independent nurse prescriber

Order Description

case study on a prescribing medicine scenario within your area of practice.

Background to Case study
34 year old female,
Complaining of headaches which are not being controlled with paracetamol, and feeling dizzy for more than a week, she is currently 26 weeks pregnant.
Is found to have a very high blood pressure, which is what is concluded is causing these problems.
Patient was known to be Hypertensive before becoming pregnant and was on the ACE inhibitor enalapril, which she states worked well for her and she had no problems

with. These were stopped when she got pregnant.
She is also a diabetic on metformin 1gm twice a day, and her blood sugars remain well controlled, and has had 1 previous pregnancy with no complication. Normally fit

and well.
What medication would you prescribe safely for the high blood pressure instead of the enalapril and why – I would say labetalol –
Does this have interaction with her metformin? May mask warning signs of low blood sugars, but not interact directly with the medication
Can she have any other pain relief other than paracetamol – yes codeine, but risks of constipation.

Planning your case study – some guidance
The following extract from the Standards of proficiency for nurse and midwife prescribers (NMC 2006) should be used as a step wise process to guide your in depth case

study and reflections from practice. You may also like to use this for the prescribing workshops you will be attending. This will not only help prepare you for your

clinical assessment, for the OSCE, contribute to your portfolio but also be used as a tool for your continuing professional development in prescribing practice.

The suggestions are NOT comprehensive and are there to serve as an aide memoir. You will need to add to them depending on the prescribing situation you are faced with.

You will also need to demonstrate recognition of the unique implications and developmental context of the anatomical and physiological differences between neonates,

children and young people where appropriate. Finally, you should refer to and reference primary research where appropriate in order to substantiate your decision

making processes.

1.    Assess a patient/clients clinical condition
What clinical assessment skills did you bring to the consultation?
What learning needs do you have? Were any tests required?

2.    Undertake a thorough history, including medical history and medication history and diagnose where necessary, including over the counter medicines and

complementary therapies
This must include asking about allergies, pregnancy, breastfeeding etc
Did you use a model of consultation, which one and why? What skills did you use in order to diagnose? Consider street drug usage. Cognitive issues? Use of translators?

What impact did the age of the patient have on your strategy?

3.    Decide on the management of the presenting condition and whether or not to prescribe
What is the evidence base? What decision support tools were available to you (CKS, policies, guidelines etc)
What alternatives were there? How did you arrive at your decision to prescribe?

4.    Identify appropriate products if medication is required
What previous knowledge did you employ? Pharmacology? Interactions?
What influenced your choice of product?
What sources of information did you refer to? Allergies?
Use mnemonics taught in class STEP, EASE

5.    Advise the patient on the effects and risks
Written information? Language or other communication barriers and how did you overcome this?
Contact details for patient in case of problems out of hours? Check patients understanding to aid concordance
Storage of medication? Disposal of unused medication?

6.    Prescribe if the patient/client agrees
Consider issues around informed consent and other legal, policy and ethical aspects. Consider communication with other team members. Patient/clients health beliefs?

Supplementary prescribing?

7.    Monitor response to medication and lifestyle advice
Public health issues. Safety netting?
How will you monitor response? Appointment or telephone? Record keeping
Clinical governance issues/audit

Consider which learning outcomes/competencies you are addressing having completed this exercise.
2000-2500 words not including appendices and text boxes

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