Josip Benko Medical Surgical I November 5, 2012 Geriatric atient Medication !

ssessment Student" Josip Benko atient Initial" #ctober 2, 2012 !ge" $$ %ealt& roblem o' atient" resent" (eakness to muscle and pain'ul to (alk Medical" osteoart&ritis, osteoporosis, &)pertension, &eart disease, &ig& c&olesterol Trade name C$olecalcifero l Generic name %itamine &' Dose ordere d ( )))u nits * (Ta+ Route ordered "O Time of adminis tration Dail, MEDICATION LIST Drug action/indications Indications- %itamin D .it$ calcium is used to treat or pre/ent +one loss Action- &ound to a specific 01 glo+ulin# Can +e stored in adipose 2 muscle tissue for long periods of time# Slo.l, released from storage sites 2 s!in .$ere it is formed in t$e presence of sunlig$t or u/ lig$t# Ma, distri+ute into +reast mil!# Indication- osteoart$rit$is Action- in$i+its prostaglandin s,nt$esis to produce anti1 inflammator, analgesic and antip,retic effects Nursing implications considerations side effects to loo! for "t# education 1 3,percalcaemia# E/idence of /itamin D to4icit,# 3,perp$osp$ataemia or $,percalcaemia 5in e4cessi/e inta!e6# Associated effects of $,percalcaemia include $,percalciuria ectopic calcification 2 renal 2 C% damage# 1 E4cessi/e inta!e ma, lead to de/elopment of $,perp$osp$ataemia or $,percalcaemia# Infants renal impairment or calculi $eart disease# Monitor plasma p$osp$ate 2 calcium le/el# "regnanc, lactation# - aseptic meningitis an4iet, depression di::iness insomnia +lurred /ision e,e pain +leeding $eart failure acute renal failure ast$ma anap$,la4is - ma, increase ALT AST +iliru+in &;N and creatinine le/els - NSAIDs cause an increase ris! of serious GI ad/erse e/ents - Tell patient to ta!e medication .it$ mil! meat or antacids to minimi:e GI distress - Teac$ patient ad/erse effects of medication and to report to $ealt$care pro/ider - $eadac$es di::iness insomnia r$a+dom,ol,sis

7reete4t

Diclofenac Sodium

89mg

"O

Dail,

Lo/astatin

Me/acor

<)mg

"O

Dail,

Indication- to pre/ent and treat

*( Ta+

coronar, $eart disease Action- in$i+its 3MG1CoA reductase

metoprolol

Lopressor

<9mg *( Ta+

"O

=(<3

Indication- $,pertension angina Action- selecti/e +eta1+loc!er decrease CO perip$eral resistance and cardiac o4,gen consumption

ras$ pruritus +lurred /ision flatulence nausea /omiting - interacts .it$ c,closporines /erapamil and !a/a - $a/e patient follo. diet restricted in saturated fat and c$olesterol during t$erap, - instruct patient to ta!e medication .it$ e/ening meal - fatigue di::iness depression +rad,cardia $eart failure a/ +loc! edema .$ee:ing ras$ - ala,s c$ec! patients apical pulse +efore gi/ing medication - taper medication o/er ( to < .ee!s do not stop a+ruptl, - tell patient to alert prescri+ers if s$ortness of +reat$ occurs Nursing implications considerations side effects to loo! for "t# education 1 $eadac$es di::iness fatigue 1 ma, cause deat$ or in>ur, to de/eloping fetus do not gi/e to pregnant .omen 1 monitor +lood pressure for effecti/eness 1 facial and t$roat s.elling ma, occur especiall, after first dose 1 $,pogl,cemia leu!openia 1 man, OTC and prescription products contains acetaminop$en@ +e.are of t$is .$en calculating total dail, dose 1 tell parents to consult prescri+er +efore gi/ing drug to c$ildren ,ounger t$an age < 1 ad/ise parents t$at drug is onl, for s$ort term use Nursing implications considerations side effects to loo! for "t# education

Trade name =uinapril

Generic name Accupril

Dose ordered ()mg * ( Ta+

Route ordered "O

Time of adminis tration Dail,

MEDICATION LIST Drug action/indications Indication- $,pertension $eart failure Action- pre/ents con/ersion of angiotensin I to angiotensin II a potent /asoconstrictor Indications- mild pain relie/er fe/er reducer Action- t$oug$t to produce analgesia +, in$i+iting prostaglandin and ot$er su+stances t$at sensiti/e pain receptors# Drug ma, relie/e fe/er t$roug$ central action in t$e $,pot$alamic $eat1regulating center Drug action/indications

Acetaminop$en

T,lenol

?9)mg * <Ta+

"O

=?3 "RN Mild "ain

Trade name

Generic name

Dose ordered

Rout e orde red

Time of administ ration

Acetaminop$en 1 Codeine

T,lenol A '

'omg/' ))mg * (Ta+

"O

=B3 "RN Moderat e "ain

Indication- relief of mild to moderatel, se/ere pain Action- com+ines analgesic effects of centrall, acting analgesic codeine .it$ perip$erall, acting analgesic acetaminop$en

c,anoco+alamin

%itamin &(<

()))mc g

( puff

Dail,

Indication- /itamin +(< deficiencies due to mala+sorption due to anema GI d,sfunction folic acid deficienc, Action- essential to gro.t$ cell reproduction $ematopoiesis and m,elin s,nt$esis

1$eadac$es constipation nausea /omiting di::iness 1 s$allo. +reat$ing slo. $eart+eat feeling lig$t1$eaded fainting confusion unusual t$oug$ts or +e$a/ior sei:ure 5con/ulsions6@ 1 as! if patient is allergic to codeine 1 as! patient if $istor, of +rain disorders +reat$ing pro+lems !idne, disease li/er disease mental/mood disorders drug a+use 1 anap$,lactic s$oc! pulmonar, edema congesti/e $eart failure diarr$ea itc$ing feeling of s.elling of entire +od, 1 $,po!alemia and sudden deat$ ma, occur 1 anap$,lactic s$oc! 1 %itamin &(< deficienc, t$at is allo.ed to progress for longer t$an ' mont$s ma, produce permanent degenerati/e lesions of t$e spinal cord#

1* Is t&e patient taking t&e medications as prescribed+ !ns(er" ,es 2* I' not, (&ic& medication-s. is being taken incorrectl)+ !ns(er" None /* I' t&e patient is not taking t&e medication as prescribed, &o( is t&e patient taking t&e medication-s.+ !ns(er" Nurse in c&arge o' medication is administering t&em as directed* 0* 1&at t&erapeutic e''ects is t&e patient e2periencing 'rom eac& medication !ns(er" 3rug 4&erapeutic 5''ect %itamine &' 6eels as t&oug& bones are stronger Diclofenac Sodium !lleviated art&ritis Me/acor 3ecrease in c&olesterol levels Lopressor 3ecrease in blood pressure Accupril 3ecrease in blood pressure T,lenol 3ecrease in pain T,lenol A ' 3ecrease in pain %itamin &(< 6eels stronger

5* 1&at adverse e''ects t&e patient is e2periencing and to (&ic& drugs+ !ns(er"

3rug %itamine &' Diclofenac Sodium Me/acor Lopressor Accupril T,lenol T,lenol A ' %itamin &(<

!dverse 5''ect None 3epression, e)e pain, di77iness 3i77iness, &eadac&es 6atigue, di77iness, depression %eadac&es, di77iness, 'atigue 8onstipation, nausea 8onstipation, di77iness, &eadac&es, nausea None

9* 1&at potential drug:drug or 'ood:drug interactions could occur+ !ns(er" 3rug 3rug:3rug %itamine &' Asprin, duloxetine, vitamin B12: decreased e''icac) o' t&ese drugs Diclofenac Sodium Antihypertensives, diuretics: decreased e''icac) o' t&ese drugs Me/acor Warfarin: increased prot&rombin time, bleeding Lopressor Accupril T,lenol T,lenol A ' %itamin &(< Antihypertensives, nitrates: additive &)potension Antacids: decreased ;uinapril absorption Activated charcoal, cholestyramine, colestipol: decreased acetaminop&en absorption Bar!iturates: increased risk o' &epatoto2icit) 3o not use i' allergic to cobalt, or i' )ou &ave =eber>s disease

6ood:3rug 6ood signi'icantl) decreases t&e bioavailabilit) o' alendronate, possibl) to negligible levels* garlic, ginger, ginkgo, ginseng: increased risk o' bleeding Grapefruit juice: increased lovastatin blood level ed yeast rice: increased risk o' adverse reactions Any food: en&anced drug absorption %ig& 'at" decreased rate and e2tent o' drug absorption< salt substitutes" increased risk o' &)perkalemia None None None

?* 1&at teac&ing did )ou do to decrease adverse e''ects or interactions+ !ns(er" take 4)lenol (it& 'ood in order to decrease nausea < take Mevacor (it& evening meal or e2tended:release tablets at bedtime $* &)sical assessment 'indings pertinent to t&e medication-s." !ns(er" 3rug 6indings Diclofenac Sodium @enal 'unction (it&in normal range< blood pressure 10$A$0

Me/acor Lopressor Accupril T,lenol %itamine &'

=iver 'unction (it&in normal range Blood pressure 10$A$0 Bital signs and cardiovascular status (it&in range, no increase in potassium levels atient usuall) cannot sleep because o' pain, usuall) takes to reduce pain and induce sleep Bitamin 3 levels (it&in normal range, calcium levels (it&in normal range

C* %o( is t&e patientDs spirituall) a''ected b) t&e medications being taken" !ns(ers" atient 'eels t&at &aving to take medication 'or osteoporosis is GodDs (a) o' punis&ing &er 'or not being a ver) good person because s&e (ants to run around and continue to (ork and, as t&e patient said, Epla) around and &ave 'un, but cant because o' m) osteoporosis*F 10* Give a t&oug&t'ul summar) o' (&at )ou learned (&ile doing t&is assessment* !ns(er" I learned a lot about &o( important it is to be t&oroug& in t&e details (&en processing and documenting (&at t&e patient describes (&en relating t&eir e2periences* ItDs vital to document eac& time I take vitals and remember t&e di''erent drug and 'ood interactions*