Therapeutic Use of Medicines (TUM202) Assessment 2 Polypharmacy case study Background informationRosa has been admitted to the Geriatric Evaluation Management (GEM) ward following a functional decline at home and urinary tract infection (UTI). Prior to admission, an on-call GP visited Rosa at home, because she had been feeling unwell with symptoms of urinary frequency, dysuria … Continue reading “Therapeutic Use of Medicines | My Assignment Tutor”
Therapeutic Use of Medicines (TUM202) Assessment 2 Polypharmacy case study Background informationRosa has been admitted to the Geriatric Evaluation Management (GEM) ward following a functional decline at home and urinary tract infection (UTI). Prior to admission, an on-call GP visited Rosa at home, because she had been feeling unwell with symptoms of urinary frequency, dysuria and urge incontinence for a few days. The GP diagnosed a UTI and prescribed trimethoprim 200 mg BD for 3 days. Rosa deteriorated the following day with symptoms of confusion, nausea and unsteady gait. Rosa’s husband called an ambulance, resulting in a subsequent visit to an emergency department (ED), where she was transferred to the GEM ward for further assessment and management. Patient DetailsName: Rosa FerarriAge: 86Allergies: NoneLanguage Italian (limited English)Medical Past HistoryCoronary heart disease (CHD)AsthmaAnxietyInsomniaModerately impaired left ventricular systolic function on ECHOHypertension (HT)Partial deafness (L) earSocial HistoryLives with husbandSupportive sons x2Smokes 10 cigarettes dailyDrinks 4-6 standard alcoholic beverages per weekResultsBP 170/80 mmHgRespiratory Rate 26 per minute (rest) 36 on exertion Sp02 94% on Room AirU&Es all within normal rangePulse 91 bpm regular Current MedicationsOmeprazole 20 mg once dailySimvastatin 40 mg at nightClopidogrel 75 mg once dailyBisoprolol 2.5 mg once dailyAmlodipine 10 mg once dailyFurosemide 40 mg once dailyTemazepam 10mg PRN at nightSalbutamol Inhaler 4 puffs PRNTrimethoprim 200 mg BD for 3/7Admitting DiagnosisUTIFunctional declineClinical Handover 07:00amNight shift report Rosa was irritable and unsettled overnight, she was given 15mg Temazepam at 02:20am as prescribed PRN for insomnia. Night shift nursing staff tell you that they have recently paged the medical officer to review and request a telephone order for nebulised salbutamol 5mg, as they think Rosa is experiencing an exacerbation of asthma as she’s a little breathless. Rosa is drowsy and unable to co-ordinate using the salbutamol, and the uncoordinated use of the puffer had no effect on her symptoms of breathlessness. Rosa shows increased used of accessory muscles, is breathless at rest, and this becomes worse with any exertion. She needed assistance x2 to be propped up in bed and she was sliding down the bed. Night shift observed persistent issues with peripheral pitting oedema, and lower limbs leaking serous fluid at times. Night shift document suspecting Rosa shows signs of early dementia, she is confused and irritable, with a GCS of 12 (eyes open to speech, verbal responses are confused and she moves to localised pain).
