LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit.
PMH:
- HTN
- Alzheimer’s disease
- Hypothyroidism
- Osteoarthritis
- Diabetes
MEDICATIONS:
- Amlodipine 10 mg QD
- Donepezil 10 mg QHS
- Levothyroxine 0.88 mg QAM
- Celecoxib 200 mg QD
- Furosemide 40 mg QAM
- Metformin 500mg, 1 BID
- Glyburide 5mg, 1 BID
ALLERGIES: NKA
SOCIAL HISTORY:
Widowed with 2 adult children living in town, retired photographer and owner of an art supply store
VITALS: LABS:
Weight: 129 lbs TSH 2.45 Free T4 0.98
Height: 64 inches Na 135, K+ 3.8, Cl 99, CO2 25,
BP: Supine = 177/82 Glucose 101, SCr 0.9, BUN 42
HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1
Plt 255
Cr: 1.6 UA: Clear
eGFR: 45 ml/min
PE:
- HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranes
- CV: RRR
- Respiratory: Clear to auscultation bilaterally
- Abdomen: Soft, non-tender, no masses or guarding
- G/U: Skin intact, assisted with toileting and personal hygiene by staff
- Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm
- Neuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months.
PAIN ASSESSMENT:
Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to severe
2- to 3-page and following:
- Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
- Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
- Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvement
References x 3 including :
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier
