CASE STUDY

Anastasia Steele is a 48 year old woman who has been suffering increasingly from morning stiffness as well as generalized joint pain. Her symptoms have intensified during the last several weeks. Both of her hands are swollen and she is no longer able t wear her wedding ring. Her joint pain has forced her to quit her job as a cashier and she now rarely ventures from her home. A thorough physical and laboratory examination result in the diagnosis of rheumatoid arthritis.

The physician instructs Ms. Steele to begin taking aspirin tablets at a dosage of three 325mg tablets 4 times a day. After several days of therapy the client experiences moderate epigastric pain, as well as nausea. She decides to use acetaminophen in place of the aspirin and experiences relief of her epigastric pain and nausea, but no improvement of her joint pain and stiffness.

At her next visit to the physician she is told to begin using ibuprofen at a dose of 400mg 4 times daily. After 30 days of therapy her symptoms have improved although some nausea is occasionally evident.

QUESTIONS

1. What measures could have been employed to improve the clients tolerance of aspirin?

ANSWER: First thing first, n aspirin, a salicylate drug often used as an analgesics to relieve minor aches and pain. Now what id drug tolerance? It is a stable of adaptation in which exposure to a drug induces changes that result in a diminution of one or more f the drugs effects over time. Now the basic safety measure is taking aspirin as prescribed and on time. This means it shouldnt be taken in a few dose or in excess. If the patient takes aspirin every time she is in pain, drug tolerance occurs. Aspirin use has been shown to increase the risk of gastrointestinal bleeding. In the patients case, the patient experienced epigastric pain and nausea, if taken correct and with the right amount this could also be prevented. Some studies suggest, taking it with vitamin C help reduced gastric irritation.

2. Is acetaminophen an acceptable substitute for aspirin? Explain.

ANSWER: Acetaminophen is a drug used for relief of minor pain like other common analgesic drugs aspirin and ibuprofen, acetaminophen relieves pain by inhibiting the synthesis of prostaglandins in body but doesnt not reduce inflammation as do have to analgesics but it also not irritate. The stomach lining as aspirin teds to do for some users.

3. What nursing actions would be appropriate in optimizing the long term drug therapy of this client?

Monitor elderly patients closely because they may be more susceptible to aspirins toxic effects. Monitor salicylate level. Therapeutic salicylate level for arthritis is 150 to 300 mcg/ml, but this isnt a reliable indicator of toxicity, especially in very young patients and those older than age 60. With long-term therapy, severe toxic effects may occur with levels exceeding 400mcg/ml. During prolonged therapy, assess hematocrit, hemoglobin level, PT, INR, and renal function periodically. Advise patient to watch for small, round, red pinprick spots, bleeding gums, and signs of GI bleeding, and to drink plenty of fluids. Encouraged use of a soft-bristled toothbrush.

4. Would the use of systemic corticosteroids be advisable in this client? Explain.

ANSWER: Corticosteroid controls inflammatory by suppressing or preventing many of the components of the inflammatory process at the injured site, corticosteroid have been widely prescribed for arthritic conditions but not the drug of choice for arthritis because of humerous SE and beside when it use with acetaminophen it enhances salicylate elimination and decrease aspirin effect.

BNS-4B (group B)

Parangan, Rhenanie Ramil, Queeny Raymundo, Roxan Rejano, Teodoro Reyes, Christine Anne