NURS6521F Case Study Instructions SEPT 22

Week 4
WEEK 4: Gastrointestinal and Hepatobiliary System
Class,
Welcome to week 4! This week we will apply pharmacology concepts to the
gastrointestinal and hepatobiliary systems.
Symptoms of various gastrointestinal (GI) and hepatobiliary disorders often
overlap, making diagnosis and treatment challenging. For example,
symptoms such as nausea, vomiting, constipation, and diarrhea are non-
specific and could also be the result of
underlying medical history or current prescription drug use. As an advanced
practice nurse, you could be potentially responsible for providing care to a
patient who may present with non-specific symptoms related to the
gastrointestinal and hepatobiliary systems.
When selecting drugs and determining dosages for patients, it is essential to
consider individual patient factors that might impact the patient’s
pharmacokinetic and pharmacodynamic processes. These patient factors
include genetics, gender, ethnicity, age, behavior (ie diet, nutrition, smoking,
alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.
ASSIGNMENT
Submit your Assignment by Day 7 of Week 4 (Sunday night, 11:59 pm ET)
Case studies are a useful way for you to apply your knowledge of
pharmacokinetics and pharmacodynamic aspects of pharmacology to
specific patient cases and health histories.
For your week 4 assignment, evaluate drug treatment plans for patients with
various disorders and justify drug therapy plans based on patient history and
diagnosis.
To Prepare:
• Review assignment rubric and case studies. Be sure to thoroughly answer
ALL questions.
• Explain the problem and discuss how you would address the problem.
• When recommending medications, write out a complete prescription for
each medication. What order would you send to a pharmacy? Include drug,
dose, route, frequency, special instructions, # dispensed (days supply),
refills, etc. Also state if you would continue, discontinue or taper the patient’s
current medications.
• Answer questions using your required learning resources, clinical practice
guidelines, Medscape and JNC 8.
• Include at least three references to support each scenario and cite them in
APA format. Please include in-text citations. You do not need an introduction
or conclusion paragraph.
SCENARIO 1
Donald is a 60 year old male presenting with dyspnea (shortness of breath),
chronic productive cough, wheezing, and fatigue. He smokes 1 pack of
cigarettes per day for the last 40 years. Post-bronchodilator FEV1/FVC ratio <
0.70 confirms persistent airflow limitation. What treatment plan would you
implement for this patient? What medication(s) would you prescribe? How
would you monitor the effectiveness of this plan?
SCENARIO 2
Allen is a 49 year-year-old man seeking evaluation for “a burning sensation
in my chest,” often after eating and worse at night. He has frequent feelings
of bloating and occasional nausea. Allen consumes a diet high in fatty foods
and caffeine. He drinks alcohol socially on weekends. PMH includes asthma,
diabetes and hypertension. His current medications include prn albuterol,
metformin 1000 mg po BID, nifedipine ER 60 mg po daily. How would you
improve his drug therapy plan? What changes would you make? What is your
working diagnosis and what medication would you prescribe? What
information would you provide to the patient at his visit?
SCENARIO 3
Jessica is a 37-year-old female diagnosed with mild persistent asthma.
During her visit today, she reports having to use her albuterol 4 days per
week over the past month. Over the past week she has been using albuterol
at least once per day. She reports being awakened by a cough five nights
during the last month. Her current medications include: fluticasone HFA 44
mcg, two puffs BID, albuterol MDI two puffs Q 4–6 H PRN shortness of breath,
Medrol Dosepak, metformin 500 mg PO BID, Inderal LA 160 mg po daily. How
would you step up therapy for this patient? What medication changes would
you make? How would you monitor the effectiveness of this plan? What
patient teaching would you provide?
SCENARIO 4
June is a 71-year-old female and has Alzheimer’s Disease x 2 years. She
presents with daytime dizziness, fatigue and increasing forgetfulness.
Consider her labs and provide an updated drug therapy plan. Include
complete medication orders. How would you monitor drug therapy? Labs:
TSH 5 mU/L, vitamin D 29 ng/mL, B12 350 pg/mL, Hb 12.1 g/dL, HgA1C =
5.5% Meds: donepezil 5mg po qhs, zolpidem 10mg po qhs
If you are going to write a prescription, they MUST be in this form.

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Week 4

WEEK 4: Gastrointestinal and Hepatobiliary System

If you are going to write a prescription, they MUST be in this form.

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