LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls

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:

  • HTN
  • Alzheimer’s disease
  • Hypothyroidism
  • Osteoarthritis
  • Diabetes

MEDICATIONS:

  • Amlodipine 10 mg QD
  • Donepezil 10 mg QHS
  • Levothyroxine 0.88 mg QAM
  • Celecoxib 200 mg QD
  • Furosemide 40 mg QAM
  • Metformin 500mg, 1 BID
  • 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:

  • HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranes
  • CV: RRR
  • Respiratory: Clear to auscultation bilaterally
  • Abdomen: Soft, non-tender, no masses or guarding
  • G/U: Skin intact, assisted with toileting and personal hygiene by staff
  • Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm
  • 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-page and following:

  • Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
  • Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
  • Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvement

References x 3 including :

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier

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