NR 508 Week 6 Discussions 1 (Part Three) Recent

discussion part three

this is your third time seeing this patient, and he reports the nsaid that he has been prescribed is not addressing his pain. he reports his pain is a 10 out of 10, hr 108, talking extremely fast, he is diaphoretic, unshaved, his clothes are a bit wrinkled and he is requesting that you prescribe him percocet because he doesn’t think tramadol, that you are considering prescribing, will work.

what are the possible signs of prescription drug abuse?

what should the np do when a patient has continued to return?

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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?