The patient is malnourished and has a low serum albumin. The physician has ordered aspirin, a highly protein-bound drug, for the patient. Which evaluation by the nurse best describes the effect this will have on the patient?
1. The patient will be at risk to experience a decreased effectiveness of the drug.
2. The patient will be at risk to experience toxic effects of the drug.
3. The patient's kidneys will excrete the drug at a faster rate.
4. The patient's serum globulin is more important than serum albumin.
2
Rationale 1: Effects from the drug will not be decreased because there is less protein for aspirin to bind with and more free drug available.
Rationale 2: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic effects from the drug because there is less protein for aspirin to bind with and more free drug available.
Rationale 3: The kidney will not be able to balance the amount of the drug and excrete it at a faster rate.
Rationale 4: Serum albumin plays a major role, more than serum globulin.
Global Rationale: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.
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