Assignment task:
AD is a 79-year-old woman brought from a nursing home to the emergency department for evaluation of altered mental status. The staff has noticed changes evolving over the past few weeks, but now she is unable to eat or take fluids without assistance. About 1 month ago she was able to feed herself. The clinician covering the long-term care facility is worried about the need for enteral or parenteral feedings.
Past Medical History: HTN, Hyperlipidemia; Hypothyroidism; Allergic rhinitis; Urinary tract infection;
Osteoarthritis; Presbycusis; Constipation/diarrhea intermittently
Medications Lisinopril, 20 mg orally once daily Atenolol, 50 mg orally once daily Lovastatin, 20 mg orally once daily Hydrochlorothiazide, 25 mg orally once daily Cetirizine, 10 mg orally once daily; Levothyroxine, 100 mcg orally once daily; Diphenoxylate/atropine, 2.5 mg orally every 12 hours as needed for diarrhea; Melatonin, 5 mg orally before bed; Acetaminophen, 500 mg 2 tablets orally every 6 hours as needed for pain; Diphenhydramine, 25 mg orally every 6 hours as needed for agitation; Amoxicillin/clavulanate, 500 mg/125 mg orally three times a day for a recent bladder infection; Lorazepam, 1 mg orally before bed as needed for sleep; Multivitamin
Physical Examination: Blood pressure: 82/50; pulse: 108; respiration rate: 16; temperature 97.2 °F; Cachectic female without contractures; Awake but nonresponsive; Lungs: Bilateral scattered rhonchi; Heart regular rate and rhythm, grade I systolic murmur; Stage I decubitus ulcer over the coccyx
Labs and Imaging: Complete blood count (CBC): Normal; Albumin: 2.8 mg/dL
Questions: The patient's renal and hepatic functions are relatively normal, but her albumin is low. How will this affect her medication regimen?