Arthritis, Angina, CKD & Asthma Case Study

• The case study involves assisting Ms. Periwinkle, who has arthritis, angina, CKD, and a fungal rash under her left breast due to intertrigo.
• Ms. Periwinkle has a special connection with her caregiver, making her deteriorating condition distressing.
• She also has a new diagnosis of asthma
• She struggles to open her medication bottles and has blurry vision
• Document all medications on the MAR (Medication Administration Record) immediately after administering them

Medications and Administration

• Assist with 650 mg of Acetaminophen (Tylenol).
• Assist with 40 mg of Furosemide (Lasix).
• Assist with Salbutamol (Ventolin) MDI (metered dose inhaler) and spacer.
• Apply Nitro patch each morning, which her daughter removes after 12 hours.
• Apply a thin layer of Fucidin prescription cream to the crease in her left breast after her bath using a gloved finger.
• Provide oral care after MDI administration.

Factors Influencing Drug Action

• Age slows metabolism, increasing the risk of side effects and toxicity.
• Kidney function issues (CKD) and impaired liver function affects drug metabolism.
• Polypharmacy (multiple medications) increases risk
• Weak vision and arthritis affects her ability to take medications herself.
• A fungal rash under her breast affects the absorption of topical medications.

Medication Names

• Acetaminophen is the generic name for Tylenol (trade/brand name).
• Furosemide is the generic name for Lasix (trade/brand name).
• Salbutamol is the generic name for Ventolin (trade/brand name).

Medication Classification and Action

• Acetaminophen (Tylenol) is a pain reliever and fever reducer to reduce pain and fever.
• Furosemide (Lasix) is a diuretic (water pill) that increases urine output (diuresis), reduces fluid retention (edema), and decreases blood pressure by reducing blood volume.
• Salbutamol (Ventolin) is a bronchodilator that causes airway relaxation and widening (支氣管擴張藥)to relieve bronchospasms in conditions such as asthma and COPD.

Responsibilities with Each Medication

• For Acetaminophen (Tylenol) administer the correct dose, observe for signs of nausea, jaundice, or dark urine (indicating liver toxicity), and document at MAR
• For Furosemide (Lasix) administer correct dose in the morning to prevent nighttime urination, encourage fluid intake, monitor for dehydration, low blood pressure, dizziness and electrolyte imbalances (confusion, fatigue, constipation, cramps or weakness, nausea/vomiting, numbness), and document at MAR.
• For Salbutamol (Ventolin) administer using a metered-dose inhaler (MDI) with a spacer, assist her to press the inhaler, offer water to rinse mouth (preventing throat irritation), observe for side effects (tremors, fast heart rate), and document at MAR.

Needed Observations

• Observe for signs of nausea, jaundice, and dark urine (indicate liver toxicity).
• Observe for any side effects (tremors, fast heart rate).
• Observe for electrolyte imbalances such as confusion, fatigue, constipation, muscle cramps or weakness, nausea and vomiting, and numbness in limbs, fingers, and toes.

Dosage Discrepancy and Reporting

• If the Tylenol is 325 mg per tablet, administer two tablets to achieve the required 650 mg dose from the blister pack.
• Report any discrepancy between the prescribed and available dosage to the nurse to avoid confusion and mistakes.

Inhaler Use

• Instruct Ms. P to wait at least 30 seconds between puffs when using her inhaler, and 30-60 seconds is a good practice

Nitro Patch Removal and Disposal

• For sensitive skin, slowly peel off the nitro patch while wearing gloves
• Observe for any rash, redness, or irritation on the skin
• Dispose of the used patch in a medication disposal container, not regular trash since the patch contains medication.

Refusal of Medication

• You can't force Ms. P to have the cream applied, because she has the right to refuse medications
• You must tell the nurse and document the refusal of the cream in the MAR.

MAR Documentation

• Acetaminophen (Tylenol) 650 mg given at 0700, PL.
• Furosemide (Lasix) 40 mg given at 0700, PL.
• Salbutamol (Ventolin) MDI with spacer (2 puffs) given at 0700, PL.
• Nitro patch applied at 0700, PL.
• Fucidin cream refused at 0700, PL.

Case study on managing medications for a patient with arthritis, angina, chronic kidney disease (CKD), and a fungal rash. Focus on assisting with Acetaminophen, Furosemide, Salbutamol inhaler, Nitropatches and Fucidin cream. Includes oral care and MAR documentation.