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Nursing or professional caregiving always demands interdisciplinary skills among which critical thinking ability and knowledge has a major role. Identification of the clinical issue by analysing medical reports and data along with conduction of appropriate clinical intervention is needed. Pharmacological intervention is a major part of clinical intervention. In the provided case study, the nurse has to apply interdisciplinary skill regarding the management of the issue of heartburn.
As per the case study, a male patient with 45 years age has reported the issue of heartburn on evening time for 3weeks. As per the viewpoint of Richter and Rubenstein (2018), heartburn is invoked by acid reflux, in which the abdominal content is forced back into the esophageal region and invokes pain and burning sensation in the lower chest area. Moreover, Hunt et al. (2017) has further added in this context and mentioned that the occurrence of acid reflux more than two times a week on a regular basis is considered as GERD (gastroesophageal reflux disease). The case study has already mentioned that the patient is suffering from heartburn constantly in every evening for the last 3 weeks. Hence, from this angle, it can be diagnosed that GERD has developed. In this condition, backflow of stomach acid takes place which create immense discomfort and burning sensation in the lower chest region. On the contrary Ness-Jensen et al. (2016) has argued that the presence of injury in the mucus of the oesophageal region is associated with GERD and this invokes reflux of gastric content abnormally in oesophagus. No cardiac issue is associated with heartburn and this is entirely a gastrointestinal issue.
For the patient of the case study, this issue of GED has been reported in the time of his routine check-up. In the last 5 years the patient has been diagnosed with medical issues like hypertension and dyslipidaemia. As per the viewpoint of Kopin and Lowenstein (2017), dyslipidaemia is the medical condition in which the lipid content of blood gets increased which invokes clogging of arteries. Jacobson et al. (2015) has further added that the lipid content of blood includes the presence of HDL (high density lipoprotein), LDL (low density lipoprotein), VLDL (very low density lipoprotein), triglyceride and cholesterol as well. As per the case study, the patient has identified with a high level of the presence of lipids in the blood, in spite of intake of the drug Atorvastatin. The mentioned medicine has been prescribed for long term regular administration a bedtime for 5 years ago and the dosage was about 40 mg.
Atorvastatin is a very effective drug for the management of dyslipidemia and has been identified as the first line pharmacological intervention to manage the said issue. The application of this drug invokes reverse inhibition of HMG-CoA reductase (drugbank, 2020). The risk of dyslipidemia-induced CVD is highly managed with the administration of this drug. As per the medical report of AFP, the administration of first line therapy for dyslipidaemia is continued till the LDL level of the patient is 160 mg per DL. Hence, from this angle, it can be analysed that the administration of atorvastatin should be continued for the patient of the case study, routine check-up of lipid profile has revealed that the LDL level of the patient is 145 mg per DL which is uite higher than the safety range which is between 60 to 130 mg per DL. This is the rationale behind keeping the medicine of dyslipidaemia unaltered for the patient. The patient has been identified as overweight. As per the case study, the weight of the patient is about 113kg which is quite higher with respect to the age of the patient (45 years). However, As per the viewpoint of Clarke et al. (2016), the dosage of Atorvastatin is not associated with the body weight of the patient but is tagged with the level of baseline LDL of the patient. Individuals having the level of LDL between 150 to 159 mg per dl are generally treated with the titration of dosage of Atorvastatin between 20 to 40 mg. In this case, the patient is prescribed the oral intake of a 40mg tablet regularly. Hence, this is the rationale behind no alteration of the medicine and its dosage for the management of cholesterol, and lipid level of the patient. However, the other issues associated with the patient need to be managed like hypertension, creatinine level, the issue of being overweight and more. This will help the pain to get out from the housing issue of heartburn. GERD is often associated with hyperglycaemia. In this case, this aspect needed to be diagnosed in order to manage the acid reflux of the patient.
The discussion still has addressed the issue of dyslipidaemia and the management of the same issue for the patient. It has been identified that the medication of dyslipidaemia should be kept unaltered and rationale has been provided in the previous section of this study. However, the patient has the health issue of hypertension which is needed to be managed. The case study has revealed that the issue of hypertension has been identified 5 years back and the current BP reading has revealed that the patient has 150/92 Hgmm. The normal BP of an individual is within the range of less than or same as 120/90 (Ochiai et al. 2015). However, as per the research paper of Böhm et al. (2018), systolic pressure above 140 is considered as stage 2 hypertension and treatment is needed for the same. Hence, the application of angiotensin is needed. As perthe case study, the administration of losartan has been done for long term in the dosage of 100mg. The medical research proves that losartan is type II angiotensin receptor blocker and acts just like other ACE blocker but has the action of ARB (drugbank, 2020). It has further been identified that the administration of losartan with the combination of Hydrochlorothiazide helps in the minimisation of the risk of cardiac stroke for the patient with the complication of hypertension. In this case, the family history of the patient has revealed that the mother of the patient has hypertension and the brother of the patient has faced a mild cardiac attack and has the complication of hypertension. Hence, there is a family trend of hypertension in the family tree of the patient. This is needed to be handled with care to safeguard the patient from the occurrence of CVD. In this case, losartan administration should be altered with other drug molecules to manage the issue of hypertension. The administration of metoprolol as the effective drug molecule can be considered in the pharmacological intervention of nursing to manage the issue of hypertension of the patient. As per the medical research regarding drug molecule, Metoprolol acts as a beta blocker-1 and helps in the management of hypertension and prevents the patient from cardiac failure (drugbank, 2020). The heart rate and cardiac output of the patient can also be managed with the administration of metoprolol as it minimises cardiac rate .
However, the administration of Hydrochlorothiazide should be continued as the patient has a low level of renal output. This invokes accumulation of fluid in the body causing the enhancement of the body weight. As per the case study, it has been identified that creatinine level of the patient is quite high which is about 1.3 mg per dl and should be within 1.2 mg per dl (border line). Hence, from this data , it can be analysed that the patient has the issue in the renal output. Triamterene can be administered to expel out the excess fluid or water deposition in the body of the patient (Karimi et al. 2019). This will help the patient to get out of the burden of being overweight. Additionally, a low protein diet should be prescribed to the patient who will help to safeguard the health of the kidney of the patient.
The HbA1C test has been conducted to the patient who has shown that the patient has the complication of hyperglycaemia. The issue of hyperglycaemia has been noticed for the mother of the patient . The issue of hyperglycaemia is transmitted in the gene line and it is often identified as gene linked disease. Hence, this should be managed with the administration of specific drug molecules of adult diabetes. As per the viewpoint of Madiraju et al. (2018), metformin is one of the primary levels of treatment to minimise the issue of hyperglycaemia in the body of the patient and the dosage is treated as per the glucose level in the body. In this case, the dosage should be titrated as 75 mg for the patient to manage the issue of HbA1C. However, often metformin is prevented for the patient who has renal complications. In that case, the patient has to depend on the lifestyle modification and performance of physical exercise to manage the issue.
Böhm, M., Schumacher, H., Teo, K.K., Lonn, E., Mahfoud, F., Mann, J.F., Mancia, G., Redon, J., Schmieder, R., Weber, M. and Sliwa, K., 2018. Achieved diastolic blood pressure and pulse pressure at target systolic blood pressure (120–140 mmHg) and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. European heart journal, 39(33), pp.3105-3114.
Clarke, A.T., Johnson, P.C., Hall, G.C., Ford, I. and Mills, P.R., 2016. High dose atorvastatin associated with increased risk of significant hepatotoxicity in comparison to simvastatin in UK GPRD cohort. Plos one, 11(3), p.e0151587.
drugbank, 2020, Atorvastatin. [online] Available at: <https://go.drugbank.com/drugs/DB01076> [Accessed on 27 September 2020]
drugbank, 2020, Losartan. [online] Available at: <https://go.drugbank.com/drugs/DB00678> [Accessed on 27 September 2020]
drugbank, 2020, Metoprolol. [online] Available at: <https://go.drugbank.com/drugs/DB00264> [Accessed on 27 September 2020]
Hunt, R., Armstrong, D., Katelaris, P., Afihene, M., Bane, A., Bhatia, S., Chen, M.H., Choi, M.G., Melo, A.C., Fock, K.M. and Ford, A., 2017. World gastroenterology organisation global guidelines: GERD global perspective on gastroesophageal reflux disease. Journal of clinical gastroenterology, 51(6), pp.467-478.
Jacobson, T.A., Ito, M.K., Maki, K.C., Orringer, C.E., Bays, H.E., Jones, P.H., McKenney, J.M., Grundy, S.M., Gill, E.A., Wild, R.A. and Wilson, D.P., 2015. National lipid association recommendations for patient-centered management of dyslipidemia: part 1—full report. Journal of clinical lipidology, 9(2), pp.129-169.
Karimi, R., Gholivand, M.B. and Amiri, M., 2019. Monitoring of triamterene and hydrochlorothiazide at carbonic materials modified electrode. Journal of Electroanalytical Chemistry, 847, p.113176.
Kopin, L. and Lowenstein, C.J., 2017. Dyslipidemia. Annals of internal medicine, 167(11), pp.ITC81-ITC96.
Madiraju, A.K., Qiu, Y., Perry, R.J., Rahimi, Y., Zhang, X.M., Zhang, D., Camporez, J.P.G., Cline, G.W., Butrico, G.M., Kemp, B.E. and Casals, G., 2018. Metformin inhibits gluconeogenesis via a redox-dependent mechanism in vivo. Nature medicine, 24(9), pp.1384-1394.
Ness-Jensen, E., Hveem, K., El-Serag, H. and Lagergren, J., 2016. Lifestyle intervention in gastroesophageal reflux disease. Clinical gastroenterology and hepatology, 14(2), pp.175-182.
Ochiai, H., Ikei, H., Song, C., Kobayashi, M., Takamatsu, A., Miura, T., Kagawa, T., Li, Q., Kumeda, S., Imai, M. and Miyazaki, Y., 2015. Physiological and psychological effects of forest therapy on middle-aged males with high-normal blood pressure. International journal of environmental research and public health, 12(3), pp.2532-2542.
Richter, J.E. and Rubenstein, J.H., 2018. Presentation and epidemiology of gastroesophageal reflux disease. Gastroenterology, 154(2), pp.267-276.
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