NUR231 Jolene Case Study Sample

• Subject Code : NUR231
• University : University of Sunshine Coast My Assignment Services is not sponsored or endorsed by this college or university.
• Subject Name : Nursing

Drug Therapy

Ans 1- The terms mentioned in the study can be defines as follow:

• Tachycardia is a clinical condition which is characterized by an increased heart rate. The heart rate observed in patients having tachycardia is usually above 100 beats per minutes (Inoue 2018, pp.352-361).
• Tachypnea of the other hand is common medical terminology to define and increased and rapid breathing pattern in the patient. In this condition the respiratory rate is usually measured more than 20 breaths per minute (Aiosa 2019, pp.1272-1275).
• Angina is also commonly known as chest pain. The patient might experience a pressure like sensation on the chest cavity. It is brought about by decreased oxygenated blood supply to the heart muscles (Ong 2018, pp.16-20).
• Hypertension is a condition where there is an increased blood pressure in the arteries. Patient in stressful condition might experience anxiety which tends to rise in the blood pressure drastically. The blood pressure readings in hypertensive cases can be observed to be more than 140/90 mm Hg. This can also be brought about by panic attack experienced by the individual.
• Tremors can be defined as an involuntary contractions and relaxation of the body. It can range from a mild to severe intensity episode.
• Palpitations can be referred as experience of rapid beating of the heart felt by the patient. It can also be accompanied with severe breathlessness and chest heaviness.

Ans 2- The nursing interventions can be based in accordance with the symptoms of Jolene. Patient can be managed by both medical management as well as conservative management. For helping the patient with her stress and anxiety she can be asked to perform deep breathing exercises. This will be helpful in promoting overall relaxation and will also be helpful for her symptoms of hypertension, tachycardia, tachyponea and palpitations. For medical management the patient can be treated with Primidone. This is a muscles relaxant and will be helpful in providing the patient with a sense of relief. The drug class of ACE inhibitors can be provided to manage with the hypertensive status of the patient (Gitt 2016, pp.56-62). Nitro-glycerine can be the drug choice for managing her angina. Cordarone can be given to stabilize her tachycardia (Robinson 2019, pp. 376-384). Patient can also be provided salbutamol for respiratory relief as she is having an underlying history of Asthma as well.

Ans 3- The main mechanism of asthma is by the root cause of development of hypersentivity of the lung passages. Asthma mainly involves inflammation of the air passages which causes a severe obstruction in the air flow. This restriction them causes airway hyper responsiveness. The recurrent inflammation of the airway passages the causes a bronchoconstriction. Patient is also having a history of hypertension, this can be seen as an underlying factor leading to airway inflammation as well (King 2018, pp. 262-271). Tachycardia might also have been developed in the patient due to excessive use of accessory muscles. Asthma therefore, impacts the overall functioning of the body as it causes a restrictive oxygenation throughout the body.

This causes the body to tire out from additional work of breathing. Patient is currently taking three medication for management of her asthmatic status. These drugs are inclusive of Ventolin, Serevent and Atrovent. Atrovent is mainly used to manage the bronchospasm caused by asthma (George 2017, pp.39-41). Ventolin is another choice of drug used for the same purpose, the only difference being that it is used for reversible obstructive airway diseases. There can be underlying reaction that can occur between two drugs, namely, Atrovent and Ventolin. Ventolin also has multiple side effects including muscle pain and tremors. As the patient is currently facing tremors, she should be discontinued with this drug immediately. The side effects of Atrovent drug mainly include dizziness, back pain, headache and so on. In the given case study however, the patient is not having any of these side effects, therefore, she can be continued with this medication.

Ans 4- The three drugs taken by the patient to manage her asthma include the following:

• Serevent- It’s generic name is salmeterol. It is also a long acting beta 2- adrenoceptor agonist (Spahn 2018, pp.428-433). It mainly works by helping in relaxing the muscles around the airways of the lungs and thus, enhancing the breathing pattern. It is also indicated in averting exercise induced bronchospasm in asthmatic patients.
• Atrovent- It is a common bronchodilator used for patients having asthma. It has lesser number of side effects as compared with Ventolin drug. It helps by relaxing the narrow lung passages and thus promoting the distribution of the drug to the lower air passages.
• Ventolin- It is also known as salbutamol. It is beta-adrenergic medicine which is helpful in providing for immediate relief for the patient. Its main objective is to help the patient with their breathlessness. It is helpful in providing an instant relief to the patient and promoting a sense of relaxation in the acute symptoms (Anderson 2018, pp.419-430). It is the most preferred choice of drug due to least number of adverse effects on patient. It is also helpful as a conservative part of treatment management for the patient.

Ans 5- Grave’s disease is a disorder of the immune system that leads to the development of patient having hypothyroidism. The thyroid glands produce excessive hormones (Haider 2017, pp.994-1000). It is an auto-immune condition which can be observed to be marked with weight loss, tremor, anxiety and goiter in patient. This condition is also observed more commonly in women than in men. The patient in our case study can therefore, be observed to be having tremors and palpitation. This can also be an underlying cause of hyper stimulation of the thyroid gland, due to underlying Grave’s disease. There are chronic flare ups also observed in patients having this disease, as observed in our given scenario.

Ans 6- Anti-thyroid drug treatment is the best optimal approach in cases of Grave’s disease. These medications help in ensuring the destruction of the antibodies of thyroid (Cooper 2019, pp.230-233). It also make sure the remission of the diseased condition is attained. Iodine therapy is another form of anti-thyroid therapy can be used to destroy the antibodies, giving rise and promotion to hypothyroidism in the patient. This treatment therapy is also helpful in reducing the production of the thyroid hormone being produced in excessive amounts. This is helpful in balancing the thyroid hormone production. Antithyroid drugs also help in blocking the coupling reaction of monoiodotyrosine and diiodotyrosine, which is helpful in delaying the synthesis of thyroid hormone all together, thus, providing the patient with symptomatic relief (Schellack 2018, pp.25-31).

Ans 7- The treatment of anti-thyroid drugs is mainly given to reduce the secretion and production of the thyroid hormone. This however, can be found to have a negative impact on the other parts of the body. The impact can be observed most commonly in the form of an allergic reaction. These reactions can be observed in the form of skin rashes, fever, and burning sensation while peeing and so on. These are some of the symptoms observed in the patients who are on anti-thyroid medication management. The patient is being managed with a combination of the beta-blockers and anti-thyroid drugs. This is an effective and fruitful method of management as the use of beta-blockers will be able to bring about a state of hyper metabolism in the patient (Brito 2016, pp. 1144-1145). This method of medical management can be useful for treating both Grave’s disease and Goiter of the patient. The primary choice of drug will still remain anti-thyroid drug as the patient’s primary diagnosis is Grave’s disease.

Ans 8- Hyperthyroidism is a critical condition to be managed during pregnancy. The drugs namely Carbimazole and Methimazole, both are helpful in controlling the Grave’s disease condition (Okosieme 2016, pp. 2005-2017). However, both of these medications are also bound to have side-effects. These drugs can be harmful to the unborn child by increasing the chances of causing congenital abnormality and hepatotoxicity in the patient. Propylthiouracil is another anti-thyroid drug that can bring about birth defects in the child (Korevaar 2018, pp. 328-329). Hyperthyroidism is also been observed to cause still birth as well as pre-term abortions in the child bearing women. The patient’s main priority is having her Grave’s disease controlled for now.

Continuing with her pregnancy along with medical management of anti-thyroid drug therapy can be harmful for both her as well as her child. Even if the delivery is a success, the child still have a grave chances of developing one or the other congenital birth defect. These abnormalities can also impact the quality of life of the child born with the same. Therefore, all of these underlying risk factors should be closely examined before planning a child. Both the mother and the child will be the bearer of the repercussions of the adversities that might be caused due to the extreme side effects of taking anti-thyroid medications.

References for Drug Therapy

Aiosa, N.M., Laux, J., Rojas, O., Bennett, R.S., Logue, J., Lee, J.H., Bollinger, L., Byrum, R., Claire, M.S. and Feuerstein, I.M. 2019. Acute transient tachypnea following gadoxetate administration in a rhesus macaque during contrast-enhanced magnetic resonance imaging. Radiology Case Reports, 14(10), pp.1272-1275.

Anderson, G., Johnson, N., Mulgirigama, A. and Aggarwal, B. 2018. Use of spacers for patients treated with pressurized metered dose inhalers: focus on the VENTOLIN™ Mini Spacer. Expert Opinion on Drug Delivery, 15(4), pp.419-430.

Brito, J.P., Schilz, S., Singh Ospina, N., Rodriguez-Gutierrez, R., Maraka, S., Sangaralingham, L.R. and Montori, V.M. 2016. Antithyroid drugs—the most common treatment for Graves' disease in the United States: a nationwide population-based study. Thyroid, 26(8), pp.1144-1145.

Cooper, D.S. 2019. Long-Term Antithyroid Drug Treatment of Patients with Graves’ Disease. Clinical Thyroidology, 31(6), pp.230-233.

George, M., Joshi, S.V., Concepcion, E. and Lee, H. 2017. Paradoxical bronchospasm from benzalkonium chloride (BAC) preservative in albuterol nebulizer solution in a patient with acute severe asthma. A case report and literature review of airway effects of BAC. Respiratory Medicine Case Reports, 21, pp.39-41.

Gitt, A.K., Bramlage, P., Potthoff, S.A., Baumgart, P., Mahfoud, F., Buhck, H., Ehmen, M., Ouarrak, T., Senges, J. and Schmieder, R.E. 2016. Azilsartan compared to ACE inhibitors in anti-hypertensive therapy: one-year outcomes of the observational EARLY registry. BMC Cardiovascular Disorders, 16(1), p.56-62.

Haider, U., Richards, P. and Gianoukakis, A.G. 2017. Thymic hyperplasia associated with Graves' disease: pathophysiology and proposed management algorithm. Thyroid, 27(8), pp.994-1000.

Inoue, A., Hifumi, T., Kuroda, Y., Nishimoto, N., Kawakita, K., Yamashita, S., Oda, Y., Dohi, K., Kobata, H., Suehiro, E. and Maekawa, T. 2018. Mild decrease in heart rate during early phase of targeted temperature management following tachycardia on admission is

associated with unfavorable neurological outcomes after severe traumatic brain injury: a post hoc analysis of a multicenter randomized controlled trial. Critical Care, 22(1), p.352-361.

King, G.G., James, A., Harkness, L. and Wark, P.A. 2018. Pathophysiology of severe asthma: We’ve only just started. Respirology, 23(3), pp.262-271.

Korevaar, T.I. and Peeters, R.P. 2018. Antithyroid drugs and congenital malformations. Nature Reviews Endocrinology, 14(6), pp.328-329.

Okosieme, O.E. and Lazarus, J.H. 2016. Current trends in antithyroid drug treatment of Graves’ disease. Expert Opinion on Pharmacotherapy, 17(15), pp.2005-2017.

Ong, P., Camici, P.G., Beltrame, J.F., Crea, F., Shimokawa, H., Sechtem, U., Kaski, J.C., Merz, C.N.B. and Coronary Vasomotion Disorders International Study Group 2018. International standardization of diagnostic criteria for microvascular angina. International Journal of Cardiology, 250, pp.16-20.

Robinson, D., Hand, G., Ausman, J. and Hackett, A. 2019. Brugada pattern exposed with administration of amiodarone during emergent treatment of ventricular tachycardia. The American Journal of Emergency Medicine, 37(2), pp.376-384.

Schellack, G. and Schellack, N. 2018. An overview of thyroid disorders and their management. SA Pharmaceutical Journal, 85(2), pp.25-31.

Spahn, J.D. 2018. Combination inhaled glucocorticoid/long-acting beta-agonist safety: The long and winding road. Annals of Allergy, Asthma & Immunology, 121(4), pp.428-433.

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