Nursing ASSIGNMENT: CASE STUDIES
Nursing ASSIGNMENT: CASE STUDIES
ANSWER
To address each scenario effectively, I’ll provide a structured response including the treatment plan and prescription details based on clinical guidelines and the patient’s specific conditions.
Scenario 1: Sara
Problem: Elevated blood pressure.
Goal for Blood Pressure: The goal blood pressure for Sara should be <140/90 mmHg, or even lower if she has comorbid conditions like diabetes or chronic kidney disease.
Medication and Prescription: Given Sara’s blood pressure of 160/90 mmHg and her history of hypertension, I would prescribe an antihypertensive medication. Based on clinical guidelines, a suitable initial medication could be:
- Medication: Amlodipine 5 mg PO daily
- Route: Oral
- Frequency: Once daily
- Special Instructions: Take with or without food.
- # Dispensed (Days Supply): 30 tablets
- Refills: 1
Education:
- Advise Sara on the importance of medication adherence.
- Educate her on lifestyle modifications including dietary changes (e.g., DASH diet), regular physical activity, smoking cessation if applicable, and limiting alcohol intake.
- Instruct her on self-monitoring blood pressure at home and when to seek medical attention for elevated readings or adverse effects.
Scenario 2: Monty
Problem: Dyslipidemia (high cholesterol levels).
Goals for Lipid Profile:
- Total Cholesterol (TC): <200 mg/dL
- LDL Cholesterol (LDL-C): <100 mg/dL (or <70 mg/dL if high-risk)
- HDL Cholesterol (HDL-C): >40 mg/dL for men
Treatment Plan:
- Medication: Atorvastatin 40 mg PO daily (based on high LDL-C)
- Route: Oral
- Frequency: Once daily
- Special Instructions: Take in the evening; may take with or without food.
- # Dispensed (Days Supply): 30 tablets
- Refills: 1
Monitoring Effectiveness:
- Follow up with lipid panel after 6-12 weeks to assess response to therapy.
- Monitor liver function tests periodically due to potential hepatotoxicity with statins.
Risk Factors for Coronary Artery Disease (CAD):
- Smoking (1 risk factor)
- Elevated LDL-C
- Hypertension (if present)
Scenario 3: Beatrice
Problem: Suboptimal asthma control.
Treatment Plan:
- Medication Changes:
- Increase Flovent HFA to 110 mcg, two puffs BID (from 44 mcg) for better control of persistent asthma.
- Continue Proventil HFA as needed for acute symptoms.
- Consider adding a long-acting beta agonist (LABA) such as salmeterol if symptoms are not controlled with current therapy.
- Education:
- Review proper inhaler technique.
- Discuss asthma triggers and avoidance strategies.
- Provide an asthma action plan for monitoring symptoms and adjusting medications.
Monitoring Effectiveness:
- Assess asthma symptoms and frequency of rescue inhaler use.
- Perform spirometry or peak flow measurements to monitor lung function.
Scenario 4: Daute
Problem: Chronic obstructive pulmonary disease (COPD) exacerbation.
Treatment Plan:
- Medication:
- Restart salmeterol/fluticasone (Advair Diskus) one inhalation twice daily for maintenance therapy.
- Consider adding short-acting bronchodilators (e.g., albuterol) for acute exacerbations as needed.
- Route: Inhalation
- Frequency: Twice daily (for Advair), PRN for albuterol
- Special Instructions: Rinse mouth after Advair use to prevent oral thrush.
- # Dispensed (Days Supply): 1 Advair Diskus (30-day supply), albuterol MDI as needed
- Refills: 1
Monitoring Effectiveness:
- Evaluate symptom improvement, reduction in exacerbations, and increase in exercise tolerance.
- Perform pulmonary function tests periodically to assess lung function and response to therapy.
By following these structured treatment plans and prescriptions based on clinical guidelines and patient-specific factors, you can effectively manage the conditions presented in each scenario while ensuring patient safety and optimal therapeutic outcomes.
QUESTION
For your week 4 assignment, evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
To Prepare:
· Review the case studies and answer ALL questions.
· When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.
· Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website and JNC 8 to complete assignment.
· Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.
Week 4 Assignment:
Directions: For each of the scenarios below, answer the questions below using clinical practice guidelines where applicable. Explain the problem and explain how you would address the problem. If prescribing a new drug, write out a complete medication order just as you would if you were completing a prescription. Use at least 3 sources for each scenario and cite sources using APA format.
· Sara is a 45-year-old female presenting for her annual exam. Her blood pressure today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal for her blood pressure? What medication would you prescribe to treat her blood pressure? What education would you prescribe?
•Monty is a 52-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan would you implement for Monty’s lipid profile? What is the goal Total Cholesterol (TC), HDL-C, and LDL-C level for Monty? How would you monitor the effectiveness of your treatment plan? How many risk factors for coronary artery disease does this patient have? Identify them specifically.
•Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days per week over the past 2 months. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough three nights during the last month. She is becoming more short of breath with exercise. She also has a fluticasone MDI, which she uses “most days of the week.” Her current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA two puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80 mg PO BID. What treatment plan would you implement for this patient? What medication changes would you make? How would you monitor the effectiveness of this plan?
•Daute is a 56-year-old man seeking evaluation for increasing shortness of breath. He noticed difficulty catching his breath about 3 years ago. Physical activity increases his symptoms. He avoids activity as much as possible to prevent any SOB. His previous physician had placed him on salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He did not refill the prescription and has not been taking it. Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12 months of treatment with oral antibiotics. He has a 40-pack-year smoking history. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?
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