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Jolene who had a history of an accident

Jolene who had a history of an accident


Within the present case of Jolene, it is visible that because of the issues on the farm, she is been assisting out at the farm. She has a records of a twist of fate which brought on deep vein thrombosis because of which she become no longer capable of breathe and she is given anticoagulant for the same. She had an episode of tonic-clonic seizures which was due to the accident for which she became given medication and at present, she is recognized with depression for which she was given medicinal drug and also she is in the first trimester of her pregnancy. The intention of the present essay is to discuss the underlying pathophysiological standards and pharmacology of the drugs concerned and discusses intervention according to the priority.


The primary aspect that the patient has passed through is the accident which has precipitated the formation of an embolus inside the blood flow which has precipitated deep vein thrombosis and with time it turned into visible that the embolus was lodged within the respiration machine causing her to have trouble in respiratory. The pathophysiology in the gift case is due to the fracture that had taken area because of the coincidence. The fractures passed off within the tibia and fibula of the patient though it changed into constant with the help of plates and pins there would have been the formation of a blood clot. As the blood receives circulated, the clot changed into detached from its original function and may get lodged within the small blood vessels. The most commonplace web page of lodgment of the embolism is the breathing device in case the fracture is originated from decrease extremities. The factors that are contributing to the formation of thrombosis are venous stasis, injury to the blood vessel and hypercoagulability. Valves gift in the veins regulate the glide of blood at the identical time it's far liable for the stagnation of blood. This with different elements is accountable for the expanded ratio of procoagulants to anticoagulants which boom the hazard of thrombus formation and because of impaired anticoagulant assets this is fashioned within the blood the formation of thrombus is promoted.

The next component that is visible is the development of tonic-clonic seizures which became diagnosed to be the result of the twist of fate and resultant damage that might have caused in the brain and associated structure like the spinal cord. An epileptic episode of tonic-clonic seizure is a brief occurrence of signs and symptoms and signs which can be due to the immoderate or abnormal but synchronous neuronal hobby in the brain that could have diverse consequences like cognitive, mental and social troubles. The seizures can arise immediately after the accident or can be past due depending at the vicinity affected. In Jolene, it changed into past due which means that that temporal lobe of her mind might have been affected as it is the maximum normally affected observed by the frontal lobe.

Tormented by the accident and no longer being capable of completely recover from the situation and similarly she turned into having breathlessness which changed into a result of the clot lodged in her respiration device and later she had a fainting spell accompanied by means of an epileptic episode.


Within the given case study, no precise medications are cited which can be given to Jolene. The primary remedy that is given to the affected person is anti-coagulant which is prescribed for the control of deep vein thrombosis. The anti-coagulant that may be prescribed to the affected person is heparin. It is one of the most generally prescribed anti-coagulants that is indicated in case of clotting disorders and deep vein thrombosis. It is acidic anionic which is acquired from liver, lung and mast cells of different vertebrates.  It acts through inhibiting the reactions which lead to the formation of clots inside the blood or even after the formation of thrombosis, it functions by means of inactivation of thrombin and conversion of fibrinogen to fibrin does now not manifest. It destroys the present clot with the aid of endogenous thrombolytic activity. It has terrible first-bypass metabolism and it is most generally administered as an intravenous infusion. It has the excessive binding potential to low-density lipoproteins and is metabolized inside the liver and is excreted via reticuloendothelial system of the corporeal by a small quantity is excreted unchanged in the urine. The half-life is dose-based and it varies from one hour to 150 mins. There are some side effects which might be related to heparin are easy bleeding and brusability will increase. It may also purpose ache and redness on the website online of management.

The second one drug that can be prescribed to the patient is Levetiracetam for epilepsy. Levetiracetam is a drug which belongs to the elegance of drug that is pyrrolidine and it could prevent the seizures which can be due to an epileptic disorder. It is given as adjunct remedy in people who have partial-onset seizures diagnosed with epilepsy and are of one month and older. It is also prescribed in case of pyoclonic seizures in sufferers 12 years and older and generalized tonic-clonic seizure in sufferers older than 6 years of age. It acts by using acting on sodium and calcium contemporary by way of reducing the release of calcium this reduces the GABA-ergic receptors and inflow of potassium is decreased. This reduces the releases of neurotransmitters as a result reduces the seizure pastime. It has a terrific first pass and the drug is hastily absorbed within the intestine and there's nearly 100 per cent bioavailability and top plasma concentration is reached within three hours. It isn't notably metabolized and is excreted unchanged in the urine. The damaging consequences which might be related to the use of Levetiracetam are fatigue, anorexia, diarrhoea, trade in weight, double vision, hepatitis and pancreatitis and others.

The third drug this is administered to the affected person for the put up-demanding melancholy that she has been recognized is Mirtazapine. It belongs to the class of drug that is a tetracyclic antidepressant and is frequently prescribed for the sufferers who have most important depressive signs. Different symptoms of the drug encompass generalized panic, tension, anxiety complications, put up-traumatic stress sickness, sleeplessness and others. It acts on alpha-2 adrenergic receptors each auto and hetero within the central nervous system. The symptom of depression is alleviated by using more suitable functioning of noradrenergic and serotonergic activity. It increases the transmission of dopamine by means of acting as an antagonist at the dopamine receptors. Whilst administered orally, the bioavailability is 50 per cent and the height concentration of blood is attained within 2 hours. It has high binding to plasma protein and is metabolized within the plasma and is especially excreted by way of the kidneys. There are a few negative consequences that are related to the management of mirtazapine and they are drowsiness, weight gain, xerostomia, fatigue, weakness and others.

Within the present case of Jolene, it is seen that within the current visit she contemplated that she believes that she is pregnant and after the test, her general practitioner confirmed that she was pregnant and turned into the first trimester of her being pregnant. the first intervention that requires to be executed is to ensure that the medication which are given to the patient are re-evaluated as there may be adverse outcomes that are related to the administration of the drug. The first drug that become administered turned into heparin which changed into for the diagnosis of deep vein thrombosis. The connection amid deep vein thrombosis and being pregnant is profound. Because of the accident, the affected person has already developed the circumstance and pregnancy, in addition, will increase the risk of blood clots and the risk of deep vein thrombosis increases. There are different factors which might be related to the development of deep vein thrombosis in the course of being pregnant like varicose veins, diabetes, urinary tract infection, age of gestation and parity. To reduce the probabilities of miscarriage, throughout pregnancy, the blood of the affected person reaches the state of hypercoagulability and with the history of Deep vein thrombosis, the threat of blood clot will increase. The patient is already administered with heparin as an anticoagulant in ordinary instances of pregnancy it is seen that the use of anticoagulant has created no distinction however with records, it is essential that heparin therapy endured.

Jolene is recognized with person-onset epilepsy for that is given medicine Levetiracetam. The drug is thought to have a carcinogenic impact and throughout being pregnant, it has teratogenicity effect. The maximum not unusual final results impact that may be visible is the formation of neural tube disorder and early bleeding that is visible in neonates. It also interacts with the folic acid and vitamin k that is typically given as supplementation throughout the being pregnant and minimizes the beneficial effect of the identical at the fetus. The pharmacological effect of the drug can cause exaggeration of the seizure interest at some point of being pregnant. Seizures all through the being pregnant can cause untoward final results for the fetus and depend at the development of being pregnant it can wither motive miscarriage or pre-time period labour. The medication should be regulated and prevented during the phase of organogenesis which is visible throughout the second one trimester. Epileptic attack can arise while there are stress and childbirth may be traumatic and it is often suggested that the affected person is given anti-epileptic medicine before delivery so that the seizure may be avoided in the course of childbirth and the baby is not always affected.

The third intervention this is most importantly required is affected person education and referral that is required for the affected person-focused approach as properly. The care plan and referral need to be such that it is custom-designed to the desires of the affected person taking into consideration the ideas and possibilities. The affected person is regularly visiting her preferred practitioner for her follow-ups is compliant in the direction of her medicine. The general practitioner needs to train the affected person regarding the implication of her circumstance and the way the medication may have an impact on her health as well as that of her infant. The GP need to inform her concerning the things that she may need to avoid and be precautionary of throughout the path of her pregnancy. The right referral is a part of individual-centred care approach and in the present case, it is required that the patient is cited obstetrics and gynaecologist so that suitable supplements and alteration to her regular medicinal drug in terms of dose and frequency can be made. within the current visits, the affected person stated she is depressed through the healing that is taking place and pregnancy can add to the stress and it is required that the affected person is noted a psychologist.


The prevailing case changed into of Jolene who had a history of an accident which had brought on her deep vein thrombosis, post-traumatic epilepsy and ultimately her depression. She was given medication for the identical and she was taking follow-up with her general practitioner. Fracture in her leg induced the formation of the clot which become accountable for the deep vein thrombosis while the injury to the frontal or temporal lobe was associated with the seizure. Now the affected person is pregnant and it is required that the medication that is given is evaluated which is custom designed to the wishes of the patient. She calls for referral to the gynaecologist for the same and to a psychologist for the treatment of her depression.


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