Drug Therapy

Introduction to Drug Therapy

The case study is based on Jolene who has a history of Asthma and Graves’s disease. Currently she is being managed for her depression and post-operative management for compound fracture of tibia and fibula and a blunt force trauma to head after meeting with a motor bike incident. Post 3 months of her surgery she was admitted to the emergency care unit with a complaint of chest pain and dyspnoea. She was diagnosed with DVT and pulmonary embolus. She also had an episode of tonic-clonic seizures for which she was prescribed medication. She is currently in a depressive state due her ongoing prolonged treatment. The case study will help in identifying the drug interaction and the best possible nursing intervention for the patient.

Pathophysiology

Patient is having severe pain in legs. It is very common to have pain surgery even post full recovery. Pain persists as the tissues take a longer duration to heal and as in the given case scenario she was having compound fracture, she is liable to have a severe intensity pain (Olapour 2017, pp.25-29). The patient had compound fracture as was surgically managed with fixing plates and screws. Complicated surgeries like these requires prolonged bed rest for the patient. Due to prolonged inactivity there is a decreased blood flow to the body as well as there is a hampered back flow of blood. Due to this underlying cause the blood tends to pool in the extremities. This leads to clot formation, especially in the deep veins of the leg. This is also known as the deep vein thrombosis (Kapoor 2016, pp. 220-224).

The condition can worsen with low physical activity which brings about reduced back pumping of the blood to the hearts vessels. This clot might get dislodged on mild movement and can get deposited in any of the major artery through the means of blood stream. The most common site of clot deposition is lung or brain. This could have been an underlying factor attributing to the development of pulmonary embolus in the patient. Pulmonary embolus is mainly a type venous thromboembolism that is found to travel from legs to the upward directions of lungs (Di Nisio 2016, pp. 3060-3073).

This on accumulation in the heart vessels might put an additional constrain on the heart to work harder than the normal anticipated functional capacity, in order to compensate for the inadequate circulation in the body as a whole. This over compensation can also sometime mimic a heart pain or congestion like symptoms, as clinically represented in the case study. Head injury is the most common mechanism to initiate the development of seizures in a patient. The chances of development of seizures are greater with the traumatic injuries having a much greater impact (Mahler 2018, pp.779-789).

Trauma is one of the main underlying factor for causing tonic clonic seizures. It is a medical condition which can be life threatening only if it has a re-occurrence. As the patient was diagnosed with traumatic epilepsy, this can be one of the main reason for her to having seizures. Depression can be observed in patient that have prolonged treatment management. The primary choice of treatment method is medication for such patients. Jolene is having limited support from her family as well as in terms of financial aid. These can be seen as the predisposing factors of her developing depression. Due to her lack of interaction she is in a depressive state of mind. This is one of the psychological factor contributing to the formulation of depressive state of mind in patients.

Medication

The patient is currently being managed with anti-coagulant drugs. Anticoagulant drugs can be used for both initial as well as for long term treatment purpose. It is mainly given to reduce the reoccurrence of the symptoms as well as for reducing the mortality in the patient. Presence of embolus in the circulatory system can be very fatal for the patient. It can lead to development of left ventricular failure as well. The use of anticoagulation therapy will help in resolution of the clots and will also help in thinning the blood. This will be helpful in lowering the tendency of the blood to form clot. This therapy however, can be harmful for Jolene as she is pregnant. However, studies have shown that pregnant females can be given heparin as it does not crosses over the placenta (Neki 2019, pp.550-558).

This will be helpful in managing both the pregnancy as well as the associated cardiovascular risks to the patients. However the patient has only had one episode of tonic-clonic seizures, she is still being managed on anti-epileptic drugs. These drugs help in blocking the neurotransmitter release. This brings about an inhibition in the excitatory receptors that are responsible for calcium channels activation. This helps in preventing any further episode of epilepsy. These medications are however, harmful for pregnant females as they are found to cause certain birth and neural tube defects in the baby (Veroniki 2017, pp.1-20). The potential risk is the highest, especially in the early stages of pregnancy and thus, it should be avoided to be given to the patient.

The medication can be discontinued as Jolene only had one mild episode and that was also observed in quite later months post her motorbike accident. Anti-depressants are also useful drugs for management of people with depression. Jolene is having a long-going depression due to her slow progress and thus, she is being given this medical management. These drugs helps the patient by increasing the serotonin production but by reducing its uptake and reabsorption by multiple folds. This helps in increasing the level of serotonin at the level of synaptic cleft and making it freely available to bind with the postsynaptic membrane (Zanos 2018, pp.197-227).

This helps in providing the patient with a sense of relief and calmness. Although most of the selective serotonin reuptake inhibitors are considered a safe medication, they are also found to cause birth defects in pregnant ladies. Therefore, a strong medication reconciliation is needed in Jolene’s case in order to avoid any potential risk to Jolene and her child. Medication reconciliation will be helpful in discontinuing medication that can be a potential risks to her pregnancy. It is will also be helpful in providing the patient with the required medication with regularized potencies, keeping a close consideration to the pregnant status of Jolene.

Nursing Interventions

The nursing care consideration for the case study can be as follow-

  • Pain management- The patient can be helped with small doses of pain medication to help him ease with his pain. Patient can be taught to make use of the deep breathing exercises, whenever he tries to ambulate. Use of modalities such as heating pad/ice packs can be provided at the surgical site to ease with the discomfort. The patient can also be advised to massage the margins of surgical site with oil. This will help in reducing the stiffness around the surgical site and will thus, be helpful in easing the pain (Drake 2017, pp. 3-15). Patient can also be made to do some bed exercises which will be helpful in reducing the stiffness and will help in enhancing the range of motion of the joint.
  • Physical activity- It is important to maintain the physical activity status in the patient. The patient is at a high risk due to pulmonary embolus. The physical activity inclusion will be helpful in reducing the associated cardiovascular risks. Engaging in exercises will also be helpful for the patient in managing her depression. The exercises have to of low intensity. Cardiovascular exercises including swimming can be inculcated in daily routine as it will be helpful in benefiting the patient, as it will be requiring less efforts from the patient end.
  • Diet management- The patient can be helped by working in close coordination with the dietician, in order to provide her with a customized diet plan. This can be formulated keeping a close consideration for her pregnancy as well as for her cardiovascular risk. Maintaining a good physical health status will be beneficial for the patient in attaining a good mental health status as well. Well balanced diet plan will also be helpful in managing her heart condition and will help in promotion of blood circulation in the body (Lamminpää 2018, pp.1721-1736).
  • Pregnancy management- Jolene is in her first trimester. She can be counselled about her dietary management and her vitamins and supplements uptake. Nurse can help Jolene set up with a gynecologist, in order to get a detail of her health as well as her baby’s health. She can be taught about the various precautions she should be taking in order to manage her child as well. The nurse can also work in close coordination with Jolene and her gynecologist to keep a constant monitoring on her overall health status.
  • Medication reconciliation- The patient is on multiple medication for pain, managing pulmonary embolus, seizures and so on. These medication are bound to interact with the patient’s ongoing pregnancy. There is a dire need of medication reconciliation for the patient, so as to remove some of the drug that might pose a threat to her pregnancy (Mekonnen 2016, pp.128-144). The patient should be helped with more introduction of conservative management approaches.
  • Counselling- Patient is observed to be depressed in the given scenario. She can be provided with counselling for the same. Patient can be enrolled in group sessions which will help her share her grief and sorrow she might be pilling up inside. She can be provide with the help of music therapy, which will distract her from her ongoing turmoil and will help in subsiding her thoughts. He will also help in giving a sense of calmness and re-assurance to the patient.
  • Financial aid- Jolene can be set up for a small job, which will be helpful for her to compensate for the financial constrains she might be facing as the farm is not doing so well. Nurses can work with the help of liaison officers, to provide her with job requiring minimum skills and yet providing her with a source of income (Hassan 2018, pp.125-139).
  • Patient and family education- Patient can be counselled in front of her family to provide her with all the details regarding her ongoing status. She and the family can also be taught as to what all options they have to themselves, which can be helpful in assisting Jolene in overcoming her given situation (Shereda, 2019). The family can also be asked to be an integral part of the counselling sessions set up for Jolene and they can provide with the required physical and emotional comfort during her transition of care.

Conclusion on Drug Therapy

Nursing care is the most important intervention in the management of the patient care and coordination. This is important from the point of view of collecting all of the important clues and information regarding the patient and drafting a comprehensive care plan for them. It is also important to provide the patient with a holistic care model approach to target all of his medical needs and requirements. Nurses can work in close collaboration with the healthcare professional as a part of the multidisciplinary team, to provide the patient with care and support as deemed by them. This will help the patient in overcoming all of her short comings in terms of her physical and mental health and will be helpful in attaining an independent functional status for the patient.

References for Drug Therapy

Di Nisio, M., van Es, N. and Büller, H.R. 2016. Deep vein thrombosis and pulmonary embolism. The Lancet, 388(10063), pp.3060-3073.

Drake, G. and Williams, A.C.D.C. 2017. Nursing education interventions for managing acute pain in hospital settings: a systematic review of clinical outcomes and teaching methods. Pain Management Nursing, 18(1), pp.3-15.

Hassan, G.A. and Ibrahim, H.S. 2018. The effect of supportive nursing intervention on the burden and coping strategies of caregivers of children with cancer. Journal of Nursing Education and Practice, 8(7), pp.125-129.

Kapoor, C.S., Mehta, A.K., Patel, K. and Golwala, P.P. 2016. Prevalence of deep vein thrombosis in patients with lower limb trauma. Journal of Clinical Orthopaedics and Trauma, 7, pp.220-224.

Lamminpää, R., Vehviläinen-Julkunen, K. and Schwab, U. 2018. A systematic review of dietary interventions for gestational weight gain and gestational diabetes in overweight and obese pregnant women. European Journal of Nutrition, 57(5), pp.1721-1736.

Mahler, B., Carlsson, S., Andersson, T. and Tomson, T. 2018. Risk for injuries and accidents in epilepsy: a prospective population-based cohort study. Neurology, 90(9), pp.779-789.

Mekonnen, A.B., McLachlan, A.J. and Brien, J.A.E. 2016. Pharmacy‐led medication reconciliation programmes at hospital transitions: a systematic review and meta‐analysis. Journal of Clinical Pharmacy and Therapeutics, 41(2), pp.128-144.

Neki, R., Mitsuguro, M., Okamoto, A., Ida, K., Miyoshi, T., Kamiya, C., Iwanaga, N., Miyata, T. and Yoshimatsu, J. 2019. A less-intensive anticoagulation protocol of therapeutic unfractionated heparin administration for pregnant patients. International Journal of Hematology, 110(5), pp.550-558.

Olapour, A.R., Mohtadi, A.R., Soltanzadeh, M., Ghomeishi, A., Akhondzadeh, R. and Jafari, M. 2017. The effect of intravenous magnesium sulfate versus intravenous sufentanil on the duration of analgesia and postoperative pain in patients with Tibia fracture. Anesthesiology and Pain Medicine, 7(2), pp.25-29.

Shereda, H.M.A., Shattla, S.I., Amer, H.M. and Kasemy, Z.A.A. 2019. The effectiveness of a psycho-educational nursing intervention on illness perception, knowledge and expressed emotion of caregivers of patients with first episode psychosis. Journal of Nursing Education and Practice, 9(7). pp. 102-115.

Veroniki, A.A., Cogo, E., Rios, P., Straus, S.E., Finkelstein, Y., Kealey, R., Reynen, E., Soobiah, C., Thavorn, K., Hutton, B. and Hemmelgarn, B.R. 2017. Comparative safety of anti-epileptic drugs during pregnancy: a systematic review and network meta-analysis of congenital malformations and prenatal outcomes. BMC Medicine, 15(1), pp.1-20.

Zanos, P., Thompson, S.M., Duman, R.S., Zarate, C.A. and Gould, T.D. 2018. Convergent mechanisms underlying rapid antidepressant action. CNS Drugs, 32(3), pp.197-227.

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