LM is an 89-year-old female resident of

LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit. PMH: HTN Alzheimer’s disease Hypothyroidism Osteoarthritis Diabetes MEDICATIONS: Amlodipine 10 mg QD Donepezil 10 mg QHS Levothyroxine 0.88 mg QAM Celecoxib 200 mg QD Furosemide 40 mg QAM Metformin 500mg, 1 BID Glyburide 5mg, 1 BID ALLERGIES: NKA SOCIAL HISTORY: Widowed with 2 adult children living in town, retired photographer and owner of an art supply store VITALS: LABS: Weight: 129 lbs TSH 2.45 Free T4 0.98 Height: 64 inches Na 135, K+ 3.8, Cl 99, CO2 25, BP: Supine = 177/82 Glucose 101, SCr 0.9, BUN 42 HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1 Plt 255 Cr: 1.6 UA: Clear eGFR: 45 ml/min PE: HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranes CV: RRR Respiratory: Clear to auscultation bilaterally Abdomen: Soft, non-tender, no masses or guarding G/U: Skin intact, assisted with toileting and personal hygiene by staff Extremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearm Neuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months. PAIN ASSESSMENT: Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to severe Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned. Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples. Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. SCIENCE HEALTH SCIENCE NURSING NURS 6521

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