Pharmacology Case Study

The patient’s medical diagnosis

The patient experienced shortness of breath, lung crackles, leg edema, orthopnea, paroxysmal nocturnal dyspnea, and a chest X-ray revealing pulmonary edema, which all indicated that he might be suffering from Acute exacerbation of chronic congestive heart failure. Also, judging from his medical history, indications of elevated blood pressure, and lab results that were consistent with AKI and pneumonia, it was possible that he had uncontrolled hypertension, community-acquired pneumonia, type 2 diabetes mellitus, and acute kidney injury. The hypertension and fluid overload in the chest may have likely triggered the Acute exacerbation of chronic congestive heart failure. The best cause of medical action would be the optimization of heart failure medications and aggressive diuresis, administered together with antibiotics and blood pressure control medications. However, the developing pneumonia condition would complicate the treatment of his chronic congestive heart failure condition.

Summary of patient’s medical history

The patient’s present signs and symptoms

The male patient, aged 84, was admitted upon being diagnosed with acute exacerbation of chronic congestive heart failure, evident from his shortness of breath. The normal treatment for his condition would be aggressive diuresis, administered together with the optimization of heart failure medications. During his admission, he showed signs and symptoms that were key in backing up the diagnosis of acute decompensated heart failure condition.

He experienced shortness of breath (dyspnea), had a respiratory rate of 27, his oxygen desaturation had gone to 82% on 3L nasal cannula, his chest X-ray confirmed pulmonary edema, he had Tachycardia with a heart rate of 120 BPM, bilateral pulmonary crackles and a history of uncontrolled hypertension. He experienced shortness of breath as a result of an acute flare-up of chronic systolic heart failure, which resulted in fluid backing up in the lungs, thus impairing gas exchange. To treat the acute decompensated heart failure would require aggressive IV diuresis with loop diuretics like furosemide to reduce fluid overload along with optimization of medications like ACE inhibitors and beta blockers, and close monitoring of the patient’s response to the treatment would be required for early identification of any complication (Poulter et al., 2020). The patient’s uncontrolled blood pressure, old age, and history of hypertension, diabetes, gout, and chronic alcohol consumption necessitate alertness for abrupt complications since they accelerate his heart disease progression. His advanced age would mean he has a decreased cardiovascular reserve and is therefore prone to acute decompensation episodes, the remedy of which would be to optimize his comorbid conditions such as diabetes and hypertension.

Medication chart (Satoskar et al., 2020)

Interpretation of prescribed medication

Medication interpretation is crucial for both the patient and the practitioner administering them. This process aids in understanding the role and effect of these medications prescribed to the patient (Kapur et al., 2020). In this case study, the medication prescription serves several functions to address the patient’s complex medical condition. There were several medications for this patient were prescribed; for example, Lidocaine, which is a local anesthetic, was most likely administered to relieve the patient from pain related to biceps tendinitis in the left shoulder there was a need to assess the intensity of pain before and after administration of medication. In addition, Rozerem, which is a sedative-hypnotic drug, may be aimed at addressing primary insomnia, where nursing assessment aims at sleeping patterns of patients and related adverse effects, including dizziness or drowsiness. Also, acetaminophen, an analgesic drug, could be administered to control and manage arthropathy and biceps tendinitis-related pains. This requires a nurse to assess hepatotoxicity signs, particularly in patients with liver-induced conditions.

Moreover, the patient was administered insulin lispro, an antidiabetic agent important in managing glucose levels in diabetic patients, making regular monitoring of glucose levels in blood necessary and assessing hypoglycemia or hyperglycemia signs and symptoms. This is accompanied by metoprolol succinate, a beta-blocker very crucial for managing chronic diastolic congestive heart failure or hypertension. This is done by medical practitioners assessing blood pressure, heart beat rate, and signs of worsening heart failure. The patient was also administered Mirtazapine, which is an antidepressant to manage recurrent disorders (Davis, 2020). In addition to this, the nurse monitors the patient’s appetite, mood, and related changes in their mental health while keeping vigilant to any suicidal thoughts or other syndromes such as serotonin as potential adversative effects. Lastly, famotidine medication could be administered to treat gastrointestinal-related symptoms like gastroesophageal reflux disease (GERD). This is assessed by examining related symptoms and adversarial effects such as confusion and dizziness. In conclusion, nursing assessment is crucial for properly managing complex medical conditions, where potential adversarial effects and therapeutic monitoring are done before and after medication.

Assessment of the effect of medication

Once proper prescription and interpretation of medication are done, it is crucial to monitor the effect of such medications (Poulter et al., 2020). In this case study, several observations have been made in assessing the effectiveness of these medications, and many insights have been obtained concerning the achievement of intended goals. For example, the patient’s blood pressure would be an essential indicator of the effectiveness of antihypertensive medications like metoprolol succinate. Observing the pressure running at the expected range indicates that the medication effectively controls hypertension. Moreover, the prescription of medications such as insulin lispro for managing diabetes necessitates regular monitoring of glucose levels in the blood. Maintenance of glucose levels in the blood within a specific range would be an essential indicator of the efficiency of medication in managing diabetes. Also, medication such as famotidine, which is usually applied to reduce acid production in the stomach, would eliminate symptoms like reflux and heartburn. These symptoms have diminished or reduced, which indicates achieving the intended medical effect.

Nevertheless, specific assessment findings could stop further administration of drugs to this patient. For example, if symptoms of severe dysfunction of the liver are observed in the patient, this would necessitate warranting caution against the administration of medications such as acetaminophen, which can exacerbate damage to the liver. In addition, monitoring the liver’s functionality and observing hepatotoxicity symptoms would be necessary to prevent possible adverse effects. In a similar direction, the availability of respiratory distress or reactions of hypersensitivity would warrant restriction of medication administration such as lidocaine or lorazepam. Lastly, there should be close monitoring of respiratory symptoms such as respiratory depression or allergic reactions to determine the effectiveness of patient medications. This case warrants a thorough assessment of the patient’s clinical conditions to ensure proper medication and management.

Patient’s Pertinent lab values

Several factors are vital in analyzing pertinent lab values. These values are indications of the patient’s medication condition before and after medication. In this case, the sodium level was 144 mmol/l, within the accepted range of 135-145 mmol/l. This is an indication that there was a significant anomaly associated with the balance of electrolytes (Shin et al.,2020). Nevertheless, the potassium level was 3.2 mmol/l, which is a bit lower than the normal range of 3.5-5.0 mmol/l. This suggests hypokalemia, which usually results from diuretic use like the patient’s medication metoprolol succinate. This condition is associated with muscle weaknesses and cardiac arrhythmias, necessitating close monitoring and possible medication dosage adjustment.

Also, a notable condition was that the patient’s glucose level was 145mg/dl, which is above the normal range of 70-100 mg/dl, which shows a potential indicator of hyperglycemia. Given that the patient was diagnosed with diabetes and followed with medication of insulin lispro for the management of glycemic control, the finding, in this case, underscores the significance of monitoring the level of glucose in blood regularly and managing insulin therapy as required to prevent diabetes-associated complications. In addition, the hemoglobin level was 11.2g/dl, lower than the normal range of 12-16 g/dl in females. This could be an indication of a possible anemic condition, which is intensified by chronic diseases like COP and congestive heart failure, and also the administration of medications such as metoprolol succinate and aspirin. These medications result in gastrointestinal bleeding and reduced erythropoiesis. These patients’ pertinent lab values provide important insight into this patient’s current medical condition and warrant an all-inclusive approach to managing medications and such conditions effectively.

Summary of patient’s teaching required

By looking into this particular case study for the prescribed medication, several important topics regarding the patient’s teaching must be covered. First, the patient should be informed about the purpose of the prescribed medications and how they work. Specific focus should be on how these medications help manage their health conditions. This should include explaining how various medications such as metoprolol succinate control blood pressure and functions of the heart under conditions such as chronic diastolic heart failure and hypertension. It is broadly agreed that patients should understand the importance of adhering to the prescribed dose and schedule. This is because inconsistent medication use can increase symptoms and affect treatment effectiveness. In addition, the patient should be educated about the potential side effects and adversarial reactions linked to every medication administered to help them make informed decisions and recognize unusual symptoms early enough, hence promoting their safety and compliance with medication.

Moreover, understanding of medical prescriptions by the patient can be enhanced by integrating non-pharmacologic methods to improve their health outcome (Satoskar et al., 2020). These methods include diet modifications, including regular exercise, dietary changes, and techniques of stress management, among others, to address underlying factors affecting the patient’s health outcome. In this case, non-pharmacologic methods for a healthy heart include observing diets low in saturated fats and sodium. These low concentrations can mix well with medications such as metoprolol to manage blood pressure and reduce exposure to risks that can lead to cardiovascular events. In addition, patients should be encouraged to end alcohol and smoking by providing them with the necessary resources to prevent the increase in adverse effects of the consumption of alcohol on cardiovascular health and mental disorders. Lastly, this patient should be engaged in decision-making, and health goals should be tailored to their specific needs and preferences to promote their adherence to both pharmacologic and non-pharmacologic interventions, optimizing therapeutic outcomes and quality of life.

Conclusion

To conclude, this case study’s holistic assessment and discussion addresses essential issues about the interplay of several comorbidities and the significance of patient-centered care in promoting health care outcomes. By discussing medication side effects, teaching needs, adherence, and incorporation of both pharmacologic and non-pharmacologic approaches, healthcare professionals can encourage patients to manage their health outcomes effectively. This kind of management focusing on patients can promote adherence to medication and lifestyle modification that complements pharmacological approaches, improving health outcomes.

References

Davis, M. P. (2020). Mirtazapine and Depressions. NeuroPsychopharmacotherapy, 1–29.

Kapur, B. M., & Aleksa, K. (2020). What the lab can and cannot do: clinical interpretation of drug testing results. Critical reviews in clinical laboratory sciences, 57(8), 548-585.

Poulter, N. R., Borghi, C., Parati, G., Pathak, A., Toli, D., Williams, B., & Schmieder, R. E. (2020). Medication adherence in hypertension. Journal of hypertension, 38(4), 579-587.

Satoskar, R. S., & Bhandarkar, S. D. (2020). Pharmacology and pharmacotherapeutics. Elsevier India.

Shin, W. Y., An, M. J., Im, N. G., Oh, K. R., Choe, Y., Yoon, S. R., & Ryu, S. R. (2020). Changes in blood glucose level after steroid injection for musculoskeletal pain in patients with diabetes. Annals of Rehabilitation Medicine, 44(2), 117–124.