La Trobe University HEALTH SCI-NSG1ITN – You are a nurse who is providing advice to a patient in hospital

QUESTION

1. You are a nurse who is providing advice to a patient in hospital regarding their newly prescribed medication warfarin to prevent stroke in a patient with Atrial Fibrillation. Outline the teaching points you would make to this patient. (200 words)

2.Using Naproxen (Non-Steroidal anti-inflammatory) can pose a problem for someone who has a history of Gastro-Oesophageal Reflux disease (GORD). How would you explain this contraindication to another student nurse taking a scientific basis for the nature of interaction?(200 words)

ANSWER

1. Teaching points for a patient prescribed warfarin to prevent stroke in Atrial Fibrillation:

a) Explanation of Warfarin: Explain to the patient that warfarin is an anticoagulant medication that helps prevent blood clots. It is commonly prescribed to patients with Atrial Fibrillation to reduce the risk of stroke.

b) Importance of Consistent Dosage: Emphasize the importance of taking warfarin exactly as prescribed, at the same time each day. Stress that missing doses or taking extra doses can affect its effectiveness and increase the risk of complications.

c) Regular Monitoring: Inform the patient that regular blood tests are necessary to monitor their International Normalized Ratio (INR). This test measures how long it takes for the blood to clot and helps determine the appropriate dosage of warfarin. Explain that the target range for INR may vary depending on individual circumstances.

d) Dietary Considerations: Discuss the importance of maintaining a consistent intake of vitamin K-rich foods, such as leafy greens, as vitamin K plays a role in blood clotting. However, emphasize the need to avoid drastic changes in vitamin K intake, as it can affect the stability of warfarin. Encourage the patient to consult with a healthcare professional before making any major dietary changes.

e) Drug Interactions: Explain that warfarin can interact with other medications and supplements, including over-the-counter medications, herbal remedies, and even some foods. Encourage the patient to inform their healthcare provider about all the medications they are taking to ensure there are no potential interactions.

f) Signs of Bleeding: Educate the patient about the signs of bleeding and the importance of promptly reporting any unusual bleeding or bruising, prolonged nosebleeds, blood in urine or stool, or bleeding gums. Emphasize that immediate medical attention is necessary if any of these symptoms occur.

g) Follow-up and Support: Assure the patient that regular follow-up appointments with their healthcare provider are essential to monitor their progress, adjust medication dosages if needed, and address any concerns or questions they may have.

2. Explaining the contraindication between Naproxen and Gastro-Oesophageal Reflux Disease (GORD):

Naproxen, a non-steroidal anti-inflammatory drug (NSAID), can pose a problem for someone with a history of Gastro-Oesophageal Reflux Disease (GORD) due to its potential to worsen gastrointestinal symptoms. Here’s how you can explain this contraindication to a student nurse, based on the scientific basis of the interaction:

a) Mechanism of Action: Start by explaining that Naproxen belongs to a class of drugs called NSAIDs, which work by inhibiting the enzyme cyclooxygenase (COX). COX is responsible for the production of certain chemicals called prostaglandins, which promote inflammation, pain, and fever. By inhibiting COX, Naproxen reduces these symptoms.

b) Gastro-Oesophageal Reflux Disease (GORD): Provide a brief overview of GORD, explaining that it is a chronic condition characterized by the reflux of stomach acid into the esophagus, causing symptoms such as heartburn, regurgitation, and chest pain.

c) Increased Gastric Acid Production: Highlight the fact that NSAIDs, including Naproxen, can inhibit the production of prostaglandins not only in inflammatory cells but also in the stomach lining. Prostaglandins normally play a protective role by promoting the secretion of mucus and bicarbonate, which help protect the stomach lining from gastric acid. Without sufficient prostaglandins, the stomach’s protective mechanisms are compromised, leading to an increased risk of gastric irritation, ulcers, and worsening of GORD symptoms.

d) Enhanced Acidic Environment: Explain that the reduction in protective mechanisms and the potential for gastric irritation caused by Naproxen can result in an enhanced acidic environment in the stomach. This acidic environment can further exacerbate the symptoms of GORD and increase the risk of complications.

e) Alternative Medications: Suggest alternative pain management options for patients with GORD, such as acetaminophen (paracetamol), which is an analgesic that does not have the same effect on gastric acid production as NSAIDs.

f) Individual Assessment: Emphasize the importance of assessing each patient’s medical history, including any pre-existing conditions, before prescribing medications. This helps healthcare professionals identify potential contraindications and select the most appropriate treatment options for each patient.

g) Collaboration and Communication: Highlight the significance of interdisciplinary collaboration and effective communication between healthcare professionals to ensure patient safety and optimal treatment outcomes. Encourage the student nurse to consult with healthcare providers and pharmacists when considering medication options for patients with specific conditions like GORD.