Just wondering if anyone has any bright ideas for a medication assignment I'm doing. Sorry if this is long-winded
We've been given a scenario of a man (age not given) falling into river while rowing. He developed a cough, then severe 'indigestion'-like pain in the early hours a week later, lasting only 10 mins. His cough worsened so he went to his local hospital. Emergency doctors assessed him, took blood tests and performed an ECG: signs of NSTEMI with moderate troponin rise of 56 ug/L. His other blood tests were:
Urea: 4.5mmol/L; Creatinine 0.11mmol/L; Na+ 136mmol/L; K+ 3.1mmol/L; Hb 158 g/L; Platelets 405x10 to 9/L; WCC 13.8x10 to 9/L; INR 1.1; APTT 38 seconds; Troponin 56 ug/L.
He was admitted to hospital. He had no relevant past history and was not on medications. His registrar commenced him on:
Heparin infusion IV at 1200 units/hr
Cardiprin 100mg PO mane
Betaloc 50 mg PO BD
Lasix 40 mg PO BD
GTN patch 25 mg daily (on 0800 off 2200)
Anginine 1/2 tab SL PRN
His cough worsened and he was prescribed Amoxyl 250 mg PO QID.
It is now Wednesday 0930 and his vital signs are: Temp 37.8 C (metric!), BP 115/76, Pulse 95 (slightly irregular). He rings his bell complaining of epitaxis, started 30 mins ago and not stopped. He also has area of petechiae on his thorax.
We have to discuss which medications we think may be causing his recent symptoms (ie bleeding and petechiae), linking his path and pathophys. We also have to briefly mention the nursing care whilst on these meds with these symptoms.
So far I'm guessing it's the heparin and Cardiprin (aspirin) interracting and he might have HITS? I'm not entirely sure and not sure what his nursing care should be other than stopping the nosebleed and suggesting a LMWH. I don't think we have to concentrate too much on the MI, Troponin etc....Could his petechiae be an allergic reaction to something? The antibiotics?
Any help appreciated!!!