...Therapeutics: The Pharmacotherapy Preparatory Review and Recertification Course 31 Geriatrics Learning Objectives: The following case pertains to questions 2 and 3. J.T. is an 82-year-old community-dwelling woman with a history of stage III Parkinson disease, hypertension, and urinary incontinence (UI). She is receiving carbidopa/levodopa, pramipexole, selegiline, tolterodine, diazepam, metoprolol, and hydrochlorothiazide. When she comes to your pharmacy to get her prescriptions, she walks slowly with a cane, and she is stooped over. 1. Identify age-related pharmacokinetic and pharmacodynamic changes in older people. 2. Evaluate the pharmacotherapy regimens of older people to support the maintenance of optimal physical and mental function. 3. Identify inappropriate medication prescribing in older people. 4. Recommend appropriate pharmacotherapy for patients with dementia. 5. Evaluate the risks and benefits of the use of antipsychotics (APs) (including atypical APs) in older patients with dementia. 6. Recommend appropriate interventions for patients suffering from behavioral symptoms related to dementia. 7. Identify the types of urinary incontinence and recommend appropriate treatments. 8. Given a patient’s American Urology Association Symptom Index for benign prostatic hyperplasia, recommend appropriate therapy. 9. Recommend appropriate analgesic therapy for older patients with osteoarthritis. 10. Discuss risks and benefits of medication...
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...concern where much focus was given. When obtaining information about the things that are most important for her health, maintaining a healthy weight was given highest priority second was blood pressure and cholesterol control. This was interesting because the family has a significant history for heart disease, and hypertension, both of which medications are being prescribed for. However, blood pressure and cholesterol control was not given as much priority as weight management. Since years of elementary school, teachers have instructed their students on the importance of a good night’s rest. Somehow as adults we often forget these basic principles instilled in us. For years her family heard complaints of chronic fatigue, even after a four nights rest, regardless of activity or hour of sleep. Upon speaking with the primary care physician, Ms. Houston was given a referral for a sleep study to be performed. She was then diagnosed with sleep apnea, and prescribed a C-PAP machine at bedtime. The results were remarkable, first the chronic fatigue...
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...A Complete Patient Assessment Susan Eisen RN Ramapo College of New Jersey A 63 y/o African American female presents to the emergency room complaining of shortness of breath worsening over the past week. Patient states she becomes severely short of breath while preforming everyday activities and has noticed that her legs have been “getting bigger”. Patient had been sleeping with 3-4 pillows a night for comfort and occasionally sleeping in a recliner. Patient states this evening she got up to use the restroom and had a sudden onset of severe shortness of breath. Felt as though she wasn’t moving any air. Patient called 911. The paramedics on scene established IV access and medicated patient with 40 of furosemide and Nitroglycerin sublingual 0.4 mg times 3 doses. Patient was placed on CPAP and brought to the ER. Upon arrival CPAP was continued, a nitroglycerin infusion was started at 20mcg/min. Additional IV access was established and labs were obtained. Stat EKG and Chest Xray were completed. Additional dose of furosemide 80mg was administered IV push and patient was provided with an indwelling foley catheter which is draining clear yellow urine. Past Medical History is significant for Hypertension, Diabetes, Congestive Heart failure, and Atrial Fibrillation with two unsuccessful cardioversions. Medications: Patient currently taking Furosemide, Lisinopril, Digoxin, ...
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...enzymes are in an inactive form in the pancreas, they are 'activated' in the duodenum to digest food. Groups of special cells called 'Islets of Langerhans' are scattered throughout the pancreas. These cells make the hormones insulin and glucagon. The hormones are secreted directly into the bloodstream to control the blood sugar level. The bile duct carries bile from the liver and gallbladder. This joins the pancreatic duct just before it opens into the duodenum. Bile also passes into the duodenum and helps to digest food. Pancreatitis occurs when the pancreas becomes inflamed. When pancreatitis occurs, it's largely due to digestive enzymes attacking and digesting the pancreas, which produced them in the first place. There are two types of pancreatitis: Acute pancreatitis - when the inflammation develops quickly, over a few days or so. It often goes away completely and leaves no permanent damage. Sometimes it is serious. Chronic pancreatitis - when the inflammation is persistent. The inflammation tends to be less intense than acute pancreatitis but as it is ongoing it can cause scarring and damage. Gallstones are the most common cause in the UK. A gallstone can pass through the bile duct and out into the duodenum. This usually does not cause a problem. However, in some people, a gallstone gets stuck in the bile duct or where the bile duct and pancreatic duct open...
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...One could choose a practice that specializes in exotic animals, or even farm animals. It all depends on what that person is into. So, as one can see, there are great advantages that come along with being a Veterinary Technician. Just like any other career field, there are some drawbacks associated with this career field. “Administering Euthanasia can be emotional and hard for you and dealing with the owner during this time can be hard” (Sanford Brown). As everyone knows, at a Veterinary facility euthanasias are involved. When dealing with this type of situation owners tend to be very sensitive. Some people may not be able to handle the stress and sensitivity to this subject. “During this profession it will become necessary to clean up the dirty work like urine in blood. You will have to come in contact with bodily fluids” (Sanford Brown). Not everyone is fit for this job. Not everyone will be able to walk up and clean up these types of things. If one was, for say, a germaphobe, this career path would not be recommended due to the amount of bodily fluids they would come in contact with just through one shift. Another drawback would be “Dealing with frightened animals, not all will willingly come into the office or take their shots like a champ” (Sanford Brown). Sometimes an animal comes into the office so scared that they will get aggressive. In the career one will never know what is going to come through that door. The animal could be the sweetest one but can easily be frightened...
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...Applying Orem's theory to care for patients with neurogenic bladder INTRODUCTION The core of nursing is theory guided practice. Nurses uses concepts, principles and theories of nursing to meet the health needs of the patients. Nursing practice is the art and science of caring and healing. In order to provide holistic and effective interventions, nurses use the theories to develop plan of care. Nursing is a combination of theories and it always guides practice. Theory-based nursing practice is the “application of various models, theories, and principles from nursing science and the biological, behavioral, medical and sociocultural disciplines to clinical nursing practice” (Kenney, 2013, p. 333). As one of the oncology and rehab nurse we come across many patients who suffer from neurogenic bladder problems. The importance of this paper is to educate about self-care for the patients with neurogenic bladder, with emphasis on Orem’s theory. The intent of this paper is to show how nurses use the theoretical principles in practice. Neurogenic bladder problems are seen in spinal cord injury patients. An article from the Journal of Nursing stated that each year about 11,000 people are affected by spinal cord injuries in United States. A number of cases have spinal tumors which may cause compression of the spinal nerves and cancer patients who have undergone sacrectomies, all end up with neurogenic...
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...Cystoscopy: Patient Two Patient number two, is a 51-year-old female who was diagnosed with a neurogenic bladder. According to Cleveland Clinic (2018) a neurogenic bladder means a patient’s nervous system affects their bladder, causing the patient’s bladder to become either overactive or underactive; spastic or flaccid. The patient’s diagnosis history includes: neurogenic bladder, multiple sclerosis, urinary urgency and frequency, urinary urge incontinence, incomplete bladder emptying (requiring intermittent catheterizations), and recurrent urinary tract infections (UTIs). The patient was scheduled for a cystoscopy with 300 units of Botox injections into the bladder, while using a local anesthetic to help relieve discomfort during the...
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...|[pic] |[pic] |[pic] |[pic] | |[pic] |[pic] |[pic] |[pic] | |[pic] |[pic] |[pic] | |[pic] |[pic] |[pic] |[pic] | |[pic] |[pic] |[pic] |[pic] | |[pic] |[pic] |[pic] | Sanitary pads plays a major role in a woman's life. A lady's intimate friend. The quality of sanitary pads can influence ladies' emotions during period. That is why choosing a suitable sanitary pad is very important. According to research, when blood on used sanitary pads is exposed to the air, approximately 100,000 bacteria will grow on it in a mere 4 minute. This has been a major factor of various female sicknesses such as itchiness, sensitive skin, inflammation, lower back pain, fatique, emotionally unstable and others. Kotex is a brand that plays an undeniably significant role in the female population. With almost 60 years of experience in Malaysia, Kotex is constantly striving to develop innovative campaigns and products to help...
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...not being in the room, Eric entered alone carrying a book. When questioned, Eric said he was very happy but never had time to read. His parents always wanted him to play outside, but two best friends also enjoyed reading and playing “pirates.” He described how he used reading to ignore the kids who teased him on the bus. Eric began to squirm when asked about the “accidents.” He stated he really didn’t mind except his parents were really upset and he didn’t want to lose his friends. He explained that when it did happen he was either ready or playing pirates and did not want to stop. Eric grimaced and said, “Yuck, that’s gross,” when asked why he never urinated his pants. The diagnosis was Encopresis, Secondary Type. DSM-IV Made Easy (2006) lists four criteria for Encopresis: * Accidentally or on purpose, the patient repeatedly passes feces into inappropriate places (clothing, on floor)....
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...Young Adulthood Stages of Development Physical development for the young adult typically sees one in the best physical condition: strong, sharp senses, and stamina. Memory and thinking (cognitive) abilities are at their highest. The social development and personality development for the young adult can be identified with a desire to be socially independent and with a high ambition to succeed and can include occupation selection, selecting a life-partner, starting a family, accepting responsibilities, and social networking. (Nevid & Rathus, 2005) Middle Adulthood Stages of Development The physical development in middle adulthood can be accompanied a loss of strength, vision sharpness, strength, and coordination. Cognitive development during middle adulthood generally shows an average memory loss and a reduced ability to perform tasks requiring speed. The social and personality development during middle adulthood is considered by some to be synonymous with "mid-life crisis" which heralds the reevaluation of one's life goals and accomplishments and can spur positive changes, not just the negative changes generally associated with mid-life crisis and greater psychological health. (Nevid & Rathus, 2005) Late Adulthood Stages of Development Late adulthood can be marked by menopause and osteoporosis, a reduction in bone density, grey hair, less skin elasticity, and a loss of muscle mass resulting in an increase of body fat. Cognitively, during late adulthood verbal skills...
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...A written assignment that evaluates comprehensive approaches to nursing assessment for an older person with multiple health problems. The account should reflect on how the multidisciplinary team and other agencies including the family, may contribute to these assessment approaches. Particular attention should be paid to national policies in this area and evidence of best practice. The patient that will be discussed within this assignment is a 70 year old male admitted to hospital following a stroke. Pressure ulcer risk assessments and nutritional risk assessments will be discussed within this assignment looking at how they are used in the assessment of an older people with multiple health problems. A stroke occurs when there has been a disturbance or cut off of blood flow within the brain, this disturbance damages or destroys brain cells preventing these cells from doing their job. Damage to the brain causes problems with bodily functions and can also affect mental processes (Stroke Association, 2010). A stroke can cause sudden weakness or paralysis which often only affects one side of the body and is one of the most common symptoms of a stroke. It can also cause swallowing difficulties (dysphagia), speech and language (dysphasia) can be affected also, patient may have difficulty in understanding and basic things such as reading and writing following stroke. Problems with eyesight, perception and interpretation, mental processes, bladder and bowels, mood swings, sensation and...
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...Neeraj’s USMLE Step-2 CS Notes The Perfect “Encounter”: A Strategic Approach to Communication & Interpersonal skills The encounter in a USMLE CS examination is between a non-physician medical educator (SP: Standardized Patient) and an examinee, who may be a medical student or a physician. SPs are defined as "a simulated or real patient who has been taught to present a problem so accurately that the simulation cannot be detected by a skilled clinician.” (1) These SPs will seem like real patients to you and should be treated as such during the USMLE examination. With this in mind, it is important to remember that good communication and interpersonal skills are a top concern for every patient. If you have a pleasing personality, patiently hear all of their dilemmas and concerns, and have good communication skills, it will surely create and maintain long lasting and conducive relationships with your patients. Before we talk about strategies to delineate an ideal and perfect encounter with a SP, we should know a few facts about the examination. First, what is the purpose of the examination? It is very interesting that this examination is structured to test your clinical skill proficiency and not the diagnosis that you arrive at. Three components of the report score: One must pass all three components in a single test administration. These three components are as follows: ICE (Integrated Clinical Encounter): assess data gathering and data sharing ability...
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...HPI: Patient is a 35-year-old male with history of hypertension and hyperlipidemia. Patient recalls that symptoms became worst about a week ago. He noticed that he needed to take more breaks at work to use the restroom, from three to four times in his eight-hour shift to almost every hour frequency. Denies burning, hesitance, or pain with urination. He also recalls his fluid, mainly water, intake has increased because he feels thirsty often; three to four glasses more a day. He tried to drink less fluid to avoid urinating so frequently, but became thirty soon and couldn’t refrain from drinking fluids. He started to get worried about the symptoms and called the office to make an appointment for today. No previous episode of similar symptoms. Patient’s hyperlipidemia is currently being treated with simvastatin and his hypertension with enalapril. He states he has been taking all his medications. PMH: Hypertension controlled with enalapril and Hyperlipidemia controlled with simvastatin. PSH: Denies Medications: Enalapril 10mg PO daily. Simvastatin 20mg PO daily Allergies: No known drug or food allergies FMH: Father is living, age 65 – CAD, MI x2 (first one before age 40), Hypertension, Hyperlipidemia, Diabetes Mellitus Type II, Bronchiectasis. Mother is living, age 57 – Hypertension. Patient has 4 brothers, all are living. Older sibling, age 41, with history of Hyperlipidemia and MI at age 30. Other siblings in good health. SH: The patient is single and...
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...the physician, yet she believed both roles were an integral part of the rehabilitation phase. Henderson also believed the nurse should be independent from the physician and make independent judgments (Henderson, 1966, p. 22). Henderson proposed 14 basic human needs that help focus the nursing care (Alligood & Tomey, 2010, p. 56). She believed these 14 needs would help a patient return to independence. She believed only a dedicated and devoted nurse would help a patient fulfill these needs. According to Henderson, a nurse that helped a patient acquire independence or helped a patient accept their limitations was a successful nurse (Henderson, 1966, p. 23). The diagram below depicts Henderson’s 14 basic human needs. They are divided into four categories: physiological, psychological, social/moral, and sociological. Henderson claimed that the physiological needs are experienced by all human beings and are the most important for survival. If the physiological needs are not met first it will be nearly impossible to meet other needs. In Principles and Practice of Nursing, Henderson gives an example of this. She noted that a person going through hunger would not be interested in anything else but food. This person would not be able to meet needs such as worship because the physiological need of nutrition is not met. In order to completely care for a...
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...forget things as we get older. Many older people have a slight loss of memory that does not affect their daily lives so doctors diagnose dementia only if two or more brain functions - such as memory, language skills, perception, or cognitive skills including reasoning and judgment. All forms of dementia result from the death of nerve cells and/or the loss of communication among these cells. Things that may cause dementia are Strokes, tumors, or head injuries. Some diseases that cause Dementia are Parkinson's disease, dementia with Lewy bodies, and frontotemporal dementia. In some cases dementia is caused by a problem that can be treated like underactive thyroid gland, not getting enough vitamin B12, and fluid buildup in the brain. Many types of dementia, including Alzheimer's disease, Lewy body dementia, Parkinson's dementia, and Pick's disease, are characterized by abnormal structures called inclusions in the brain. Because these inclusions, which contain abnormal proteins, are so common in people with dementia, researchers suspect that they play a role in the development of symptoms. However, that role is unknown, and in some cases the inclusions may simply be a side effect of the disease process that leads to the dementia (Web MD, 2009) According to The Alzheimer's Society, Alzheimer's...
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