient diagnosis, causes of patient problems and drug history should be the contributing factors for designing interventions so as to ensure patient safety (Hongoltz-Hetling, 2013). According to Gebhart (2001), pharmacological strategies to reduce effects of overmedication and prolonged use of medicine can be used to help Ms. Kruzwoski to overcome the side effects she is experiencing. First, she needs to be screened to find out the concentration of drugs in her system to prevent further damage and adverse effects to body organs.

Once she has been screened, the nurses can choose to do nothing or opt to pump out the drugs in order to regain the normal blood concentration and urine content. Some of the drugs that are performing the same function should be eliminated and the remaining ones if any should contain a right mix to avoid dangerous interactions. The nurse should initiate therapy to manage her blood pressure. Another technique to reduce adverse effects of medication can include the use of herbal drugs like the garlic capsules in manageable levels. The garlic capsule is a natural drug which aids in some functions including detoxifying the blood, improving the lung function, reducing blood pressure and also provides a variety of nutrients which are necessary for disease management.

The nurse should perform various assessments so as to determine which drugs to do away due to redundancy or lack of effectiveness. According to Stipp, (1994) the nurse should put together an analysis of all the drugs the patient has taken in her life and also identify the medications that do not interact well with the body. Using her clinical reasoning abilities the nurse should distinguish which ailments need medication and which ones can be managed naturally. For such drugs, she may choose to recommend non-pharmacological strategies to reduce disease effects.

There should be an in-depth examination of the patient so as to establish the various effects of prolonged medication and the interactions of different medicines caused by the use of too many drugs for too long (Stipp,1994). The nurse should also consider the pharmacological characteristics of the patient’s body due to age and determine the most effective methods of treatment for the patient (Fishman, Ballantyne, Rathmell,& Bonica,2010). The nurse should also recommend nonpharmacological treatment strategies like therapy, diet management, and regular exercise. Also for some of the pains the nurse can support the use of massage and music therapy instead of too many different types of NSAIDS and Opioids.

Patient education should be in depth and very clear since the patient's cognitive abilities are reduced. According to Stipp, (1994), the education part should be done with the presence of a close relative or personal nurse who can be in a position to monitor her application of the training. In the training plan, the patient should be taught on how to manage her diet and which foods she should avoid. The elderly people, for example, require a very high intake of proteins so as to replace the rapidly dying cells in their bodies. Also, her history with hypertension and thrombosis requires her to have a lot of vitamins, mineral, and low fat intake so as to enhance the cardiac functions and improve the function of blood vessels. The patient should be educated on the importance of regular exercise and also the various methods of exercising.

According to Stipp (1994), the exercise increases the rate of metabolism and also helps to develop the cardiac function which is a good way to manage hypertension and thrombosis. Workouts should include brain exercise like puzzle games to help regain the cognitive and memory abilities of the patient. Ms. Kruzwoski should get the education on the dangers of using multiple doctors for her treatment plans since most doctors will just recommend a new drug for everything without making an analysis of the medication history of the patient. The patient should also be educated on the need to avoid buying drugs over the counter since the pharmacists may only sell drugs to gain a profit yet it may not be the appropriate drug and can cause to kidney failure (Baltimore et al., 2014).

Question three

Paracetamol has the least side effects and is not addictive. According to (Stipp, 1994), benefits of regular analgesic include avoiding the need for oral administration and absorption which usually lead to gastro-intestinal complications. Also, some of the metabolic effects get avoided which could have caused an alteration of the electrolyte balance. Regular analgesic is the best alternative to the oral administration as it provides a more direct target access to the affected area meaning it is more efficient. According to Gebhart (2001), the method is very convenient regarding administration and also enhances the patient adherence and acceptance. The drug can be administered in small doses thus reducing risks of over-medication.

Question four

Warfarin is an anticoagulant which is taken to manage blood clotting (Fishman, Ballantyne, Rathmell, & Bonica, 2010).In Ms, Kruzwoski to manage her vein thrombosis. The Internationalized Normalized Ration (INR) test is a way of monitoring the effectiveness of medication by expressing the time taken to form a clot (Yamada, Chen, Yamada, Fahs & Fukawa, 2006) in a more standardized manner by comparing the results of different clinical tests to a scale (Gebhart 2001). It gets expressed as a whole number. According to Fishman, Ballantyne, Rathmell, & Bonica, (2010), the longer it takes for the blood to clot, the higher the INR and PT. The target INR is between 0.8 and 1.1, and a low rate shows that the blood is taking a shorter period to coagulate meaning there is a higher risk of blood clotting. If the INR test of the patient shows a quick coagulation, then it means that War fin is not the most effective method of treatment, and the doctor may recommend another form of medication.