Reference no: EM134000653
Assignment
Marianne Terra, a 69-year-old female client (DOB: 11/17/1955), presents with complaints of heartburn and difficulty swallowing. She is diagnosed with esophagitis, which the NP suspects is an adverse effect of her medication. Her physical exam and lab results are otherwise normal. A recent DXA scan revealed a 4.4% 10-year probability of hip fracture and a 15% 10-year probability of a major osteoporosis-related fracture.
Past Medical History: Osteoporosis
Allergies: Penicillin
Medications: alendronate (Fosamax) 10mg PO daily, calcium acetate (PhosLo) 1334mg PO BID, cholecalciferol vitamin D3 600IU PO daily
Social History: She has never smoked cigarettes and drinks alcohol once per month.
Physical Exam:
1) Height: 5 ft 6 in
2) Weight: 142 lbs
3) Body Mass Index (BMI): 22.9
4) Blood Pressure (BP): 111/76
5) Heart Rate (HR): 75
6) Respiratory Rate (RR): 18
7) Oxygen Saturation (O2 Sat): 96% on RA
8) Temperature (TEMP): 98.7 oral
An appropriate prescription for Marianne is:
Name: Marianne Terra
Date Of Birth: 11/17/1955
Date Prescribed: Current Date
Rx: denosumab (Prolia) 60mg prefilled syringe
Disp: 1
Sig: Administer one 60mg prefilled syringe subcutaneously in the upper arm, upper thigh, or abdomen once every six months.
Refills (O-4): 1
Dispense as Written:
Generic Substitution Permitted:
Either Dispense as Written or Generic Substitution Permitted should be checked on every written prescription depending on what is best for each client. Refer to the Week 1 lesson for criteria.
Rationale: RANKL inhibitors like denosumab are recommended for osteoporosis treatment in post-menopausal women and men with primary osteoporosis if clients cannot tolerate bisphosphonates or have adverse effects, according to the CPG (Qaseem et al., 2023). Since the client experienced esophagitis, a side effect of bisphosphonates like alendronate, the CPG recommends RANKL inhibitors. Since this medication is administered subcutaneously, the provider must ensure the client receives education and can administer the medication correctly. This medication is also taken every six months, so one refill is provided for the provider to follow up after two treatments to assess its efficacy.
Step I: Assess the client's case and the prescription writing activity for that client within the lesson.
Step II: Answer the discussion prompts below with explanation and detail, providing complete references for all citations. Refer to the lesson for client information.
Include the following sections:
Application of Course Knowledge: Answer all questions/criteria with explanations and detail. Get the instant assignment help.
A. Describe your assigned client's situation. Why are they presenting to the clinic? What medications are they currently taking?
B. Discuss your personal professional assessment of the client's situation provided in the scenario. What pharmacological treatment is necessary and why?
C. Reflect on additional questions you have about your assigned client that may influence treatment. What else do you need to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?