The scenario of Mr. Woods, a patient with a hip fracture combined with his history of atrial fibrillation, is more of a complicated medical case. It can be explained by the necessity of both physical and internal treatment. Thus, the nursing activity should be complex enough as well to reach satisfying results.
The medications of the patient due to his atrial fibrillation condition include digoxin, warfarin, opioids, and ibuprofen. The researchers note that digoxin is recommended for the rate control in patients of AF (Lopes et al., 2018, p. 1063), warfarin is supposed to decrease the risk of a stroke (Nelson et al., 2015, p. 207). Moreover, according to Davis et al. (2017), opioids are supposed to reduce chronic pain (p. 148) and, according to Cardiol (2017), ibuprofen is an anti-inflammatory drug (p. 181). Thus, the most controlled rates in the analysis should be Digoxin level and INR. Regarding the latter case, the researchers state that monitoring the serum concentration should be “targeting blood levels <1.2 ng/ml” (Lopes et al., 2018, p. 1074). Meanwhile, the INR, as the researchers note, should stay in the “therapeutic range of 2.0–3.0” (Nelson et al., 2015, p. 205). After concluding the treatment with digoxin, the nurse must examine the heart rate and determine whether the administration of digoxin improved it.
In the scenario of Mr. Woods returning to bed due to bilateral calf pain, several actions should become a priority for a nurse. These include determining the reason for calf pain and whether it is connected to either hip fracture or the AT. The results will incline a necessary treatment, whether it should be surgical intervention or the medicine prescribed for AT patients.
Thus, in the scenario of Mr. Woods, it is vital to observe Digoxin level and INR while he takes the drugs to determine the results and influence on physical therapy. If the calf pain shows up, the nursing actions must include the diagnostic search and development of further treatment.
References
Cardiol, A. J. Ibuprofen-induced Kounis syndrome with diffuse ST segment depression and atrial fibrillation. The Anatolian Journal of Cardiology, 18(5), 180-181.
Davis, M.T., Bateman, B., Avorn, J. (2017). Educational outreach to opioid prescribers: the case for academic detailing. Pain Physician, 20, 147-151.
Lopes, R. D., Rordorf, R., De Ferrari, G. M., Leonardi, S., Thomas, L., Wojdyla, D. M… Wallentin, L. (2018). Digoxin and mortality in patients with atrial fibrillation. Journal of the American College of Cardiology, 71(10), 1063-1074.
Nelson, W, W., Desai, S., Damaraju, C. V., Lu, L., Fields, L. E., Wildgoose, P., Schein, J. R. (2015). International normalized ratio stability in warfarin-experienced patients with nonvalvular atrial fibrillation. American Journal of Cardiovascular Drugs, 15(3), 205–211.