Mr. Hodges has a previous history of high blood pressure and high cholesterol. His rapid heart rate, extreme exhaustion, and chest pain led to his hospitalization. An ECG is taken, revealing a rapid ventricular reaction associated with AF with RVR. Thyroid function assays and troponin levels are normal, serum potassium is 3.1 mmol/L and magnesium is 0.65 mmol/L. From this, it can be concluded that he has paroxysmal AF.

Common risk factors for developing atrial fibrillation

Heart disease.
High BP
Obesity
Age
Thyroid disease

The necessity to treat AF with anti-arrhythmic and anticoagulant

The chance of stroke due to an ischemic attack, along with other embolic issues, can be reduced in most patients with AF by taking long-term oral anticoagulation. When it comes to anticoagulation, the benefit typically outweighs the increased chance of bleeding for the vast majority of patients. The use of anti-arrhythmic drugs has emerged as a means to cut down on deaths and illnesses caused by atrial fibrillation.

Q2.

A. Amiodarone’s mechanism of action

During the third period of the cardiac action potential, potassium currents are blocked, preventing the heart muscle from repolarizing. Therefore, amiodarone lengthens the time it takes for heart cells to generate an action potential and an effective refractory period. (myocytes). As a result, the excitability of cardiac muscle cells is decreased, which helps avoid and treat abnormal heart rhythms.

B. The necessity of thyroid function test while on amiodarone

When an individual takes amiodarone, T4 and T3 are prevented from accessing the organs of the periphery. The cytotoxic effects of amiodarone and its primary constituent can have a direct impact on thyroid cells called thyrocytes or thyroid follicular cells, which can lead to a condition known as destructive thyroiditis (Barrett et al., 2019).

C. The rationale for treating an AF patient with a focus on reestablishing normal levels of two ions

He with atrial fibrillation may experience less need for antiarrhythmic medication and fewer adverse effects if potassium and magnesium can be restored.

Process information

Q3. a. The reason behind the drugs digoxin and amiodarone was not given together

When Mr. Hodges developed AF with RVR, the team discussed whether to treat it with digoxin or amiodarone. There is an increased risk of death when treating atrial fibrillation with digoxin and amiodarone in combination. The risk of dying from cardiovascular causes other than arrhythmia and stroke was also increased in individuals given this combination. That's why Mr. Hodges didn't get both of those medications at once (Adenin and Hasani, 2023).

B. Possible cause of Mr. Hodges' lightheaded symptoms

This is typically a symptom of bradycardia or a slow heart rhythm. If amiodarone lowers the heart rate too much, this may occur.

The rationale for close cardiac and hemodynamic monitoring in amiodarone-infused patients

The pulse rate and blood pressure of patients taking amiodarone can be slowed. This medication has the potential to induce QT prolongation and other changes in his heart's rhythm. It could have severe side effects, including fainting.

C. One possible local complication from amiodarone infusion

It can cause phlebitis, which is the redness and swelling of a capillary that runs close to the skin's surface.

The way through which its occurrence can be minimized

By picking an appropriate vein, IV device, and safe method for placement.
By using blood-thinning medicine and anti-inflammatory medicines, it can be controlled.

D. The pharmacodynamics leading to bradycardia

Adrenaline and its hormone counterpart, epinephrine, are the targets of beta blockers like Bisoprolol. Beta-blockers reduce blood pressure by slowing the heartbeat and making it beat with less power (Mohamed Thayub et al., 2020). Blood flow is enhanced by beta blockers because they dilate blood vessels.

Bisoprolol is a type of medicine known as a beta-blocker. Bisoprolol modifies the cardiovascular system's response to specific nerve signals. It reduces blood pressure and makes it easier for the heart to circulate blood throughout the body. Mr. Hodges can face rebound hypertension and palpitations if bisoprolol is suddenly stopped. In addition, suddenly stopping treatment has been linked to new cases of myocardial infarction, angina pectoris, and ventricular arrhythmia, as well as the worsening of preexisting cases in some patients.

Identify problems/issues

Q4.

Reasons for replacing warfarin with dabigatran

On his third day in the hospital, Mr. Hodges told the other patients and staff that he had become a vegetarian after being diagnosed with hypertension and that he particularly liked eating a variety of green, leafy veggies at every meal. A broad variety of leafy green vegetables are rich sources of vitamin K because of their green color and foliage. Vitamin K has the opposite impact on the body as the blood thinner warfarin. Consuming these vegetables has the potential to modify the anticoagulant effects of the medication warfarin. Without vitamin K, the formation of blood clots is impossible. Warfarin, on the other hand, is capable of preventing the clotting of blood by working against the effects that vitamin K has. On the other hand, if he consumes these vegetables, the beneficial effects of the medication might be canceled. Because of this, the specialist who treats his heart condition prescribed dabigatran rather than the blood thinner warfarin (Catterall et al., 2020).

Evaluate outcomes

Q5. Three pieces of important information for Mr. Hodges’ education about long-term anticoagulation therapy of dabigatran (Pradaxa) 110 mg bd

The most common adverse reactions, how to treat them if they occur, what to do to prevent or reduce their severity of them, and when to see a doctor if they do occur.
The route of administration, the dosage form, the quantity, the total number of treatments, and the overall amount of time all need to be taken into consideration.
Not only do the instructions cover the process of producing the medication, but they also cover how the patient should administer the medication to themselves.

Q6.

Atorvastatin and citrus juice interaction

If one takes atorvastatin with grapefruit juice, one's blood levels will increase by approximately 80 percent. While taking simvastatin, drinking grapefruit juice may cause blood levels to rise and may also increase the probability of experiencing adverse effects. Grapefruit juice has been shown to interact with atorvastatin if consumed in large quantities (over 1.2 liters daily), but it is generally considered to be safe if consumed in moderation (Petric et al., 2020).

Associated risks for interaction between grapefruit juice and atorvastatin

When grapefruit juice is combined with atorvastatin, the potential for adverse effects such as muscle irritation, joint pain, and even rhabdomyolysis is increased.

Q7. Method for gauging Mr. Hodges' knowledge

If the nurse and the rest of the medical staff can learn to explain things to Mr. Hodge in terms that he can understand, then he will be more likely to follow their recommendations for the care that he should receive. Using his body as a means of conveying information about his illness is highly effective. If he doesn't comprehend what the nurse is saying, she'll lose him when she starts giving a detailed description of his injuries or the treatment she plans to give him. The patient will have a much easier time understanding the nurse if they can visually follow along as they discuss various areas of the body using either their own body or the nurse's. The nurse can use medical terminology if he likes; just make sure to gesture to the relevant body parts so the patient understands. Help them prepare for what to anticipate and gain insight into their condition by pointing out its location.

Section 2: Applying the ACSQHC medicine Safety Standards and Quality Use of Medicines principles to safe medicine practice

According to the original information, which is usually used in Australia, it was APINCH. According to the National Safety and Quality Health Service (NSQHS) as well as standards on medication safety, it is necessary to have a health service that helps to identify the HRMs that are usually used within the organization and also helps to take appropriate steps that help to ensure that they are safely stored, well prescribed, and also to have an administration safety measure (Nguyen et al., 2022). According to the case study, when Mr. Hodge was finally discharged from the hospital, he was prescribed bisoprolol, dabigatran, perindopril, and atorvastatin, which according to APINCH are very appropriate medications is any patient is suffering from hypertension and hyperlipidemia. which Mr. Hodge was suffering from. Thus, according to ACSQHC and the quality use of medicine, they tried to give the right proportion of medications, along with the right amount of doses that were actually required. The Commission usually tries to improve the safety and quality of medications used in Australia. It also helps to lead and coordinate, usually with all kinds of initiatives that will later help to reduce medication errors and harm from medicines (Tarrant et al., 2022). It helps the health service organizations as well as the clinicians identify and implement strategies to improve medication safety.

Section 3: Application of ICN and/or NMBA nursing ethics, codes, and standards to guide the decision-making process and safe medicine practice

Taking excellent care of patients with the aid of proper care and administering the right amount of doses at the right moment figures into the decision-making of nurses and the various practices. Nurses can also play an important part in hospitals. Medication administration mistakes are possible. On the other hand, nurses play an essential role in ensuring that the administrative systems of the hospital and the treatment provided to patients run smoothly. During the course of a patient's stay in the hospital, the nurse's decision-making processes and their perspective of providing care for the patient may intersect, resulting in the acquisition of information that can be applied to the development of a number of different interventions. Because they work in a wide variety of complicated adaptive systems, nurses frequently deal with a high rate of change. Improving patient safety and lowering the rate of medication administration errors requires recognition of, and comprehension of, the cognitive burden and complicated interactions involved. An integral component of a nurse's medication administration safety strategies is knowing and involving the patient. (Alazzam et al., 2022). Mr. Hodge received the same high-quality treatment as before, and his blood was also tested by the nurses to help his doctors determine the best dosage for his medications. The nurses treated him gently and gently throughout their encounters with him.

Reference

Adenin, I. and Hasani, R.D.K., 2023. Multiple Direct Fetal Amiodarone Administration for Supraventricular Tachycardia with Hydrops Fetalis: A Case Report. European Heart Journal-Case Reports, p.ytad128. Available at https://academic.oup.com/ehjcr/advance-article-pdf/doi/10.1093/ehjcr/ytad128/49602633/ytad128.pdf
Alazzam, M.B., Tayyib, N., Alshawwa, S.Z. and Ahmed, M., 2022. Nursing care systematization with case-based reasoning and artificial intelligence. Journal of Healthcare Engineering, 2022. Available at https://www.hindawi.com/journals/jhe/2022/1959371/
Barrett, B., Hawkes, C.P., Isaza, A. and Bauer, A.J., 2019. The effects of amiodarone on thyroid function in pediatric and young adult patients. The Journal of Clinical Endocrinology & Metabolism, 104(11), pp.5540-5546. Available at https://academic.oup.com/jcem/article/104/11/5540/5540447
Catterall, F., Ames, P.R. and Isles, C., 2020. Warfarin in patients with mechanical heart valves. bmj, 371. Available at https://www.researchgate.net/profile/Chris-Isles/publication/346242823_Warfarin_in_patients_with_mechanical_heart_valves/links/5fc4e78c458515b7978a775a/Warfarin-in-patients-with-mechanical-heart-valves.pdf
Mohamed Thayub, S., Neena Priyamalar, E.M., Christan, M., Yadhukrishnan, P.U., Singh, S. and Cherian, K.M., 2020. Digoxin Induced Sinus Bradycardia Possible Drug Interaction with Amiodarone. Available at https://www.researchgate.net/profile/Daniel-Singh-5/publication/342194280_Digoxin_Induced_Sinus_Bradycardia_Possible_Drug_Interaction_with_Amiodarone/links/611c93d6169a1a01030b19b9/Digoxin-Induced-Sinus-Bradycardia-Possible-Drug-Interaction-with-Amiodarone.pdf
Nguyen, A., Gibson, S. and Wembridge, P., 2022. Improving medicine information on discharge summaries through implementation of a reconciliation?based intervention. Journal of Pharmacy Practice and Research, 52(6), pp.454-457. Available at https://onlinelibrary.wiley.com/doi/abs/10.1002/jppr.1828
Petric, Z., Žuntar, I., Putnik, P. and Bursa? Kova?evi?, D., 2020. Food–drug interactions with fruit juices. Foods, 10(1), p.33. Available at https://www.mdpi.com/2304-8158/10/1/33/pdf
Tarrant, S.M., Kim, J.W., Matsushita, T., Minehara, H., Noda, T., Oh, J.K., Park, K.C., Yamamoto, N. and Balogh, Z.J., 2022. Fragility Fracture Systems: International Perspectives-Asia & Australia. OTA International, 5(3 Suppl). Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9359027/

Assessment Guide: NUR231 Task 2 for Nursing Students

Table of Contents

Section 1. Application of pathophysiological basis and pharmacological concepts

Collect cues/information

Q1.

Detection of the cause of Mr. Hodges's cardiac problem