Chapter 21
You are the nurse in the same-day surgery center at a local hospital. You are assigned to call patients 2
days before their procedures to educate them and answer any questions they may have about their
upcoming procedures. Mrs. Smith is a 65-year-old woman who will be coming in to have her gallbladder
removed (cholecystectomy) in 2 days. You obtain a full history on the patient and find she has the
following medications prescribed: Coumadin, 2-mg dose according to INR; 1000-mg fish oil supplements;
one multivitamin; and Pepcid, 10 mg once a day.
1.
Which substances should you be concerned with at this time?
The substances that I should be concerned with are Coumadin, fish oil and the multivitamin.
2.
The patient asks which medications she should take the day of the procedure. How should you
advise this patient?
I would advise the patient to take the Pepcid. The Coumadin intake creates a great risk for
bleeding issues during surgery so I would advise against taking that particular drug five days
before surgery. The fish oil contains omega-3 fatty acids. Omega-3 fatty acids reduce platelet
aggregation as well as reducing thrombosis. Because of those factors, I would advise against
taking fish oil before entering into surgery. Furthermore, many multivitamins contain vitamin E.
Vitamin E can increase the patient’s risk of bleeding and for that reason I would recommend
that she does not take vitamin E the day of her surgery. I would advise her to take the Pepcid.
3.
The patient has the procedure and is ready to be discharged. You are discussing diet and drugfood interactions with the patient. Based on the patient’s medication profile, how will you
advise this patient?
I would advise the patient that because she takes Coumadin, she should be mindful of taking
certain multivitamins, enteral feedings and food that are rich in vitamin K. I would advise her
that these things can interfere with the effectiveness of Coumadin. I would also advise her to
keep he intake of vitamin K consistent. Also, I would advise her that alcohol use can increase
her risk for hypopro-thrombinemia. Furthermore, I would advise against smoking or sudden
cessation from smoking because it may alter the therapeutic effect of Coumadin. In regards to
Pepcid, I would advise her that she should monitor alcohol use because it may have an
agonistic effect on blood alcohol level. Also, taking antacids may affect the absorption of
Pepcid. In regards to multivitamins I would have her consult her prescriber. Multivitamins—
depending on their components, may have ingredients that are contraindicated by her drug
regimen. Consulting her prescriber will give allow her to gain a better understanding of the
components in her multivitamin and how they may interact with her food/drug regimen. In
regards to fish oil, I would consult the prescriber because of its potential effects on increasing
your bleeding risk when taking Coumadin.