NCM 106

Nursing Pharmacology
Activity 3

I. Case Presentation. 
 
Mrs. Concepcion, a 55-year-old patient, was admitted to the floor with a deep
vein thrombosis diagnosis. Around a week ago, the client found swelling in her left
leg, but chose to treat it at home. The lower leg, four days later, was very
edematous, warm and painful to lift. The client was admitted to the hospital after an
office visit. This is first-time hospitalization of Mrs. Concepcion. Examined, you find
the left leg colder than the right one. The circumference of the left thigh is 3 inches
greater than the one of the right. After the loading dose bolus was administered, the
prescribing doctor prescribed a heparin IV drip. The drip contained 10,000 units of
heparin at 10 mL / h (200 units / h) per 500 mL of D5W. The prescribing practitioner
expects Mrs. Concepcion to be weaned from the drip of heparin and to start on
subcutaneous heparin within 5 days. She is being given Coumadin at the time of
discharge. 
 
1. Using the case, list the different factors that may possibly influence drug action. 

FACTOR  EXAMPLE 
 Asian patients, those who carry the
CYP2C9*2 allele and/or the CYP2C9*3
allele, or with the VKORC1 AA genotype
have higher risk of bleeding with the
standard dosing so their initial doses
should be lowered.
 Once the client has a history or an active
case of malignancy, stomach ulcer, liver
disease, acute kidney injury, or poor
compliance, the Coumadin should be used
with caution.
 Coumadin should not be used if there is a
Individual client characteristics  recent eye, brain, or spinal cord injury or
surgery, case of an open wound or
uncontrolled bleeding, cerebral aneurysm
or dissecting aorta, blood dyscrasias,
pericarditis, bacterial endocarditis, lumbar
puncture, major regional or lumbar block
anesthesia, hypertension, if there is a
threatened abortion, eclampsia, and
preeclampsia, when the client is an
unsupervised senile, alcoholic, or
psychotic, and if the patient is pregnant or
of childbearing potential because it can
lead to fetal harm.
Age-related factors   When it comes to age-related factors, Mrs.
Concepcion is already quite old at 55
years old. Basing from the NDH,
Coumadin or Warfarin is given, initiated,
and maintained in lower doses in older
adults due to their greater than expected
anticoagulant response towards the said
 medication.
 It is said to be safe to children, but they
will require frequent PT or INR
assessments.
 
 
2.Using the same case, devise a health teaching plan that would best fit the need of
Mrs. Concepcion. 

When it comes to the health teaching plan, it is best to inform the patient first about
the therapy itself. Along that, we should also educate them about the dos and don’ts
considering that Coumadin or Warfarin is a high alert anticoagulant. The dos and
don’ts are as follows.
As for the dos, the first one here is to always be present and on time when it comes
to schedules, especially with laboratory tests. Next is taking countermeasures like
immediate reporting if there is a problem such as bleeding or bruising. Then, the
client should also take caution in taking other medications because they are already
intaking Warfarin. This is done to prevent unwanted chemical or medical reactions.
The best applicable action there is to consult professionals before taking other
medications, either herbal or OTC. Fourth is to know how to balance the intake of
food high in Vitamin K because it can alter the medication’s anticoagulant effect.
Lastly, clients should also be taught to inform the providers if they are potentially
childbearing or pregnant at the soonest possible time to prevent fetal harm.
As for the don’ts, the patient should be informed that they should avoid contact sports
or any activity that may lead to bleeding or injury that can lead to complications. At
the same time, they should also avoid alcohol during the duration of their therapy.
All in all, it is advisable that the client also do their research on how they can improve
faster and help with their recovery.
II. CASE SCENARIO

Mrs. Concepcion, a 55-year-old patient, was admitted to the floor with a deep
vein thrombosis diagnosis. Around a week ago, the client found swelling in her left
leg, but chose to treat it at home. The lower leg, four days later, was very
edematous, warm and painful to lift. The client was admitted to the hospital after an
office visit. This is first-time hospitalization of Mrs. Concepcion. Examined, you find
the left leg colder than the right one. The circumference of the left thigh is 3 inches
greater than the one of the right. After the loading dose bolus was administered, the
prescribing doctor prescribed a heparin IV drip. The drip contained 10,000 units of
heparin at 10 mL / h (200 units / h) per 500 mL of D5W. The prescribing practitioner
expects Mrs. Concepcion to be weaned from the drip of heparin and to start on
subcutaneous heparin within 5 days. She is being given Coumadin at the time of
discharge. 
 

1. Using the presented case, how would you ensure high compliance of
Mrs. Concepcion in administering her take home medications? 

I can ensure the high compliance of Mrs. Conception towards her administration of
take home medications by doing a mixed verbal and written instruction before
discharge so she could remember them well, always doing a follow up, reminding her
the benefits and functions of the medication, and asking her to do her documentation
so we can both see the improvements she achieves and plan where we should
adjust during the next visit.
One way to check if they were listening and would probably comply is by asking
them about specific instructions like what is the time of administration, the right
dosage, the name of medication, etc. If they answer correctly, then they are indeed
ready.

III. CASE SCENARIO

While monitoring a client who has an intravenous order for Solu-Cortef and
an anti-inflammatory drug, you find that Solu-Medrol and an anti-
inflammatory drug are in the client's room. You review the order again to
make sure that the initial order was for Solu-Cortef and that the order was
not updated.  
 
1. What should be your next action??  

In this case, I will be withholding the medication administration due to the

mismatched drug given from the one written in the medication order. After that, I will
notify the prescriber to confirm the prescription and tell them that I withheld the
administration because the drug order is not updated.

2. How do you feel about a nurse who made a medical mistake but did not
know it?? 

  Making a mistake is normal may it be due to stress, tiredness, or

nervousness. But as nurses, professionals, there should be no room for mistakes
because other people’s lives depend on us. If one does make a mistake, it is
disappointing because they may have not followed through the proper protocol of
double and triple checking but at the same time, it is also saddening because I know
that as health care workers and providers, we only want the best for our clients and
by making a mistake, we fail in that aspect and end up blaming ourselves.

IV. Make a brief analysis of the most up-to - date technical developments
that are being used in the Philippines and other countries to reduce drug errors in the
healthcare system. Specify a minimum of five (5) technologies. Make sure to properly
cite your references/sources following the APA 7th edition. 

TECHNOLOG DESCRIPTION  Reference/Source 

Y 
 RPM is a type of telehealth that  
 Muller, E. (2021, August 25). 7 common remote
gathers the needed information
on the assessment using the patient monitoring devices. Remote
technological advancements Patient Monitoring & Telehealth.
rather than the traditional
 Remote visitation on the clinic. It gives Retrieved September 12, 2022, from
Patient the patient time to do their https://www.healthrecoverysolutions.co
Monitoring activities while still having their
doctors monitor their state. m/blog/7-common-remote-patient-

Some examples of devices here monitoring-devices?hs_amp=true

are Bluetooth blood pressure
cuffs, glucometers, ECG, and  
many more.  
 Advanced  This is a health care  
 AdvancedMD Telemedicine Software Doctor
Telemedicine technology that connects a
patient and a doctor through a medical app. AdvancedMD. (2022,
 January 18). Retrieved September 12,

two-way video. Mostly, it is used 2022, from

for consultations and follow up https://www.advancedmd.com/learn/tele
checkups.
medicine-sheet/

 
 The aid of artificial intelligence  
 
in health care varies from  Barth, S. (n.d.). Artificial Intelligence (AI) in
prediction of what treatments
would be successful if done with Healthcare & Hospitals. ForeSee

patients basing from their make- Medical. Retrieved September 12, 2022,
 Artificial
up and the treatment
Intelligence from
framework, up until deeper
learning towards cases that until https://www.foreseemed.com/artificial-
now, is difficult for us to fully
intelligence-in-healthcare
understand without proper
interpretation.
 
 
 
 Tamblyn, R., Buckeridge, D. L., & Abrahamowicz,

M. (2019, September 20). Effect of

electronic medication reconciliation

 Electronic
This is a system that corrects intervention on Adverse Drug Events.
discharge
the medication discrepancies at
medication JAMA Network. Retrieved September
the transitions in healthcare.
reconciliation
12, 2022, from

https://jamanetwork.com/journals/jaman

etworkopen/fullarticle/2751553

 
 
 Koshy, G. (2021, November 10). How digital
 This includes apps that take assistants are relieving the strain on
your heart rate, watches that
track your activity and fitness healthcare services. Thrive. Retrieved
levels, voice assistants like
 Healthcare’s September 12, 2022, from
Alexa and Siri that answers
digital
your questions, etc. In health https://www.thriveagency.uk/insights/ho
assistants
care, some use them as w-digital-assistants-are-relieving-the-
reminders when to drink their
strain-on-healthcare-services/
medicine and as monitors or
tracker for their physical state.