Homework: Cardiovascular System
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:
a. HTN
b. Alzheimer's disease
c. Hypothyroidism
d. Osteoarthritis
e. Diabetes
MEDICATIONS:
a. Amlodipine 10 mg QD
b. Donepezil 10 mg QHS
c. Levothyroxine 0.88 mg QAM
d. Celecoxib 200 mg QD
e. Furosemide 40 mg QAM
f. Metformin 500mg, 1 BID
g. 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:
a. HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranes
b. CV: RRR
c. Respiratory: Clear to auscultation bilaterally
d. Abdomen: Soft, non-tender, no masses or guarding
e. G/U: Skin intact, assisted with toileting and personal hygiene by staff
f. Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm
g. 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 pages and following:
a. Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
b. Describe how changes in the processes might impact the patient's recommended drug therapy. Be specific and provide examples.
c. Explain how you might improve the patient's drug therapy plan and explain why you would make these recommended improvement
Format your homework according to the give formatting requirements:
a. The answer must be double spaced, typed, using Times New Roman font (size 12), with one-inch margins on all sides.
b. The response also includes a cover page containing the title of the homework, the course title, the student's name, and the date. The cover page is not included in the required page length.
c. Also include a reference page. The references and Citations should follow APA format. The reference page is not included in the required page length.
References:
a. Rosenthal, L. D., & Burchum, J. R. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.