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Medications Case Study Question: Discuss about the Medications Case Study.   Answer: Introduction 70 year old patient is having oedema on leg, hip pain and liver cirrhosis. His preexisting disease include hypertension, peptic ulcer, hypothyroidism, pulmonary hypertension and obesity. Blood tests, CT scan and X-ray is performed o him.  Few medicines are prescribed for him for different clinical conditions. Present condition : Currently patient is having oedema on the right and left leg and also having pain in knee and right hip. Patient is also having hypervolemia due to liver cirrhosis. Due to Oedema in the leg which peripheral oedema, there is more outflow of water and electrolytes form vascular circulation to the interstitium. This outflow from the vascular circulation to the interstitium occur due to increased capillary pressure, reduced colloid osmotic pressure and insufficient lymphatic drainage. Patient has pain that may be due to osteoporosis. In osteoporosis there is the more production of osteoclast which breaks down the bone tissue and less number of ostoblast which replaces these broken bone tissues with the new tissues. In hypervolemia there is increase in concentration of sodium in the body. This leads to the increased thirst in the patient and patient increases more water intake. At the same time kidney also releases antidiuretic hormone (ADH) which results in the more retention of water in the body (Lewis et al., 2016; Goodman and Fuller, 2014). Clinical manifestations the patient exhibited including both subjective and objective data: Based on the objective data it is evident that patient has oedem, lymphopenia, anaemia, thrombocytopenia, cholestasis, hypoalbuminaemia, osteoarthritis, liver cirrhosis. Based on both subjective and objective data patient has osteoporosis. Based on the history (subjective data) it is evident that patient has pain, peptic ulcer, hypothyroidism, hypertension, pulmonary hypertension and obesity.   Diagnostic measures: Liver function tests are ordered for the patient because patient has liver cirrhosis. Liver function test mainly measures proteins like alanine transaminase (ALT), aspartate aminotransferase (AST), albumin, and bilirubin. Abnormal values of these proteins give idea of the extent of liver damage or liver scarring. Full blood examination (FBE) gives total examination of health of the patient. C-reactive protein (CRP) test is the marker of acute inflammation in the patient. As patient has peripheral oedema there is the possibility of inflammation in the patient. MBI test is mainly performed as metabolic panel test mainly for diabetes, liver disease, kidney disease and hypertension. As it is evident that patient is suffering from multiple disease, this MBI was ordered. CT scan of the right hip was mainly performed because patient has pain in hip. This CT scan demonstrates extent of the compression fracture which can be used to evaluate severity of osteoporosis. X-ray of spine pelvis right hip was performed in the patient to evaluate any dislocation of three bones of the pelvis like illiun, ischium and pubis. X-ray was performed to get more insight into the pain in the pelvis region (Fischbach and Barnett, 2009; Novelline and Squire, 2004). Treatment : Bisoprolol – Hypertension Esomeprazole  – Peptic ulcer Frusemide  – Hypertension, oedema, liver cirrhosis and pulmonary hypertension Simcastatin  – Obesity Thyroxine  – Hypothyroidism Ramipril  – Hypertension Slow K 1 – Hypervolemia Ferrous Sulfate Liq  – Low iron (Anaemia) Metformin  – Type 2 diabetes Spironoloctone  – Oedema and Hypervolemia   Treatment and Pathophysiology : Bisoprolol is prescribed for the management of hypertension in the patient. As patient has history of peptic ulcer this drug was prescribed to control acid reflux and to reduce acidity due to consumption of other medicines. Frusemide can be useful in the different conditions of the patient like hypertension, oedema, liver cirrhosis and pulmonary hypertension. Simcastatin was prescribed in this patient for obesity because there is the increased level of lipid levels and this drug is useful in lowering the lipid level. In Hypothyroidism condition of the patient there is the decreased production of thyroid hormone like thyroxine by thyroid gland. Thyroxine was prescribed to maintain normal level of thyroid hormone in the blood stream of the patient. Patient has hypertension and ramipril was used to treat hypertension. Patient has hypervolemia and in this condition, there is the decreased level of potassium. Slow K is electrolyte replenisher and it was prescribed to prevent or treat low amount of potassium in the blood. Patient has low level of iron and ferrous sulfate was prescribed to treat iron deficiency in anemia in the patient. Patient is diagnosed with type 2 diabetes and there is increased blood sugar level in the patient’s blood. Metformin was prescribed in the patient to control the blood sugar level. Patient has oedema and hypervolemia and in these conditions there is increased sodium level and water amount in the body. Spironoloctone is a potassium sparing diuretic and it was prescribed in the patient to eliminate or excrete fluid and sodium form the body. At the same time potassium should not be excreted from the body and hence spironolactone was prescribed so that it would not excrete potassium (Abate and Blommel, 2013; Malone et al., 2014).            Nursing Intervention In Side Effects: Bisoprolol – Body aches and pain. Nurse should evaluate pain regularly to asses extent of pain in the patient. Esomeprazolec- Constipation. Nurse should advise patient with food which increase bowel movement. Frusemide – Loss of appetite. Nurse should improve eating environment and make it pleasant so that patient should increase intake. Simcastatin – Indigestion. Nurse should advise patient to perform regular exercise to improve digestion. Thyroxine-Nervousness and mood swings. Nurse should communicate effectively and pleasantly with patient to give moral boost to the patient. Ramipril – Dry mouth and thirst. Nurse should advise patient to take plenty of fluid and maintain oral hygiene to prevent drying of mouth. Slow-K – Stomach pain. Nurse should make patient more socialize to divert patient’s attention from the pain.  Ferrous Sulfate – Gastrointestinal related and these are mainly dose related. Nurse should administer optimum dose to the patient to prevent these dose related side effects. Metformin – lactic acidosis. Nurse should monitor vital signs like blood pressure, heart rate and respiratory rate in the patient because these vital signs deviate from the normal values in cases of lactic acidosis. Spironoloctone – Numbness. Nurse should advise exercise to the patient to improve functioning of these body parts (Abate and Blommel, 2013; Malone et al., 2014).     Conclusion With the multiple complications, patients’s condition is very complex. Most of the vital organs of the patient are deteriorated and there is the possibility of multiple organ failure. With the administration of so many medications for different conditions, there is possibility of deteriorating patient condition due to side effects of these medicines and due to the drug-drug interactions.   References: Abate, M.A., and Blommel, M.L.  (2013). Drug Information and Literature Evaluation. Pharmaceutical Press – Remington Education.  Fischbach, F.T., and Barnett, M. (2009). A Manual of Laboratory and Diagnostic Tests. (8th ed.). Lippincott Williams & Wilkins.      Goodman, C.C., and Fuller, K. S. (2014). Pathology: Implications for the Physical Therapist. (4th ed.). Elsevier.   Lewis, S.L., Bucher, L., Heitkemper, M.M., Harding, M., et al., (2016). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. (10th ed.). Elsevier.  Malone, P., Kier, K., Stanovich, J., and Malone, M.J. (2014). Drug Information A Guide for Pharmacists 5/E. (6th ed.). McGraw Hill Professional.  Novelline, R. A., and Squire, L. F. (2004). Squire’s Fundamentals of Radiology. (6th ed.). Harvard University Press.

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