NUR 611 Module 6 Discussion Case 6
University:
St. Thomas University
NUR 611 Module 6 Discussion Case 6
Paper Instructions
Mrs. P. is an 80-year-old woman recently discharged from a 24-hour observation stay at the hospital after being diagnosed with acute bronchitis. She has a history of heart failure, hypertension, osteoarthritis, GERD, and hyperlipidemia. She has no history of smoking. While in the hospital she was prescribed doxycycline, prednisone 15 mg to taper, and a tiotropium inhaler.
Her current list of daily medications prior to hospitalization includes metoprolol succinate 12.5 mg, pantoprazole 40 mg, atorvastatin 10 mg, lisinopril 10 mg, furosemide 40 mg, potassium chloride 20 meq bid, acetaminophen 650 mg bid for pain and tramadol 25 mg as needed. She lives alone but will reside temporarily with her daughter while she recovers.
Her discharge report indicated resolving bronchitis, no exacerbation of heart failure, and stable arthritic pain. Today she reports 1 week after discharge with her daughter for a primary care appointment, and they both were concerned about the number of medications she was prescribed and wanted her medications reviewed.
In further review, she was found to have lost weight over the past 6 months of 5 lbs and her current BMI is 25. She states that the weight loss may be due to a change to a healthier diet and reducing sodium as instructed. She also reports no symptoms of GERD for the past 6 months and minimal arthritic pain because of regular use of acetaminophen and daily walking in the halls of her independent living facility.
Upon examination her lungs are clear to auscultation and no evidence of lower extremity edema.
Discuss the following:
- In reviewing her medication list and current symptoms and clinical signs, which medication could the nurse practitioner consider de-prescribing.
- Once the patient has completed the prednisone taper, which medication could the nurse practitioner begin to reduce given the patient’s reported symptoms.
- Given the absence of an exacerbation of heart failure and compliance with a reduced sodium diet, what other medication(s) adjustments could the nurse practitioner consider at this time.
Submission Instructions
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
We Work Hard So That You Don’t
We’ll write a 100% plagiarism-free paper in under 1 hour.
Sample Answer
1. In reviewing her medication list and current symptoms and clinical signs, which medication could the nurse practitioner consider de-prescribing?
Upon reviewing the patient’s medication list, symptoms, and clinical signs, the nurse practitioner may consider discontinuing the use of tramadol and pantoprazole.
Considering the patient’s consistent use of acetaminophen and daily walking, it is advisable to discontinue tramadol, an opioid pain reliever, as she reports minimal arthritic pain (Muhn et al., 2022). In addition, it may be appropriate to discontinue the use of pantoprazole for the patient, as there have been no reported symptoms of GERD in the past six months.
The patient’s BMI of 25 falls within the normal range. Thus, it is probable that there has been a decline in the demand for pantoprazole. The nurse practitioner could provide a thorough discussion on the advantages and potential drawbacks of discontinuing the use of pantoprazole and tramadol.
Additionally, she would closely observe any potential reoccurrence of GERD symptoms and arthritis-related issues.
2. Once the patient has completed the prednisone taper, which medication could the nurse practitioner begin to reduce, given the patient’s reported symptoms?
The patient is asymptomatic for heart failure, and her blood pressure is currently within normal limits, indicating the need for a reduction in the dosage of metoprolol succinate (Reeve et al., 2020). Given the patient’s diagnosis of acute bronchitis, it is possible that doxycycline, an antibiotic, was prescribed to address a bacterial infection.
Consequently, it may be necessary to adjust the dosage of doxycycline accordingly. It may be unnecessary to continue the antibiotic treatment as her bronchitis has cleared up. It is important to adhere to the prescribed duration of antibiotic treatment in order to ensure effectiveness. However, once the full course has been completed, it is safe to discontinue the medication.
Another medication that the nurse practitioner may consider reducing is Furosemide. Furosemide is a type of loop diuretic that clinicians give to treat fluid retention and edema in people with heart failure. According to the physical exam, there are no signs of swelling or blockage in the patient’s lower extremities. This indicates that she may have had excessive diuresis due to the use of furosemide.
The healthcare provider should evaluate her serum electrolytes, blood pressure, and kidney function. One option for the nurse to consider is switching to a less potent diuretic, like hydrochlorothiazide, or reducing the dosage of furosemide.
3. Given the absence of an exacerbation of heart failure and compliance with a reduced sodium diet, what other medication(s) adjustments could the nurse practitioner consider at this time?
The healthcare provider may need to adjust the dosage of furosemide or discontinue it due to the lack of evidence of worsening heart failure and adherence to a low-sodium diet. Furosemide effectively treats fluid retention in heart failure patients, but the patient has been following a low-sodium diet, resulting in stable heart failure.
The carer should reassess the necessity of furosemide and consider reducing or discontinuing its use to prevent dehydration and maintain electrolyte balance. Additionally, the nurse may consider augmenting the dosage of lisinopril, an ACE inhibitor, alongside the reduction of furosemide if well-tolerated (Reeve et al., 2020).
Healthcare providers must assess the patient’s condition, involve the patient and her daughter in the decision-making process, and weigh the risks and benefits before making any adjustments.
References
- Muhn, S., Amin, N. S., Bardolia, C., Del Toro-Pagán, N., Pizzolato, K., Thacker, D., Turgeon, J., Tomaino, C., & Michaud, V. (2022). Pharmacogenomics and Drug-Induced Phenoconversion Informed Medication Safety Review in the Management of Pain control and Quality of Life a case report. Journal of Personalized Medicine, 12(6), 974. https //doi.org/10.3390/jpm12060974
- Reeve, E., Jordan, V., Thompson, W., Sawan, M., Todd, A., Gammie, T. M., Hopper, I., Hilmer, S. N., & Gnjidic, D. (2020). Withdrawal of antihypertensive drugs in older people. Cochrane Library, 2020(6). https //doi.org/10.1002/14651858.cd012572.pub2
We Work Hard So That You Don’t
We’ll write a 100% plagiarism-free paper in under 1 hour