Problem: Describe your assigned client's situation. Why are they presenting to the clinic? What medications are they currently taking?
My assigned client is Oisin Donahey. He is 80 years old and lives in a residential nursing home where there is currently an outbreak of influenza A and B. He is not actually sick right now, which is important. He has no symptoms, his flu test is negative, and his vital signs are stable. The concern is that he is in a high-risk environment and, because of his age and diabetes, he could get very sick if he catches the flu. His history includes high cholesterol and type 2 diabetes. His medications are atorvastatin 40 mg daily, aspirin 81 mg daily, and metformin 500 mg twice daily. He also has a penicillin allergy.
Discuss your personal professional assessment of the client's situation provided in the scenario. What pharmacological treatment is necessary and why?
For me, this situation is really about prevention. Oisin does not need treatment for the flu because he does not have it right now, but I do think prophylaxis makes sense because influenza is already spreading in the facility. At 80 years old, even a "simple" flu infection can turn into something serious, especially with diabetes. I would use oseltamivir 75 mg by mouth once daily during the outbreak to help lower his risk of getting influenza. I would also allow generic substitution since generic oseltamivir is appropriate and may be cheaper. His penicillin allergy does not change this plan, and I do not see anything in his current medication list that would automatically rule out oseltamivir.
Reflect on additional questions you have about your assigned client that may influence treatment. What else do you want to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?
The main thing I would want before starting the medication is his kidney function. I would assess his serum creatinine and eGFR or creatinine clearance because oseltamivir may need to be adjusted if his renal function is decreased. Since he is older and also takes metformin, that information matters. I would also want to know if he received this season's flu shot and whether he has had close contact with any residents or staff who tested positive. For follow-up, I would ask the nursing home staff to watch for early symptoms like fever, cough, sore throat, body aches, fatigue, poor appetite, confusion, or just not acting like himself. I would also want them to monitor for side effects like nausea, vomiting, or headache and to let the provider know quickly if anything changes. I would also make sure staff know when to notify the provider and reinforce the importance of medication adherence and infection control precautions in the facility.
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