NURS 6521 Advanced Pharmacology Case Study Essay

NURS 6521 Advanced Pharmacology Case Study Essay

NURS 6521 Advanced Pharmacology Case Study Essay

 

The case study is of a 68-year-old male patient who was admitted with a diagnosis of Community-acquired pneumonia. The patient has a past medical history of COPD, hypertension, hyperlipidemia, and diabetes. He is currently on the third day of IV Ceftriaxone 1 gm and IV Azithromycin 500 mg and is allergic to penicillin. His clinical condition has improved, but he cannot tolerate a diet due to nausea and vomiting. The purpose of this paper is to discuss a treatment regimen and health education plan for this patient based on his health needs.

The patient’s health needs include decreased dietary intake, which is evidenced by the patient, not tolerating diet due to nausea and vomiting. The patient has limited airflow as a result of COPD, which also predisposes the patient to respiratory infections such as pneumonia. High blood pressure as evidenced by history of hypertension and high levels of low-density lipoproteins, which have caused hyperlipidemia. He also has uncontrolled blood glycemic levels and reduced sensitivity of body cells to insulin, which has resulted in Diabetes.

Antiemetic medication: I will recommend Metoclopramide 10 mg IV QID to be administered 30 minutes before meals and during bedtime. Metoclopramide acts by increasing motility in the upper gastrointestinal tract and increasing the lower esophageal sphincter tone hence reducing vomiting.

Antihypertensive medication: To lower blood pressure, I will recommend Hydrochlorothiazide (HCTZ) 12.5 mg PO once daily. HCTZ is a thiazide diuretic that increases excretion of potassium and bicarbonate and decreases excretion of calcium and retention of uric acid (Weber et al., 2014). Thiazide diuretics are recommended in the initial management of hypertension and can be used as monotherapy or in combination with drugs from other antihypertensive classes.

Lipid-lowering agents: I will recommend Lipitor 20 mg PO once a day. Lipitor is a HMG-CoA reductase inhibitor that inhibits the rate-limiting step in the biosynthesis of cholesterol hence lowering cholesterol levels in the body (Würtz et al., 2016). HMG-CoA inhibitors are the most effective agents in lowering low-density lipoproteins in the blood and will be the best for this patient.

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Antidiabetic medication: The drug of choice to manage Diabetes will be Metformin 850 mg PO OD, to be taken with meals. Metformin

acts by lowering hepatic glucose production and decreasing the absorption of glucose in the GI (Rena, Hardie & Pearson, 2017). It also increases the sensitivity of body cells to insulin; hence, it will be effective in maintaining glycemic control in the patient. Metformin is preferred in the management of Diabetes in overweight patients as it does not have side effects of weight gain (Rena, Hardie & Pearson, 2017). It will be the most suitable drug since the patient has hyperlipidemia.

Stop IV Azithromycin and change to oral therapy of Azithromycin 500 mg once daily for 5 days since the patient has shown improvement.  Continue with IV Ceftriaxone 1 gm. QDay up to the 5th day.

Patient Education Strategy

The patient education strategy will be on lifestyle modification to manage and prevent complications of COPD, hypertension, hyperlipidemia, and Diabetes. The patient has chronic illnesses that are mostly caused by an unhealthy lifestyle. For instance, smoking is a major risk factor that predisposes individuals to COPD, which is a prevalent condition in smokers. I will educate the patient on the effects of smoking, such as predisposing a person to respiratory diseases, hypertension, neuropathy, and diabetic foot problem in people with Diabetes (Weber et al., 2014). I will advise him on cessation of smoking to avoid worsening of COPD symptoms, lower blood pressure, and prevent diabetic complications.

Nutrition counseling will be part of the education strategy and will entail educating the patient on the type of diet to promote weight loss, lower hypertension, and normal glycemic levels.   I will recommend the DASH diet, which will help to lower blood pressure and cholesterol levels and maintain a healthy weight (Paula et al., 2015). The DASH diet recommends high servings of whole grains, vegetables, fruits, nuts, and legumes. Fewer servings of dairy products, poultry, fish and lean meat, sweets, fat, and oils (Paula et al., 2015). I will advise the patient to limit his intake of sodium, caffeine, and alcohol to lower blood pressure and blood cholesterol levels.

Advising the patient to engage in physical exercises to promote weight loss, lower blood pressure, and boost the body’s immune system (Weber et al., 2014). I will plan with the patient a daily exercise plan that will include jogging, walking, and running for about 40 minutes a day. Further, I will also advise him to be going to the gym regularly and avoid having a sedentary lifestyle.

Case study 1 HH is a 68 yo M who was admitted with Community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3)and azithromycin 500mg IV qday(day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of n/v. Ht: 5’8” Wt: kg. Allergies: Penicillin(rash) Post a description of pt. health needs,be specific, explain type of treatment regimen you will recommend, include the choice or pharmacotherapeutics you will recommend and explain why, justify response. Explain a pt. education strategy you will recommend for assisting patient with management of his health. Be specific and provide examples.

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