D6

  Case 6

Mrs. P. is an 80-year-old woman recently discharged from a 24-hour observation stay at the hospital after being diagnosed with acute bronchitis. She has a history of heart failure, hypertension, osteoarthritis, GERD, and hyperlipidemia. She has no history of smoking. While in the hospital she was prescribed doxycycline, prednisone 15 mg to taper, and a tiotropium inhaler. Her current list of daily medications prior to hospitalization includes metoprolol succinate 12.5 mg, pantoprazole 40 mg, atorvastatin 10 mg, lisinopril 10 mg, furosemide 40 mg, potassium chloride 20 meq bid, acetaminophen 650 mg bid for pain and tramadol 25 mg as needed. She lives alone but will reside temporarily with her daughter while she recovers. Her discharge report indicated resolving bronchitis, no exacerbation of heart failure, and stable arthritic pain. Today she reports 1 week after discharge with her daughter for a primary care appointment, and they both were concerned about the number of medications she was prescribed and wanted her medications reviewed. In further review, she was found to have lost weight over the past 6 months of 5 lbs and her current BMI is 25. She states that the weight loss may be due to a change to a healthier diet and reducing sodium as instructed. She also reports no symptoms of GERD for the past 6 months and minimal arthritic pain because of regular use of acetaminophen and daily walking in the halls of her independent living facility. Upon examination her lungs are clear to auscultation and no evidence of lower extremity edema.

Discuss the following:

1) In reviewing her medication list and current symptoms and clinical signs, whichmedication could the nurse practitioner consider de-prescribing.

2) Once the patient has completed the prednisone taper, which medication could the nurse practitioner begin to reduce given the patient’s reported symptoms.

3) Given the absence of an exacerbation of heart failure and compliance with a reduced sodium diet, what other medication(s) adjustments could the nurse practitioner consider atthis time.

 

Submission Instructions:

· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

· Attention: Please post your initial response by 11:59 PM ET Thursday

Grading Rubric 

Your assignment will be graded according to the grading rubric.

Discussion Rubric
Criteria	Ratings	Points
Identification of Main Issues, Problems, and Concepts	Distinguished – 5 pointsIdentify and demonstrate a sophisticated understanding of the issues, problems, and concepts.	Excellent – 4 pointsIdentifies and demonstrate an accomplished understanding of most of issues, problems, and concepts.	Fair – 2 pointsIdentifies and demonstrate an acceptable understanding of most of issues, problems, and concepts.	Poor – 1 pointIdentifies and demonstrate an unacceptable understanding of most of issues, problems, and concepts.	5 points
Use of Citations, Writing Mechanics and APA Formatting Guidelines	Distinguished – 3 pointsEffectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.	Excellent – 2 pointsEffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.	Fair – 1 pointIneffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.	Poor – 0 pointsIneffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention.	3 points