Problem
A. Your neighbor is an 89 year old Hispanic male who has been in excellent health. His wife knows you are a nurse and voices concern that her husband has been confused lately and sustained two falls this week. He had a fecal incontinence episode this morning and she said his stool was "awful dark." You ask if he is taking any medications. She proudly responds that he is not.
a. On further inquiry she says he only takes Motrin 400 BID for his arthritis. This manages his pain pretty well, but he still has discomfort at night, so last week she started giving him Tylenol PM to help him sleep.
b. What are contributing to Mr. G's symptoms?
B. Mrs Jones is an 86 y/o F who is a new admit. She was demonstrating increased confusion and sustained 5 falls over the past 2 weeks. Her Dx include DM, OA, PD, HTN, CHF, and Insomnia. From the following list of meds determine what concerns you have and what lab needs to be monitored with each specific med:
a. ASA 325 mg qd for cardiac prophylaxis
b. Ompeprazole 20 mg qd
c. Nitrofurantoin 100 mg qd for UTI prophylaxis
d. Premarin 0.625 mg qd for OP prophylaxis
e. Amitriptyline 50 mg qhs for insomnia
f. Ibuprofen 400 BID for OA
g. Digoxin 0.5 mg qud for CHF
h. Furosemide 20 mg BID for CHF
i. Zyprexa (olanzapine)5mg qd for psychosis
j. Glyburide 5 mg qd for DM.