Mr. Jon Smith, a 50 year old African American male, has come to your clinic with a 15 year history of hypertension and type 2 diabetes. He drinks “a few beers” per week and confirms cigarette use of 1 ppd for the past 30 years.

NURP 424: ADVANCED PHARMACOLOGY ACROSS THE LIFE SPAN: 15 year history of hypertension and type 2 diabetes

Please submit via uploading in this assignment section an electronic copy of your completed case study which includes an adult case and pediatric case by the end of Week 10, Sunday 11:59 PM EST.  This case study is worth 25% of your final grade and will be counted as your cumulative exam. There are 2 cases for you to complete (one adult and one pediatric). This scholarly paper requires the use of a variety of sources. You may use your textbook, journal articles from weekly discussions, lectures and any other evidence-based reference materials necessary to complete this assignment.  Case studies may not exceed TWELVE (12) pages in length (excluding title and reference page.) Anything on pages 13+ will not be read or counted toward your final grade. We want you to focus on the pharmacology aspect of this case by following the prompts in the case analysis. You must adhere to APA guidelines. The following is all the information available regarding your patients. If the information you have is incomplete, please note this in your analysis. In the clinical setting, you may be dealing with incomplete information and sometimes that must be included in your clinical reasoning.

ADULT CASE:

Brief Adult Patient History:

Mr. Jon Smith, a 50 year old African American male, has come to your clinic with a 15 year history of hypertension and type 2 diabetes.  He drinks “a few beers” per week and confirms cigarette use of 1 ppd for the past 30 years. He tells you that he works a physical job in construction so is mostly on his feet and active. He eats what is available and tries to watch his diet when he can. Mr. Smith is taking Amlodipine 10 mg daily for hypertension and metformin 1,000mg BID for diabetes.  His blood pressure has been hovering around 150/90 and Hemoglobin A1c has been 6.8. Also included in blood work is a total cholesterol of 243 mg/dL, LDL 170 mg/dL, HDL 36 mg/dL, Triglycerides 201 mg/dL.  Additional findings include normal electrolytes, renal function and liver enzymes.  You decide to enter these results in the ASCVD risk calculator to further learn his CAD risk.   

Positive Review of Systems (otherwise you can assume negative):

Respiratory: No SOB, +non productive cough that he has had for “quite sometime”

Past Medical/Surgical History:

  • Diabetes
  • Hypertension
  • Hyperlipidemia
  • Tobacco use disorder

Social History:

  • Smokes 1 PPD for the past 30 years
  • A “few beers” per week
  • Married with 2 teenage children

Medications:

Amlodipine 10 mg daily

Metformin 1000 mg BID

Naproxen 500mg PO daily PRN

Allergies: Penicillin (anaphylactic reaction)

PE: 50 year old African American Male in no acute distress. VS: Temp 98.0, BP 150/92, Pulse 86, R 18. Height 6’ 0”; weight 230 lbs. Exam unremarkable.

CASE ANALYSIS:

Illustrate your understanding of Pharmacotherapeutics in this patient’s care. Please no copying and pasting but you are welcome to make your own charts or graphs if desired.

Complete an analysis for each medication and any medication you decide to prescribe including:

  • Describe the mechanism of action, side effects, caution and/or contraindications, monitoring parameters and determine if the medication is the best option for this patient
  • Common dosage, route and schedule for the medication
  • Determine cost of each medication
  • Is the medication being used reasonably in this situation (risk/benefit analysis)?
  • Would you make any changes in the use of the drug if you were the provider?

Complete an analysis of the patient including:

  • Evidence of drug effectiveness
  • Indicate potential drug interactions (drug-drug, drug-food, drug-herb, etc.)
  • Indications of possible adverse drug effects                                           
  • Factors affecting compliance/adherence
  • What social factors must you considered for this patient?
  • What education must you provide to the patient about these medications
  • Are there special considerations for this patient population that must be considered? When would you want to see this patient again in a follow up visit?
  • Include any nonpharmacologic interventions that you feel are appropriate.

NEXT CASE:

PEDIATRIC CASE:

Brief Pediatric Patient History:

                Annie Ramirez, a nine-year-old Hispanic female, has presented to your clinic with a four-day history of cough, fever and increasing fatigue. Prior to the onset of symptoms, Annie had been feeling well, attending school regularly, and participating on her competitive soccer team. Annie has a history of a peanut allergy as well as mild persistent asthma. Annie’s father reports that at baseline, Annie has a nighttime cough “maybe once a week or so” and does wheeze “if she forgets her inhaler before her soccer games.”

                Over the past four days, Annie’s activity level has decreased dramatically and she feels that “it is hard to breathe” when she tries to move around. She has a persistent cough that is worse at nighttime. She has been using her inhalers according to her sick plan, but they “do not seem to be helping.” Her father reports that Annie’s fever has been as high as 102.9 °F (tympanic) and ibuprofen has been helpful to reduce her fever. She is eating, but less than normal, and her parents have been encouraging her to drink water throughout the day. 

                You conduct a physical exam and diagnose Annie with left lower lobe community acquired pneumonia (CAP) resulting in an acute asthma exacerbation. You administer albuterol via a nebulizer during the visit and you note that Annie has decreased working of breathing and an increased SpO2%. Your assessment is that she can be treated in the outpatient setting. What additional medications would you prescribe?

Focused Review of Systems

General: Reports fatigue; exacerbated by physical activity.

HEENT: Denies ear pain, discharge from ears, or difficulty hearing. Denies drainage or difficulty breathing through nose. Denies sore throat or difficulty swallowing. Denies neck pain or decreased range of motion.

RESP: Reports cough productive of green sputum; consistent throughout the day, but worsens at night. Shortness of breath with physical activity. Difficulty “getting the air in” even at rest. Using inhalers with minimal results.

CV: Denies heart racing.   

GI: Reports a decreased appetite but drinking water throughout the day. Reports soft daily bowel movements; voiding 4-5 times daily.

PAST MEDICAL HISTORY/PAST SURGICAL HISTORY:

  • Product of a normal pregnancy/delivery (full term infant)
  • Peanut allergy (anaphylaxis at 18 months)
  • Mild persistent asthma (diagnosed at 4yo, last required oral corticosteroids 3 years ago)
  • Denies past surgeries

SOCIAL HISTORY:

  • Lives with two fathers and one 4-year-old brother
  • 3rd grade, great student, loves reading. Plays competitive soccer
  • Parents are non-smokers, no second-hand smoke exposure

MEDICATIONS:

  • Asmanex HFA (mometasone furoate), 100mcg/actuation: 1 puff once daily when well; 2 puffs BID when sick with respiratory symptoms
  • Ventolin HFA (albuterol sulfate), 90mcg/actuation: 2 puffs every 4-6 hours PRN for wheeze/cough; 2 puffs prior to exercise; when sick with respiratory symptoms, increase to 4 puffs every 4 hours
  • Epi-pen (epinephrine), 0.3mg: Administer in thigh for any exposure to peanuts or signs consistent with an allergic reaction; seek immediate medical attention after using. May repeat in 5-10 minutes as needed for return of symptoms.
  • Motrin (ibuprofen), 100g/5mL: 15mL every six hours as needed for fever

ALLERGIES:

  • Foods: peanuts (anaphylaxis)
  • Medications: none
  • Environmental: none

PHYSICAL EXAM:

Vitals: Wt-71 lbs, Ht-54.75 inches, BMI 16.7, Temp-101.3 °F (tympanic), HR-118, RR-30, SpO2-95%, BP-92/46, pain-denies

HEENT: Normocephalic; no lesions. Pupils 3 to 4 mm, and symmetrically reactive to light. TMs are flat, non-erythematous, with appropriate light reflexes bilaterally. Nares patent bilaterally. Mucus membranes are moist, good dentition, tonsils are 2+ without exudate, pharynx is non-erythematous.

Lungs: Diffuse inspiratory and expiratory wheezes, coarse crackles in the left lower lobe; no change with deep inspiration/cough. Intercostal and substernal retractions noted. Post-albuterol: Coarse crackles RLL, occasional inspiratory wheeze, resolved retractions.

Cardiovascular: Normal S1 and S2. No murmurs or abnormal heart sounds.

Abdomen: Soft, non-tender, non-distended. No hepatosplenomegaly noted.  

CASE ANALYSIS:

Illustrate your understanding of Pharmacotherapeutics in this patient’s care. Please no copying and pasting but you are welcome to make your own charts or graphs if desired.

Complete an analysis for each medication and any medication you decide to prescribe including:

  • Describe the mechanism of action, side effects, caution and/or contraindications, monitoring parameters and determine if the medication is the best option for this patient
  • Common dosage, route and schedule for the medication
  • Determine cost of each medication
  • Is the medication being used reasonably in this situation (risk/benefit analysis)?
  • Would you make any changes in the use of the drug if you were the provider?

Complete an analysis of the patient including:

  • Evidence of drug effectiveness
  • Indicate potential drug interactions (drug-drug, drug-food, drug-herb, etc.)
  • Indications of possible adverse drug effects                                           
  • Factors affecting compliance/adherence
  • What social factors must you considered for this patient?
  • What education must you provide to the patient about these medications
  • Are there special considerations for this patient population that must be considered? When would you want to see this patient again in a follow up visit?
  • Include any nonpharmacologic interventions that you feel are appropriate.

Use the grading rubric below

NURS 424 Advanced Pharmacology Across the Lifespan

Case Study Grading Rubric

Criteria Total Points = 100A –Level Paper (1-10 points deducted)B-Level Paper (11-20 points deducted)C (or lower)-Level Paper (>20 points deducted)
Introduction (10 points)There is a strong introductory paragraph that clearly outlines topics to be discussed and triggers interest in the caseIntroduction is present, but does not clearly identify topics to be discussedIntroduction is poorly written, disorganized, missing, or too extensive
Case Study Content (75 points)Paper clearly identifies and explains the important aspects of the case; content is thorough yet concise; all required sections present (discussion is longest section)At least 5 current (2012–), relevant, variable, professional sources (nursing & medical literature) are utilized that support concerns raised & interventions proposedThere is evidence of the student’s creativity and synthesis of the student’s critical thinkingInterventions are sound and supported by the literatureBody of the paper identifies certain key aspects of the case; interventions are reasonable but not thorough; all sections included but inadequate attention to discussion sectionInadequate synthesis of the student’s opinions and integration of evidence-based resources Evidence-based resources are not all current, professional, or relevant.  Fewer than 5 sources citedBody of the paper has major flaws (ie., missing key aspects); section of paper omitted or grossly flawedThere is inadequate utilization of appropriate reference sources; paper lacks synthesisMultiple sources are not current, professional, relevant or varied; <5 resources are citedInformation from resources is not well integrated and synthesizedThere is little evidence of the student’s critical thinkingConcerns for plagiarism
Conclusion (10 points)Conclusion summarizes key points of the paper; no new information is provided that should have been elaborated in the body of the paperComments on next steps are provided as appropriateConclusion does not synthesize key points or contains new information that should have been presented in the body of the essay; comments on next steps are omittedConclusion is poorly written, missing, or too extensive
Format & grammar (5 points)Essay has excellent readability; free of grammatical and spelling errorsFormat adheres to APA standards (title & reference page, citations, spacing, 1-inch margins, size 12 font (preferably Arial or Times New Roman), page numbers; paper is organized with headings/sub-headings  A few grammatical errors are present Format does not meet all of the APA criteria  Several grammatical errors are present Format does not meet several of the APA criteria  
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