VELEZ COLLEGE- COLLEGE OF NURSING

41 F. Ramos Street, Cebu City, Philippines

Case Study
NAME: Candice Gabrielle G. Go
YEAR & SECTION: BSN-2A

Cardiovascular Indications Adverse Reactions Pharmacokinetics Nursing Considerations

Drug
warfarin (Coumadin) Treatment of patients with The main side effect of  Readily absorbed Assessment: History and Examination
AF, artificial heart valves, warfarin is bleeding. through the GI tract, o Assess for any known allergies to these drugs to
or valvular damage that metabolized in liver, avoid potential hypersensitivity reactions
makes patient susceptible Severe bleeding, including and excreted in urine
to thrombus and embolus heavier than usual menstrual and feces Nursing Diagnoses
formation; prevention and bleeding, red or brown urine, ▫ Risk for Injury related to bleeding effects and bone
treatment of venous black or bloody stool, severe Route: oral marrow depression
thrombosis, pulmonary headache or stomach pain, Onset: 3 days ▫ Disturbed Body Image related to alopecia and skin
embolus, embolus with joint pain, discomfort or Effect lasts for: 4 to 5 days rash
AF, systemic emboli after swelling, especially after an
MI injury, vomiting of blood or Implementation with Rationale
material that looks like  Monitor the patient carefully when any drug is
coffee grounds, coughing up added to or withdrawn from the drug regimen of a
blood, bruising that develops patient taking warfarin because of the risk of drug-
without a remembered drug interactions that would change the
injury, dizziness or effectiveness of the anticoagulant
weakness, vision changes,
Head injury even without Evaluation
bleeding  Monitor the effectiveness of comfort measures and
compliance with the regimen
simvastatin (Zocor) Prevention of first MI in Headaches, myalgia,  Well absorbed from Assessment: History and Examination
patients with known abdominal pain, gastritis, the GI tract and o Assess for contraindications and cautions: any
hypercholesterolemia and constipation, upper undergo first-pass known allergies to these drugs or to fungal by-
CAD; adjunctive therapy respiratory infections, metabolism in the products to avoid hypersensitivity reactions
for reduction of increased elevated AST or ALT, and liver; excreted
cholesterol and LDL impaired serum glucose through feces and Nursing Diagnoses
levels; adjunctive therapy control urine ▫ Disturbed Sensory Perception (Visual, Kinesthetic,
for reduction of increased  Most effective when Gustatory) related to CNS effects
cholesterol and LDL taken at night ▫ Risk for Injury related to headache, myalgia, and
levels; approved to lower GI effects
cholesterol levels in Route: Oral
children 10-17 years of Peak: 1.3-2.4 hours Implementation with Rationale
age who meet specific  Administer the drug at bedtime because the
criteria with genetic highest rates of cholesterol synthesis occur
 hyperlipidemias between midnight and 5AM, and the drug should
be taken when it will be most effective

aspirin (81 mg daily) Reduction of the
incidence of TIAs and
strokes in men; reduction
of the risk of death or
nonfatal MI in patients
with a history of MI or with
angina
Acute aspirin toxicity with
hyperpnea, leading to fever,
coma, and cardiovascular
collapse; nausea, dyspepsia,
heartburn, dyspepsia,
heartburn, epigastric
discomfort, gastrointestinal
bleeding, occult blood loss,
dizziness, tinnitus, difficulty
hearing, anaphylactoid
reaction
 Metabolized in liver;
excreted in urine
Route: Oral
Onset: 5-30 minutes
Peak: 0.25-2 hours
Duration: 3-6 hours
Evaluation
 Monitor for adverse effects (headache, dizziness,
blurred vision, cataracts, GI upset, liver failure,
rhabdomyolysis)
Assessment: History and Examination
o Assess baseline status before beginning therapy to
determine any potential adverse effects.
Nursing Diagnoses
▫ Risk for Injury related to bleeding effects or central
nervous system (CNS) effects
▫ Deficient Knowledge regarding drug therapy
Implementation with Rationale
 Suggest safety measures, including the use of an
electric razor and avoidance of contract sports, to
decrease the risk of bleeding

diltiazem (Cardizem) Treatment of essential
hypertension in the
extended-release form
Evaluation
 Monitor for adverse effects (bleeding, GI upset,
dizziness, headache)
Dizziness, light-headedness,  Metabolized in the Assessment: History and Examination
headache, peripheral liver; excreted in urine o Assess cardiopulmonary status closely, including
edema, bradycardia, pulse rate, blood pressure, heart rate, and rhythm,
atrioventricular block, Route: Oral, extended release to determine the effects of therapy and identify any
flushing, nausea Onset: 30-60 minutes adverse effects
Peak: 6-11 hours
Duration: 12 hours Nursing Diagnoses
▫ Decreased Cardiac Output related to hypotension
and vasodilation
▫ Risk for Injury related to central nervous system or
cardiovascular effects

Implementation with Rationale

 Monitor the patient’s blood pressure, cardiac
rhythm, and cardiac output closely while the drug is
being titrated or dose is being changed to ensure
early detection of potentially serious adverse
effects

Evaluation
 Monitor for adverse effects (hypotension, cardiac
arrhythmias, GI upset, skin reactions, headache)
atenolol (Tenormin) Treatment of MI, chronic
angina, hypertension in
adults (more widely used
that the other drugs of this
class for hypertension)
Allergic reaction, dizziness,
bradycardia, heart failure,
arrhythmias, gastric pain,
flatulence, impotence,
bronchospasm, decreased
exercise tolerance
 Excretion in bile, Assessment: History and Examination
feces, and urine o Monitor cardiac status, including pulse, blood
pressure, and heart rate, to identify changes, and
Route: Oral, IV obtain an electrocardiogram as ordered to evaluate
Onset: Varies (oral), for changes in heart rate or rhythm
Immediate (IV)
Peak: 2-4 hours (Oral), 5 Nursing Diagnoses
minutes (IV) ▫ Decreased Cardiac Output related to
Duration: 24 hours cardiovascular (CV) effects
▫ Ineffective Tissue Perfusion related to CV effects

Implementation with Rationale

 Consult with the physician about discontinuing
these drugs before surgery because withdrawal of
the drug before surgery when the patient has been
maintained on the drug is controversial

Evaluation
 Monitor for adverse effects (bleeding, GI upset,
dizziness, headache)

Based on the patient’s chief complaints are bleeding “gums,” pain in the tooth, and that it is difficult to brush teeth because his “gums are big,” it fits
the description for gingival bleeding. Considering that the patient is taking both anticoagulant (warfarin) and antiplatelet (aspirin) drugs especially
since he also had a history of open-heart surgery, as a nurse, I will inform the patient that he has an increased risk of spontaneous and prolonged
gingival bleeding. I will also remind him to not do activities that may cause injuries or bruises because he is taking warfarin and aspirin, in this case,
he should tell the dentist that he is taking warfarin before having dental procedures done.

I will also educate the patient not to crush, cut, or chew the drug, diltiazem (Cardizem) because this drug is meant for controlled release. Meaning, it
is designed to release medicine over an extended period to allow less frequent administration. Crushing may mean a fatal dose is released.
Drinking grapefruit juice is not allowed for him also because he is taking simvastatin, grapefruit juice alters the metabolism of the drug which leads
to an increased risk for adverse effects.