2
Course Project Case Study
Group2
Ms. Jones is a 92-year-old widowed, Caucasian resident of an assisted living facility. She has one offspring of male gender who lives nearby with type 1 diabetes. Ms. Jones owned a grocery store with her deceased husband for 30 years and is now retired. She has a plethora of ailments including osteoarthritis, COPD, dementia, asthma, and is legally blind. Ms. Jones was an avid smoker for 60 years and seemingly asks for a cigarette as a result of her dementia. Ms. Jones is a x1 assist with full motor and ambulatory abilities. She is continent of bowel and bladder and ingests her medications crushed with the assistance of applesauce. The client has recently complained of shortness of breath accompanied with a productive cough. She has since been diagnosed with pneumonia and clostridioides difficile (c.diff.) following multiple rounds of antibiotics. The client wears dentures and has Voltaren gel BID for chronic bilateral knee pain. Client has a diet consisting of nectar thick liquids and pureed foods. The client’s religion and or beliefs are unknown. Client is DNR via advanced directives. The client’s current medications are as listed below in table form. The table below includes medication route, side effects, diagnosis, assessments, and client education.
Medications
Drug Name Trade & generic name, dose, route & frequency |
Pharmacological & therapeutic drug class & |
What medical diagnosis is your patient taking this drug for? How will it help them? |
Side Effects & Adverse Reactions/ Complications/Top drug interactions |
Nursing Administration Special Instructions & Assessments |
Client Education Evaluation of Medication Effectiveness (e.g., Pain Scale) |
Memantine 5 mg PO daily |
Pharmacological Class – NMDA receptor antagonist Therapeutic Class – Anti-dementia. Expected Action – Memantine blocks NMDA receptors to control glutamate, a learning and memory neurotransmitter. It manages Alzheimer’s disease dementia symptoms. |
Medical Diagnosis – Dementia Benefit – Memantine improves cognition and slows dementia in Alzheimer’s patients. |
Side effects include dizziness, constipation, headache. |
Administer with or without meals; test cognitive performance frequently. |
Memory and orientation tests may evaluate cognitive progress. |
Acetaminophen | Tylenol, 650 mg, PO, every 6 hours PRN |
Pharmacological Class – Analgesic, Antipyretic, Therapeutic Class – Non-opioid analgesic. Expected Action: Acetaminophen blocks the production of prostaglandins in the central nervous system, hence reducing pain and fever. |
Medical Diagnosis – Pain, Fever. Benefit – Acetaminophen relieves pain and fever, which Ms. Jones needs for her chronic knee discomfort. |
The side effects are rare but sometimes might cause rashes or even liver toxicity when taken overdose. The medication may interact with other drugs to affect the liver. |
Do not exceed maximum daily dosage. |
Before and after medicine, measure pain. |
Albuterol Inhaler | ProAir HFA, 180 mcg, every 6 hours PRN with spacer |
Pharmacological Class – Beta2-adrenergic agonist, Therapeutic Class—Bronchodilator. Expected Action – Albuterol relaxes airway smooth muscles, bronchodilating and improving airflow in asthma and COPD. |
Medical Diagnosis – Asthma, COPD. Benefit – Albuterol quickly relieves acute bronchoconstriction and manages asthma and COPD symptoms. |
Side effects of the medication include tremors, nervousness, tachycardia. The medication can cause possible arrhythmias, and even increased heart beat rate. It interacts with beta-blockers. |
Teach correct inhaler technique and evaluate respiratory condition before and after delivery. |
Evaluate asthma/COPD symptoms and breathing improvement. |
Vancomycin | Vancocin, 125 mg, PO, QID for 10 days |
Pharmacological Class – Glycopeptide antibiotic, Therapeutic Class – Antibacterial. Expected Action – Vancomycin inhibits bacterial cell wall formation, making it helpful against gram-positive bacterial infections like C. difficile. |
Medical Diagnosis – Bacterial Pneumonia, C. difficile infection. Benefit – Vancomycin fights germs that cause pneumonia and C. difficile infection. |
Red man syndrome, nausea, vomiting is some of the side effects. The medication reaction is ototoxicity, and renal toxicity. The medication may interact with other ototoxic medications and nephrotoxic drugs. |
Assess red man syndrome, renal function, and medication levels. |
Monitor C. difficile and bacterial pneumonia resolution. |
Montelukast | Singulair, 10 mg, PO qHS daily |
Pharmacological Class – Leukotriene receptor antagonist, Therapeutic Class – Anti-asthmatic. Expected Action – In order to prevent asthma from becoming asymptomatic, the government has banned the use of the term “assembly” in the United States. |
Medical Diagnosis – Asthma. Benefit -Montelukast reduces asthma episodes and improves breathing. |
Abdominal pain and headache are among the side effects. Adverse reactions include neuropsychiatric events, and mood changes. The drug can interact with specific anti-seizure medication |
Administer at night and watch for mood or behavior changes. |
Asthma symptoms and attacks should improve. |
Memantine (N-Methyl-D Aspartate Agonist
PURPOSE OF MEDICATION
Binds to CNS N-methyl-D-aspartate (NMDA) receptor sites, preventing binding of glutamate, an excitatory neurotransmitter. Binds to CNS N-methyl-D-aspartate (NMDA) receptor sites, preventing binding of glutamate, an excitatory neurotransmitter.
Expected Pharmacological Action
Binds to CNS N-methyl-D-aspartate (NMDA)receptor sites, preventing binding of glutamate, an excitatory neurotransmitter.
Complications
Dizziness, fatigue, sedation, hypertension, headache, rash, diarrhea,
anemia, urinary frequency, weight gain
Contraindications/Precautions
Hypersensitivity. Severe renal impairment (↓ dose); Severe hepatic impairment; Concurrent use of other NMDA antagonists (amantadine, rimantadine, ketamine, dextromethorphan); Concurrent use of drugs or diets that cause alkaline urine; Safety and effectiveness in children not established.
Interactions
Drug-Drug: Medications that ↑ urine pH (e.g., carbonic anhydrase inhibitors, sodium bicarbonate) may↓ excretion and ↑ blood levels.
Medication Administration
PO (Adults): Immediate-release—5 mg once daily initially, ↑ at weekly intervals to 10 mg/day (5 mg twice daily), then 15 mg/day (5 mg once daily, 10 mg once daily as separate doses), then to target dose of 20 mg/day (10 mg twice daily); Extended-release—7 mg once daily, ↑ at weekly intervals by 7 mg/day to target dose of 28 mg once daily.
Evaluation of Medication Effectiveness
Improvement in neurocognitive decline (memory, attention, reasoning, language, ability to perform simple tasks) in patients with Alzheimer’s disease.
Therapeutic Use
Decreased symptoms of dementia/cognitive decline. Does not slow progression.
Nursing Interventions
PO: May be administered without regard to food.
Administer oral solution using syringe provided. Do not dilute or mix with other fluids.
DNC: Swallow extended-release capsules whole; do not crush, chew, or divide. Capsules may be opened, sprinkled on applesauce, and swallowed. Entire contents of each capsule should be consumed; do not divide dose.
Client Education
Instruct patient and caregiver on how and when to administer memantine and how to titrate dose. Take missed doses as soon as remembered but not just before next dose; do not double doses.
Advise patient and caregiver to notify health care professional of all Rx or OTC medications, vitamins, or herbal. herbalproducts being taken and to consult with health care professional before taking other medications.
References
Vallerand, April, H. and Cynthia A. Sanoski. Davis’s Drug Guide for Nurses. Available from: Bookshelf, (18th Edition). F. A. Davis Company, 2022.
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