NR 508 Week 5 Discussions 1 (Part One) Recent

discussion part one

leroy is a 70 year-old-man, whose wife passed away 5 years ago, and whose 2 children live out-of–state. his neighbor caretaker (ms. webb, a middle-aged retired cna, whom his children hired to provide home care to him 3x/week) brings him to your clinic. he presents with quite severe confusion, incidentally to very minor changes in his environment, which provokes some violence (a symptom which startles ms. webb), increasingly impaired judgment, and increasing repetitiousness and inconsistencies in his usual behavior. upon initial work-up and physical exam, you notice an increased respiratory rate, a slight fever (100°f), and cost vertebral angle tenderness on his right side.

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discussion part one

elliot is a 74 year-old male who presents to your clinic with complaints of frequent nosebleeds (4 in the past week) and several severe bruises scattered variously throughout his anatomy. the patient is also complaining of a runny nose, cough, and head/chest congestion. he has a history of chronic atrial fibrillation and is currently prescribed and taking warfarin. approximately 3 weeks previously, he started taking over-the-counter cimetidine for heartburn he was experiencing. below is a list of the patient’s medications, his physical examination, and his laboratory findings:

medications

digoxin 0.25 mg qd cimetidine otc bid

pseudoephedrine sr 120 bid warfarin 7 mg qd

allergies: nkda

physical examination

vs: bp: 180/95, hr 75, irregularly irregular, rr 17

weight: 95 kg

heent: wnl

abd: + bowel sounds ext: bruising on arms and legs

neuro: alert & oriented x 3 gen: well developed, well-nourished male

ecg: atrial fibrillation

laboratory

na 143 meq/l k 4.5 meq/l

cl 99 mmol/l co2 25 meq/l

bun 18 mg/dl scr 0.9 mg/dl

inr 4.8 hct 42%

hbg 15 mg/dl digoxin 3.8 ng/ml

what problems should be identified in this patient?

what are the precise mechanisms of action of each drug?

what do you think is contributing to the patient’s hypertension?

are there any drug interactions that you can identify as associated with this current drug regimen, and if so how, mechanistically, are they occurring?

what is the clinical significance of these interactions?