Posted: December 6th, 2022

LM is an 89-year-old female resident of a long-term care

Case Study
LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit.
PMH:
• HTN
• Alzheimer’s disease
• Hypothyroidism
• Osteoarthritis
• Diabetes
MEDICATIONS:
• Amlodipine 10 mg QD
• Donepezil 10 mg QHS
• Levothyroxine 0.88 mg QAM
• Celecoxib 200 mg QD
• Furosemide 40 mg QAM
• Metformin 500mg, 1 BID
• Glyburide 5mg, 1 BID
ALLERGIES: NKA
SOCIAL HISTORY:
Widowed with 2 adult children living in town, retired photographer and owner of an art supply store
VITALS: LABS:
Weight: 129 lbs TSH 2.45 Free T4 0.98
Height: 64 inches Na 135, K+ 3.8, Cl 99, CO2 25,
BP: Supine = 177/82 Glucose 101, SCr 0.9, BUN 42
HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1
Plt 255
Cr: 1.6 UA: Clear
eGFR: 45 ml/min
PE:
• HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranes
• CV: RRR
• Respiratory: Clear to auscultation bilaterally
• Abdomen: Soft, non-tender, no masses or guarding
• G/U: Skin intact, Helped with toileting and personal hygiene by staff
• Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm
• Neuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months.
PAIN ASSESSMENT:
Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to severe

To Prepare
• Review the case study assigned by your Instructor for this Assignment.
• Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
• Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
• Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
• Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.

Assignment
Write a 2- to 3-page paper that addresses the following:
• Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. Write a 2- to 3-page paper addressing the following topics:
• Explain how the factor you chose might influence the pharmacokinetic and pharmacodynamic processes in the case study patient.
• Explain how changes in processes may affect the patient’s recommended drug therapy. Provide specifics and examples.
• Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
• Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

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