Therapeutic Management and Patient Care Essay Assignment

The Problem

The following case is of a lady, 45 years of age and her weight was recorded with a BMI of 33 kg/m2, her name is Sara. She gives a history of constantly high blood pressure, which at the last checkup was 160/90 mm Hg, this falls under stage 2 hypertension. Her current use of medications: she uses ibuprofen 600 mg TID for back pain, which must be causing hypertension. The target is to get her BP back to a normal level that is lower than 130/80 mm Hg in a bid to eliminate cardiovascular incidences (Rivasi et al., 2022).

Lisinopril/Hydrochlorothiazide 20 mg/12 for hypertension should be used; Titrate dosage according to the patient’s response: We would prescribe 5mg of the antiemetic in its oral formulation, to be given to the patient on a daily basis with one month’s supply plus two renewals. As NSAIDs may affect BP, it is preferable to change the pain medication for a patient with COPD to acetaminophen, 500mg q 6h PRN (Kishore et al.,2018). Therapeutic Management and Patient Care Essay Assignment

ORDER HERE A PLAGIARISM-FREE PAPER 

Sara needs to be educated on adherence to her medication, self–BP monitoring, and the other elements of the recommended lifestyle changes like the DASH diet, regular exercise, weight loss, restricting her alcohol intake and quitting smoking if she is a smoker. The management of the treatment outcome is done in 4 weeks hence booking for a follow up appointment is inevitable (Tam et al., 2020).

A previously employed 52-year-old male smoker, Monty, from the United Kingdom who has a one pack per day smoking history is currently on Lisinopril 20mg daily for hypertension and wishes to get further follow up concerning his lipid profile that came out to be high. The patient has a total cholesterol of 266 mg/dL, where LDL cholesterol is 180 mg/dL, HDL cholesterol 40 mg/dL, and triglycerides 185 mg/dL. These results signify dyslipidemia; therefore, he is at a higher risk off respectively developing CAD. Some of the interventions for care management involve managing Monty’s cardiovascular risk through medications and changes in behavior. For hyperlipidemia, an LDL of which is moderately raised, I would prescribe Atorvastatin 20 mg orally daily. This type of statin medication has the principal role of reducing the LDL cholesterol as can be seen in the following (Hussain et al.,2023).

Monty will be advised to use Atorvastatin in the evening to improve its bioavailability as is the standard advice (Atorvastatin 2017). Usually the prescription would be for 30 tablets with two repeats meaning that the patient is supplied with enough medication for 30 days. Monitoring will involve lipid profile, where this will be done at least within the first 4-12 weeks after starting Atorvastatin without any upper limit, and then depending on his response it will be repeated after 3-12 months. Also, the routine follow-up will involve checking of adherence to anti-psychotic medication and probable side effects (Levintow et al., 2022).

Beatrice, a 17-year-old female with a history of mild persistent asthma since age 7, visited today with concerns about increasing symptoms despite her current medication regimen. She reports using her albuterol inhaler 3 to 4 days per week over the past two months, with an escalation to once daily in the past week. She also experiences nocturnal coughing episodes about three nights per month and is noticing heightened shortness of breath during exercise. Her current medications include Flovent HFA 44 mcg inhaler, taken two puffs twice daily for maintenance, and Proventil HFA inhaler, two puffs every 4-6 hours as needed for acute shortness of breath. Additionally, she takes Yaz (drospirenone/ethinyl estradiol) once daily for birth control and Propranolol 80 mg orally twice daily (Mohan et al., 2023). Therapeutic Management and Patient Care Essay Assignment

Upon assessment, it can be ascertained that Beatrice’s asthma is sub operatively managed although she is currently on optimal treatment. The use of albuterol more often than 3 days/seven days apart and presence of nocturnal symptoms imply that there is persistent inflammation and bronchoconstriction that can only be controlled by higher step therapies. Some drugs used for other health complications like Propranolol she uses it for may also be contributing to her asthma complications because it can worsen bronchoconstriction (Huang et al., 2021).

To address Beatrice’s asthma care, several modifications in the contingency plan are proposed. She will be administered QVAR RediHaler (Beclomethasone) 80 g/puff, total two puffs in the morning and evening. The drug dose change in question is to offer a higher intensity and efficacy of corticosteroids to alleviate inflammation within the person’s airways and enhance the control of symptoms. Teaching regarding correct inhaler usage will be conducted to ensure optimal cleared medication to the lungs for asthma patients. Propranolol will not be used because in the case of asthmatic patients this medication causes deterioration of the condition (Usmani & Levy 2023).

Daute, male, 56 years, complains of recurrent shortness of breath specifically, shortness of breath on exertion with this the patient has been avoiding any form of physical activity in a bid to suppress his symptoms. Past medical history includes eight years of chronic bronchitis which was recently worsened that necessitated oral antibiotics in treatment, other history includes significant smoking history of 40 pack years (Saleem et al., 2018). Therapeutic Management and Patient Care Essay Assignment

He has been diagnosed with this condition two years ago and has been taking salmeterol/fluticasone (Advair Diskus) (Zhang et al., 2022), however, compliance to the medications has not been proper. Based on his complaints, clinical signs, current history of possibly having a COPD, an Anoro Ellipta (Umeclidinium/Vilanterol) 62 intervention plan may be appropriate. 5 mcg/25 mcg inhalation powder: one inhalation/day. This medication of the combination of LAMA and a LABA provides an extended release of bronchodilation and better control of the symptoms (Riley et al.,2016). Therapeutic Management and Patient Care Essay Assignment

References

Atorvastatin. (2017). PharmacotherapyFirst Drug Information. https://doi.org/10.21019/pfdi.atorvastatin

Huang, K., Tseng, P., Wu, Y., Tu, Y., Stubbs, B., Su, K., Matsuoka, Y. J., Hsu, C., Lin, C., Chen, Y., & Lin, P. (2021). Do beta-adrenergic blocking agents increase asthma exacerbation? A network meta-analysis of randomized controlled trials. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-020-79837-3

Hussain, A., Kaler, J., & Ray, S. D. (2023). The benefits outweigh the risks of treating Hypercholesterolemia: The Statin dilemma. Cureus. https://doi.org/10.7759/cureus.33648

Kishore, S. P., Salam, A., Rodgers, A., Jaffe, M. G., & Frieden, T. (2018). Fixed-dose combinations for hypertension. The Lancet, 392(10150), 819-820. https://doi.org/10.1016/s0140-6736(18)31814-2

Levintow, S. N., Reading, S. R., Noshad, S., Mayer, S. E., Wiener, C., Eledath, B., Exter, J., & Brookhart, M. A. (2022). Lipid testing trends before and after hospitalization for myocardial infarction among adults in the United States, 2008–2019. Clinical Epidemiology, 14, 737-748. https://doi.org/10.2147/clep.s361258

Mohan, A., Lugogo, N. L., Hanania, N. A., Reddel, H. K., Akuthota, P., O’Byrne, P. M., Guilbert, T., Papi, A., Price, D., Jenkins, C. R., Kraft, M., Bacharier, L. B., Boulet, L., Yawn, B. P., Pleasants, R., Lazarus, S. C., Beasley, R., Gauvreau, G., Israel, E., … Sumino, K. (2023). Questions in mild asthma: An official American Thoracic Society research statement. American Journal of Respiratory and Critical Care Medicine, 207(11), e77-e96. https://doi.org/10.1164/rccm.202304-0642st

Riley, J. H., Tabberer, M., Richard, N., Donald, A., Church, A., & Harris, S. (2016). Correct usage, ease of use, and preference of two dry powder inhalers in patients with COPD: Analysis of five phase III, randomized trials. International Journal of Chronic Obstructive Pulmonary Disease, 11, 1873-1880. https://doi.org/10.2147/copd.s109121

Rivasi, G., Menale, S., Turrin, G., Coscarelli, A., Giordano, A., & Ungar, A. (2022). The effects of pain and analgesic medications on blood pressure. Current Hypertension Reports, 24(10), 385-394. https://doi.org/10.1007/s11906-022-01205-5

Saleem, S., Sardar, K., & Javed, N. (2018). Chronic bronchitis. The Professional Medical Journal, 25(08), 1240-1244. https://doi.org/10.29309/tpmj/18.4936

Tam, H. L., Wong, E. M., & Cheung, K. (2020). Effectiveness of educational interventions on adherence to lifestyle modifications among hypertensive patients: An integrative review. International Journal of Environmental Research and Public Health, 17(7), 2513. https://doi.org/10.3390/ijerph17072513

Usmani, O. S., & Levy, M. L. (2023). Effective respiratory management of asthma and COPD and the environmental impacts of inhalers. npj Primary Care Respiratory Medicine, 33(1). https://doi.org/10.1038/s41533-023-00346-7

Zhang, X., Liu, M., & Mao, Y. (2022). Efficacy of Fluticasone and Salmeterol dry powder in treating patients with bronchial asthma and its effect on inflammatory factors and pulmonary function. Evidence-Based Complementary and Alternative Medicine, 2022, 1-6. https://doi.org/10.1155/2022/8555417 Therapeutic Management and Patient Care Essay Assignment

Directions: For each of the scenarios below, answer the questions below using your required learning resources, clinical practice guidelines, medscape and JNC 8. Explain the problem and explain 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. Use at least 3 sources for each scenario and cite sources using APA format.

Sara is a 45-year-old female presenting for her annual exam. Her blood pressure today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal for her blood pressure? What medication would you prescribe to treat her blood pressure? What education would you prescribe? Therapeutic Management and Patient Care Essay Assignment

Monty is a 52-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan would you implement for Monty’s lipid profile? What is the goal Total Cholesterol (TC), HDL-C, and LDL-C level for Monty? How would you monitor the effectiveness of your treatment plan? How many risk factors for coronary artery disease does this patient have? Identify them specifically.

ORDER HERE NOW

Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days per week over the past 2 months. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough three nights during the last month. She is becoming more short of breath with exercise. She also has a fluticasone MDI, which she uses “most days of the week.” Her current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA two puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80 mg PO BID. What treatment plan would you implement for this patient? What medication changes would you make? How would you monitor the effectiveness of this plan? Therapeutic Management and Patient Care Essay Assignment

Daute is a 56-year-old man seeking evaluation for increasing shortness of breath. He noticed difficulty catching his breath about 3 years ago. Physical activity increases his symptoms. He avoids activity as much as possible to prevent any SOB. His previous physician had placed him on salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He did not refill the prescription and has not been taking it. Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12 months of treatment with oral antibiotics. He has a 40-pack-year smoking history. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan? Therapeutic Management and Patient Care Essay Assignment