How to write diagnose Pharmacological Treatment case studies (Solved)

How to write diagnose Pharmacological Treatment case studies (Solved)

Case study 1 (3 pages)
Johnathan, age 7, presents to the office with symptoms of worsening cough and wheezing for the past 24 hours. He is accompanied by his mother, who is a good historian. She reports that her son started having symptoms of a viral upper
respiratory infection 2 to 3 days ago, beginning with a runny nose, low-grade fever of 101.0 degrees F orally, and loose cough. Wheezing started on the day before the visit, so Johnathan 's mother started administering albuterol metered-dose inhaler (MDI) two puffs before bed and then two puffs at around 2 AM. The cough and wheezing appear worse today, according to the mother. He had difficulty taking
deep-enough breaths to inhale this morning's dose of albuterol, even using the spacer.
Johnathan has been a patient at the clinic since birth and is up to date on his immunizations. His growth and development have been normal, and he is generally healthy except for mild intermittent asthma. This is his first asthma exacerbation of
the school year, and his mother expresses a concern about sending him to school with an inhaler.
Johnathan is afebrile with a respiratory rate of 36 and a tight cough every 1 or 2 minutes. He weighs 45 pounds (20.5 kgs.). The examination is all within normal limits except for his breath sounds. He has diffused expiratory wheezes and mild
retractions. Pulse oximetry readings have been 93% of oxygen saturation.
1. What are the appropriate pharmacological therapies to be prescribed for
Johnathan?
2. What information is necessary to provide to Johnathan and his mother
regarding asthma exacerbation?
3. What is an appropriate clinical assessment tool to be use with Johnathan?
4. What are the classification of asthma?
5. How would you as the NP address his mother's concern regarding providing
an inhaler at school?
6. What is an appropriate plan of care for Johnathan?
7. What is the pathophysiology of patho?

Discussion Question #1 (3 pages)
For this questions, please read the following case study and then respond to the
questions noted below.
Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery
disease (CAD), who presents to your clinic with substernal chest pain for the past 3
months. It is not positional; it reliably occurs with exertion, approximately one to
two times daily, and is relieved with rest, or one or two sublingual nitroglycerin
(NTG) tabs. It is similar in quality, but is much less severe, than the chest pain that
occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the
past 3 months, he has felt well.
The chest pain is accompanied by diaphoresis and nausea, but no shortness of
breath (SOB) or palpitations. He does not vomit. He denies orthopnea, paroxysmal
nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and
symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done
after his MI demonstrated a preserved left ventricular ejection fraction (LVEF).
Other medical problems include well-controlled type 2 diabetes mellitus (DM),
well-controlled hypertension (HTN), and hyperlipidemia, with low-density
lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and
diabetic neuropathy. He no longer smokes and does not use alcohol or recreational
drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO
bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500
mg PO bid.
Mr. EBR's physical examination includes the following: height 68 inches, weight 185
lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and
temperature 98.6°F orally. He is alert and oriented, and in no apparent distress
(NAD). His neck is without jugular venous distention (JVD) or carotid bruits. Lungs
are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without
rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender,
and nondistended (NTND). Extremities are without clubbing, cyanosis, or edema.
Distal pedal pulses are 2+ bilaterally
1. What would you add to the current treatment plan? Why?
2. Would you discontinue any of the currently prescribed medication? Why or
why not?
3. How does the diagnosis stage 3 chronic kidney disease affect your choices?
4. Why is the patient prescribed more than one antihypertensive?
5. What is the benefit of the aspirin therapy in this patient?
6. What is the pathophysiology of chest pain
Discussion Question #2(2 pages)

List three classes of drugs affecting the Hematopoietic System. List the mechanism
of action for each class of drug. Choose one medication from the three classes and
discuss what disorder the drug is used to treat? How often the medication is given?
What labs should get monitored while the patient is taking this medication?

SOLUTIONS TO CASE STUDIES

Case Study 1

What Pharmacological Treatments Should Johnathan Be Given?

Jonathan took albuterol to treat his problem, according to the case study. This drug is recommended for all patients with asthma exacerbation. According to Woo & Robinson (2016). albuterol is a fast-acting reliever that can reduce symptoms promptly. As a result, even though it has not resulted in significant symptom reduction, it must be included in the pharmacological treatments. Long-term control techniques, on the other hand, must be considered. Corticosteroids are also recommended to help control asthma and inflammation. Oral dexamethasone 10 mg twice a day is what I would recommend for this patient. Viral infections are respiratory illnesses, particularly flu, which heals independently (Woo & Robinson, 2016). His infection has not worsened, and he is afebrile. As a result, there is no need for medicine to treat illnesses.

What Information Is Necessary To Provide To Johnathan and His Mother Regarding Asthma Exacerbation

Health education that can be given to Jonathan and his mother is how to recognize the triggers of asthma and other nonpharmacological ways to prevent asthma flare-ups. Viruses in the lungs are one of asthma aggravating factors, according to Jones et al. (2016). Jonathan had it for around three days before seeking care, but they did not. This data demonstrates that they are lacking in knowledge about asthma aggravating variables. As a result, Jonathan and his mother need to be aware of various triggers, such as pollen and dust mites. Identifying and avoiding allergen is the most common and effective management strategy. According to Papi et al., (2020), hand washing is a crucial way to avoid catching a cold. To prevent viral infections from causing exacerbations, Jonathan’s mother should keep the environment clean, particularly his hands. Finally, they should be aware that an asthma exacerbation is a medical emergency that is extremely serious and can result in death (Papi et al., 2020). Exacerbation symptoms should be noticed as soon as possible, and medical help should be sought.

What Kind Of Clinical Assessment Tool Should Johnathan Use?

In this scenario, the Childhood Asthma Control Test is the most appropriate instrument. This tool is intended for children aged four to eleven years old, according to Alzahrani and Becker (2016). According to Alzahrani and Becker (2016), it is not only used to interview the child to assess asthma, but it also asks the caregiver about asthma control in the previous four weeks. The tool consists of seven questions, of which the child must answer at least one and the caregiver three. Furthermore, the tool inquiries the patient’s nightly and daytime symptoms (Alzahrani, & Becker, 2016). In this situation, the healthcare provider is aware of the symptoms of asthma and effective and non-invasive treatments. When it comes to asthma, how do you categorize it?

Classification of Asthma

Based on the severity of asthma, the existing research divides it into four types. According to Alzahrani & Becker (2016), the first group is intermittent asthma, which occurs less than twice a week and is characterized by symptoms such as wheezing and cough. Mild persistent asthma is defined as having symptoms three to six times a week. The third group is moderate-persistent, which means the symptoms occur daily for the patient. The last group is severe chronic asthma, which has symptoms that do not go away. The patient in this situation has intermittent asthma, which requires adequate treatment to prevent it from progressing. How would you respond to his mother’s worry about supplying an inhaler at school as a nurse practitioner? An asthma attack is an unexpected medical emergency. Because no one knows when it will strike again, Johnathan’s mother’s anxiety is justified. Since the inhaler helps treat his symptoms, the mother should ensure that the youngster has access to it. Insufficient access to inhalers may cause symptoms to continue longer, leading to emergencies. As a result, the mother should check in with Jonathan’s school nurse to see how he is doing while at school (Alzahrani & Becker, 2016). Jonathan’s asthma management will improve through collaboration with the school nurse.

What Is The Best Course Of Action For Johnathan’s Treatment?

Jonathan’s treatment strategy should include both pharmaceutical and nonpharmacological interventions. Short-acting beta-agonists are recommended by Woo and Robinson (2016). Thus the healthcare provider should continue to advocate for albuterol treatment. Corticosteroids may be given by the healthcare professional to ensure that the symptoms are under control. He should do light, well-paced exercises that allow him to rest (Brown et al., 2017). This is critical since it keeps his body in top shape while also lowering his chances of developing an exercise-induced asthma attack.

Asthma and Its Pathophysiology

Due to different changes that occur along the airways, the airflow in the airway is restricted in asthma. Bronchoconstriction, airway edema, airway hyperresponsiveness, and airway remodeling are some of the alterations that occur. Smooth muscle contractions of the bronchi as a result of stimulus exposure generate bronchoconstriction. Edema of the airway develops due to the airway’s increasing inflammation, limiting airflow even further. Because the airway’s bronchoconstrictor response to diverse stimuli is excessive, it becomes hyperresponsive (Brown et al., 2017). The structural cells of the airway are activated in the process of airway remodeling, creating irreversible changes in the airway that result in increased airway responsiveness and airflow restriction.

Case Study 2

What Modifications Would You Make To The Existing Treatment Strategy? Why?

Because the patient has Diabetic Neuropathy, Neurontin is a recommended pain relief and maintenance medication. Neurontin dosage can be started at 100mg TID and subsequently increased to help with pain management. This may reduce the need for acetaminophen, which should be used with caution and limited to no more than 2 grams per day to avoid liver problems. Gabapentin, which is used as an anticonvulsant, has been discovered to aid with nerve pain, which is what neuropathy is and to help reduce that discomfort. Elavil can help maintain and treat nerve discomfort in patients. However, it should be used with caution due to the patient’s CAD history. Elavil dosage for pain is 50 mg per day, and it should be given several times before bedtime due to the drowsiness and sleepy effect. If not adding a coagulant like Coumadin, a more potent anticoagulant like Plavix 75mg once daily or increasing the Aspirin to 325mg PO daily may be required for the patient’s CAD to cut down on the possible complications of not having adequate blood flow through the body and heart, such as making the client susceptible to DVT’s and MI reoccurrence (Kureshi et al., 2017). An oral nitrate like Imdur could help the client with his stable angina, but he’s noticed that his symptoms are getting worse, and he has trouble with routine daily tasks and journeys.

Would You Stop Taking Any of The Medications You’re Taking Now? Why Do You Think That Is?

The EBR pharmaceutical regimen has kept his blood pressure and diabetes under control, and Nitroglycerin has helped him with his angina. I would adjust his regimen by adding an oral nitrate to help lessen the need for sublingual nitrate, which has been linked to a slew of side effects and adverse responses, including hypotension and migraines, while still only treating the symptoms of angina (Kureshi et al., 2017). Because of its action on expanding blood arteries, Imdur can help the body maintain a steady volume of blood flow to and from the heart.

What Are Your Options Now That You’ve Been Diagnosed with Stage 3 Chronic Renal Disease?

Since EBR has chronic stage three kidney disease, we must prescribe medications that don’t rely heavily on kidney metabolism or excretion. If they do, it is crucial to monitor labs and symptoms of toxicity so that prompt intervention can be provided to prevent any harmful effects like death, further kidney damage, and organ failure. When it comes to medications, it is crucial to be conversant about when to modify and add adjunct medications so that the patient’s other current diseases are not impacted by medication adjustments and newly administered medications (Camero, 2017). When it comes to EBR, drugs mustn’t create excessive insulin secretion or change the effectiveness of hypoglycemics.

Why Is The Patient Given More Than One Antihypertensive Medication?

According to Woo, combining ACE and ARB’s inhibitors helps with the progression of neuropathy and also in those who are stage 2 diabetics as EBR may help with decreasing and or preventing the progression of microalbuminuria in patients who have not only to Type 2 Diabetes but also a history of hypertension and heart disease. This combo is also the first line of protection for people who have just had a MI. With the combined method, the patient’s blood pressure, diabetes, and kidney disease are all treated by his physician, leaving him to focus solely on his hypertension. According to Woo, ACE inhibitors are also advantageous since they minimize the risk of angina symptoms and MIs by treating diabetes and hypertension (Vejakama et al., 2017). These combinations have been shown in this patient to be beneficial in managing both his diabetes and hypertension, preventing additional damage to the kidneys and heart.

In This Patient, What Is The Advantage Of Aspirin Therapy?

As an anticoagulant, ASA is being used for this patient on EBR. Using this no-maintenance anticoagulant, the patient can receive all of the necessary coagulation therapy without laboratory testing and periodic adjustments that Coumadin requires. It also allows the client to receive anticoagulant therapy at a reasonable cost instead of routinely prescribed anticoagulants such as Xarelto, Eliquis, and Plavix, which are not cost-efficient. It can also be used to prevent a second heart attack (Vejakama et al., 2017). While this is an influence, most people have Aspirin in their medicine cabinet at home, and it is typically easy to purchase and inexpensive. ASA also helps to thin the blood, which reduces the chances of blood clots forming.

Pathophysiology of Chest Pain

Chest pain develops when the oxygen supply to the myocardium is insufficient compared to the demand for oxygen. When the heart’s oxygen supply is inadequate, ischemia develops, which is extremely painful. Coronary arteriosclerosis, which obstructs blood flow to the heart muscles, is the source of this oxygen deficiency (Vejakama et al., 2017). Increased coronary vascular resistance, coronary spams, and other diseases that affect the lumen of the coronary arteries are among the other causes.

Case Study 3

List Three Medication Classes That Influence The Hematopoietic System As Well As Their Mechanisms Of Action.

Thrombolytics, anticoagulants, and antiplatelets are three types of medications that influence the hematological system. The mechanism of action of thrombolytic drugs is by dissolving blood clots through the activation of plasminogen, which then produces plasminogen. Plasmin refers to a proteolytic enzyme that breaks cross-links between fibrin molecules. This is necessary for the stability of the clot structure (Klabunde, 2018). The mechanism of action of anticoagulants is to prevent blood from clotting. They work by inhibiting the activity or manufacturing clotting components found in the blood (Feden, 2018). Finally, antiplatelets prevent platelets from sticking together, which is what causes blood clots to form.

Choose One Medication From The Three Classes and Discuss What Disorder The Drug Is Used To Treat?

We employ a variety of drugs in the medical institution for various mechanisms of action. Many people are prescribed warfarin (Coumadin). Coumadin medication is used to treat a variety of blood clots in the lungs, arteries, and veins. Coumadin is a blood thinner that helps to prevent pulmonary emboli and atrial fibrillation. It also helps avoid blood clots following medical procedures such as total hip replacements, hip fractures, and the implantation of mechanical heart valves. After nearly two years in a swing-bed unit, you see Coumadin being given to patients daily for prevention. To reduce clot development after surgery, we try to get them out of bed as soon as possible (Mayoclinic, 2018). Coumadin can help lower the risks of heart attack and stroke by preventing blood clots formation and reducing the load on the arteries and veins.

How frequently is The Drug Administered?

Coumadin dosage and administration must be tailored to every individuals’ International Normalized Ratio (INR) drug reaction. Coumadin dosages are taken in the form of 1 mg to 10 mg pills once a day. Coumadin comes in two doses: an initial dose of 2mg-5 mg taken orally once per day, and the maintenance dose is 2mg-10 mg taken orally once per day (Mayoclinic, 2018). Depending on the patient’s PT and INR, the dosage may be adjusted.

What Labs Should The Patient Have Checked While Using This Medication?

Patients using Coumadin must be aware that the risk of bleeding is eminent, so educating the patient is essential. International normalized ratio (INR) and prothrombin time (PT) need to be monitored when the patient is taking Coumadin. A typical PT normal range is between 11-13.5 seconds. Therapeutic ranges of INR is 2.0-3.0; an INR of 1.1 or less is considered normal in healthy adults. Coumadin must be taken at the same time every day to maintain a therapeutic range.

 

References

Alzahrani, Y. A., & Becker, E. A. (2016). Asthma control assessment tools. Respiratory care, 61(1), 106­116.

Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis’s Medical­Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.

Camero, Y. (2017). Management of coronary artery disease and chronic stable angina. US Pharm, 42(2), 27-31.

Fedan, J. S. (2018, June 27). Anticoagulant. Retrieved from

https://www.britannica.com/science/anticoagulant

Klabunde, R., Ph.D. (2018). Thrombolytic (Fibrinolytic) Drugs. Retrieved from https://www.cvpharmacology.com/thrombolytic/thrombolytic

Kureshi, F., Shafiq, A., Arnold, S. V., Gosch, K., Breeding, T., Kumar, A. S., … & Spertus, J. A. (2017). The prevalence and management of angina among patients with chronic coronary artery disease across US outpatient cardiology practices: insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study. Clinical cardiology, 40(1), 6-10.

MayoClinic. (2018). Prothrombin time test. Retrieved from https://www.mayoclinic.org/tests-procedures/prothrombin-time/about/pac-20384661

Papi, A., Blasi, F., Canonica, G. W., Morandi, L., Richeldi, L., & Rossi, A. (2020). Treatment strategies for asthma: reshaping the concept of asthma management. Allergy, Asthma & Clinical Immunology, 16(1), 1-11.

Vejakama, P., Ingsathit, A., McKay, G. J., Maxwell, A. P., McEvoy, M., Attia, J., & Thakkinstian, A. (2017). Treatment effects of renin-angiotensin aldosterone system blockade on kidney failure and mortality in chronic kidney disease patients. BMC nephrology, 18(1), 1-9.

Woo, T. & Robinson, M. (2016). Pharmacotherapies for advanced practice nurse prescribers (4th ed.).Philadelphia, PA: F.A. Davis Company.

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