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Nurse Prescribing V150 A Case Study

4607 words - 19 pages














4. EVALUATION, Pgs 13-16






In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her ...view middle of the document...

The district nursing team were now to be responsible for the wound care of an ulcer on the sole of her right foot on her impending discharge. She had previously attended the practice nurse and a podiatry service based within her local clinic. Due to a change in circumstances, she was now clearly housebound for the near future due to mobility issues. Prior to an arranged visit, the patient had called the nurse to advise her that she was pyrexial and was experiencing a pain in her right foot that was different from her normal neuropathic pain, which was often problematic. She was also finding it difficult to mobilise and was disinclined for diet but was taking oral fluids.


The author read Mrs. X’s medical notes prior to their initial consultation to afford herself the knowledge she required should she need to prescribe for her when fully qualified. It was evident from reading her medical notes that there were a few considerations to take note of before commencing any treatment, such as her medical history, drug history and allergies. Her past medical history consisted of Type 2 diabetes mellitus, which was diet controlled, hypertension, hypercholesterolaemia, neuropathy, rheumatoid arthritis and raynauds syndrome.

Mrs X’s current drug regime included, Rosuvastatin 10mg nightly, Perindopril 4mg daily, Amitriptyline 50 mg nightly and Co-codamol 30/500 2 tablets every 4-6 hours for pain. Further questioning confirmed that there were no herbal remedies taken or indeed over the counter medicines. When contemplating initiating a prescription for any patient it is essential to have awareness of the patient’s current drug regime, as there may be potential interactions with what one may prescribe. Furthermore, Stenner and Courtenay (2010) agree that certain drugs can induce both liver and kidney function problems to name but a few and that nurse prescribers must be aware of these potential hazards, as they are accountable for their actions as prescribers.

Red flags highlighted from obtaining the past medical history were neuropathy and raynauds disease because, in this particular scenario, it made the author aware of decreased sensation in the foot due to raynauds and the pain associated with her neuropathy when considering a differential diagnosis such as arterial disease or recurrent osteomyelitis. Culley (2005) agrees that identifying and exploring red flags is crucial and very salient with regard to a robust assessment and subsequent safe prescribing. The British National Formulary (BNF) (2010pg 24 a) indicates that the ageing process can alter the pharmacodynamics and pharmacokinetics which induce a decrease in both hepatic and renal function. These pharmacokinetic changes akin with decreased mobility will hinder how they absorb, distribute, metabolise and excrete drugs, which will result in an increase in the tissue concentration of a drug. Routine bloods were obtained by the nurse, which would confirm both liver...

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