Pharmacology

1. You are the primary care provider for Mrs. Z, a 70-year-old female patient who has suffered from chronic back pain for a number of years. You are well acquainted with this patient, and due to recent changes in prescription regulations you now see her once a month to renew her narcotic prescription. Three months ago Mrs. Z’s 17-year-old granddaughter moved in with her, after a fight with her mother. Z’s granddaughter was a straight-A student prior to a car accident at the age of 15. She dropped out of high school last year and spent two weeks in rehab for substance abuse. Mrs. Z states her back pain has been worse recently, and she seems to be running out of pills before the end of the month. She is requesting a greater number of pills be prescribed.
What concerns do you have? What questions would you ask Mrs. Z? What approach would you take with? How would you help this family?

2. You are a primary care nurse in a heart failure clinic. Mr. G presents in the clinic with a three-pound weight gain in the past two days. Upon assessment, he has +2 pitting edema in bilateral lower extremities. When you ask him about his regular Lasix regimen, he shows you a plastic bag full of pills and states that he has so many pills prescribed, he just takes what he thinks he needs when he feels like he needs it. Included in the bag are Cardizem, Toprol XL, glipizide, gabapentin, Lasix, multiple vitamins, ginseng supplements, fish oil supplements, and cinnamon supplements. Where do you start? How can you coordinate a multidisciplinary approach in caring for this patient?
What patient education is necessary? How can you assist Mr. G in keeping his medications straight?

 

 

 

 

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