VSIM 2-Ms. Copper
Name (Generic)/Trade MOA Indication of Use SE/Drug Interactions Nursing Considerations Patient Education
Nitrostat It is converted into nitric oxide (NO) in smooth muscle and activates guanylyl cyclase, thereby increasing cGMP concentration, and resulting in smooth muscle relaxation. Its a vasodilator drug used for the treatment of chest pain and high blood pressure. Side effects include headache, weakness, dizziness
, and nausea.
DI: Do not take if you are taking the following drugs: avanafil, riociguat, sildenafil. Obtain the baseline data on the location and frequency of the anginal pain. Use with caution in hypotensive patients and those taking blood pressure-lowering medications. This includes daily exercise and smoking cessation. Avoid Alcohol. Do not swallow tab. Put between cheek or lip. Always check the date on the label.
(Morphine) Statex Binds to opiate receptors in the CNS and changes the perception
of and response to painful stimuli while producing
CNS depression resulting in the decrease of the severity of pain. Management
of moderate to severe chronic pain in patient. Also used with Pulmonary edema and pain associated
with MI. SE: Significant respiratory
depression (Acute or severe
DI: Use with extreme caution in patients
receiving MAO inhibitors Assess level of consciousness, BP,
pulse, and respirations before and periodically during
administration Warning: Prolonged use may lead to physical and psychological
dependence and tolerance. May cause drowsiness or dizziness. avoid concurrent use of alcohol.
(Aspirin) Bayer Aspirin
(Lehne & Lehne, 2018) Suppresses platelet aggregation by causing irreversible inhibition of cyclooxygenase which is an enzyme required by platelets to Synthesize TXA Used to reduce fever and relieve mild to moderate pain from conditions such as muscle aches and headaches. It may also be used to reduce pain and swelling and used to prevent MI SE: Risk of GI bleeding hemorrhagic stroke, and rental impairment.
DI: taken with warfarin, it can reduce the drug’s anticoagulant effects and increase the risk of bleeding Assess patient for signs of bleeding. Advise patient to avoid alcohol and to not crush or chew. Notify the prescriber if gastric irritation is severe or persistent.
(Clopidogrel)Plavix Inhibits platelet aggregation by irreversibly inhibiting
the binding of ATP to platelet receptors. Used to reduce atherosclerotic events
in patients at risk for and including
recent MI, acute coronary syndrome
stroke, or peripheral vascular disease. SE: These can include depression, dizziness, fatigue, headache.
DI: Aspirin, warfarin, rivaroxaban Assess patient for symptoms of stroke, peripheral
vascular disease, or MI periodically during therapy. Instruct patient to take medication exactly as directed.
To take missed doses as soon as possible unless
almost time for the next dose; do not double doses.
(“Daviss Drug Guide Online + App | DrugGuide.com”, 2019) This drug binds selectively to antithrombin III (AT III). This
binding potentiates the neutralization (inactivation) of
active factor X SE: Include confusion, dizziness, headache, insomnia, edema and hypotension.
DI: Include aspirin, NSAIDs, dipyridamole Nurse should assess for signs of bleeding and hemorrhage and assess for evidence of additional or increased
thrombosis. The nurse should instruct the patient not to take aspirin or NSAIDs without
consulting health care professional during therapy. Teach the patient to report any symptoms of unusual
bleeding or bruising, dizziness, itching, rash, fever,
swelling, or difficulty breathing to a health care professional
(Hydrochlorothiazide) Microzide This drug promotes urine production by blocking the reabsorption of sodium and chloride in the distal convoluted tubule. SE: Include Hyponatremia, dehydration and hypokalemia.
DI: Include Digoxin, and NSAIDs. Nurses should monitor blood pressure and intake and outtake. Also monitor electrolyte levels. Patient should take medication the same time every day. Patient should be taught if possible, how to teach blood pressure.
(Simvastatin) Zocor HMG-CoA reductase inhibitor; inhibits the rate-limiting step in cholesterol biosynthesis by competitively inhibiting HMG-CoA reductase SE: Headaches, nausea, kidney failure, liver toxicity. DI: Include erythromycin, Digoxin, Warfarin
Nurses should obtain a diet history, especially regarding fat consumption. They should also monitor liver function. Instruct patient to take medication as directed and to not skip doses or double up on missed doses. Teach patient to notify a health care professional if unexplained muscle pain, tenderness, or weakness occurs.
Oxygen (O2) This is an essential element for human survival. Treatment, with oxygen serves to increase blood oxygen levels and exerts a secondary effect of decreasing blood flow resistance in the diseased lung, leading to decreased cardiovascular workload to oxygenate the lungs. SE: Include vertigo and nausea occur, followed by behavioral changes (irritability, anxiety, confusion), clumsiness and finally convulsions.
DI: amiodarone Make sure that warning signs are posted on the clients door and above the clients bed (even if the entire facility is nonsmoking).
Do not use oil on oxygen equipment.
Be aware of all potential sources of sparks, especially when administering oxygen by means of a containment device Teach patient to not smoke around oxygen.
Turn off O2 when not using.
Know when to call 911 for emergencies
There are at least three things that can be taught to Ms. Copper and her family upon discharge. Since Ms. Copper is an African American female and is over 65 years old, she is at a much higher risk for hypertension. In fact, the prevalence of hypertension in blacks in the United States is among the highest in the world. Consequently, blacks have a 1.5 times greater rate to develop heart disease than other ethnic groups. (Wright, Still, Jones & Moss, 2018) One of the things that can be taught the patient is management of proper diet. According to studies the Dietary Approach to Stop Hypertension or DASH diet has the strongest base of evidence for lowering blood pressure. (Tyson et al., 2019) This diet includes fruits and vegetables, whole grains, beans, nuts, low-fat dairy, lean meat, and healthy fats. It also limits red meat, added sugars, and unhealthy fats. The DASH diet is high in blood-pressure-lowering potassium, magnesium, and fiber plus it also supplies plant compounds that may have a direct effect on blood vessels. In fact, an underlying cause of high blood pressure is oxidative stress from free radicals. Endothelial cells lining arteries produce nitric oxide, which causes the blood vessels to dilate therefore improving blood flow and reducing pressure. Ms. Copper should eat more foods such as beans, spinach, and blueberries. She should also use olive oil to cook as it has less fat. Also, she should replace fried foods with bake foods.
Ms. Copper should also be aware of the medication she is taking. Since she is on hydrochlorothiazide Ms. Copper should be educated to take this medication at the same time each day. She should also be educated on how to check her blood pressure and record the numbers daily. The patient or their family can buy an electronic blood pressure monitor machine at any local drug store. If needed a nurse or healthcare professional can teach Ms. Copper and her family the proper use of a blood pressure machine and how to get accurately take a blood pressure.
Ms. Copper should also be educated on the prevention of heart disease. According to the Centers for Disease Control and Prevention; African Americans are at a higher risk of dying from heart failure, regardless of the patients disease severity. In fact, African American patients have a 25 percent higher risk of dying from heart disease than do white non-Hispanic patients (CDC, 2016). The high rates of cardiovascular disease among African Americans are influenced by several determinants, risk factors, traits, and lifestyle habits including medication compliance. There are several risk factors that Ms. Copper should be aware of including, cholesterol levels in which Ms. Copper is taking Simvastatin to help control. However, Ms. Copper and her family should eat foods low in fat once again referencing the DASH diet.
One of the things that can be learned from the simulation is the importance of prevention of hypertension and heart disease. It should be noted that one should reach out to social work or a case manager to ensure that Ms. Copper has access to programs to help her manage her blood pressure and foods that are good for her. Because African Americans are more likely to report health care disparities, isolation, and lack of care, improving access to health care by expanding community-based health centers is essential. However, it not only essential to African Americans, but to all groups that have health disparities. Ms. Copper should be taught to not only realize the signs of a heart attack but ways to prevent one through diet and exercise. What should be done next time is assessing Ms. Coppers pain management. Proper assessment of pain can lead to early intervention and can help save lives. Ms. Copper should also be screened for kidney disease as well. According to the National Kidney Foundation, (“African Americans and Kidney Disease”, 2019) African Americans suffer from kidney failure at a significantly higher rate than Caucasians – more than 3 times higher in fact. Also, high blood pressure is the second leading cause of kidney failure among African Americans and remains the leading cause of death due to its link with heart attacks and strokes. Therefore, labs should have been drawn to determine Ms. Coppers BUN and creatine levels which in turn would have shown her kidney function.
African Americans and Kidney Disease. (2019). Retrieved 14 October 2019, from
Centers for Disease Control and Prevention. (2016). Public health action plan to prevent heart disease and stroke. Retrieved from
Daviss Drug Guide Online + App | DrugGuide.com. (2019). Retrieved 13 October 2019, from
Lehne, R., & Lehne, R. (2018). Pharmacology for nursing care.
Tyson, C., Davenport, C., Lin, P., Scialla, J., Hall, R., & Diamantidis, C. et al. (2019). DASH Diet and Blood Pressure Among Black Americans With and Without CKD: The Jackson Heart Study. American Journal of Hypertension, 32(10), 975-982.
Wright, K., Still, C., Jones, L., & Moss, K. (2018). Designing a Cocreated Intervention with African American Older Adults for Hypertension Self-Management. International Journal of Hypertension, 2018, 1-7