Ms Sabina Witloff, aged 72 years, is being discharged on warfarin. She normally administers her medications from a Webster pack that the pharmacist makes up for her each month. She has said that she is concerned as to how she will work out her warfarin doses each week after her blood test. She has been provided with three containers of warfarin (Coumadin [1mg, 2mg, 5mg]). Provide education for Ms Witloff to safely calculate and administer her doses of warfarin (her discharge dose will be 7.5mg; also include the following example doses in the education – 3mg, 12.5mg) at home.

2. Ms Jane Watkins, aged 70 years, is being discharged on furosemide for her hypertension. The frequency of the dose has increased from 20mg daily to 20mg bd. She is concerned this medication may interfere with her social life which is still quite active. Ms Watkins is a member of a local walking club to which she walks locally three times a week. She is also a member and attends the local lawn bowls club twice a week. As an example, Ms Watkins lives approximately 40kms from Melbourne and must travel to the city for a 9am outpatient’s appointment every two months, causing great anxiety when needing to find a toilet in a hurry. Provide patient-centred medication education for Ms Watkins related to furosemide and her concerns.

3. It is 0800 hours on the cardiac ward, and you are caring for Mr James Whitaker, aged 63 years, day 3 post cardiac surgery. Mr Whitaker has a past medical history of ischaemic heart disease and hypertension. He has a sensitivity to beta blocker medication which causes severe bradycardia. Last evening, Mr Whitaker developed atrial fibrillation (AF) and commenced on amiodarone. He is currently ordered to be given his second dose of 600mg oral amiodarone at 0800hrs for his AF. His current vital signs are BP (105/75mmHg); HR (60bpm and irregular); RR (16bpm); T (36.5oC). Speak with the cardiac surgical registrar about your concerns in administering the amiodarone.