What drug interactions could be concern

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Reference no: EM133880800

Question

Shelly is a 85-year-old female who lives alone in a three-story house. She has a daughter who lives in the same town, who works full time as a nurse, is married and has two teenage children. Shelly also has a son who is single and lives 2 hours away.

Shelly seemed to be doing very well on her own until she fell in her kitchen. Shelly was able to crawl to the telephone and call 911. The ambulance brought Mrs. Jones to the emergency department. While there it was unclear if she had a mechanical fall or if she had a syncopal episode. She was found to have a non-displaced right clavicle fracture and an arm sling was placed. She was also found to be hypotensive and dehydrated. Additionally, an EKG revealed atrial fibrillation, which has been treated in the past with cardioversion at age 67 and managed with Metoprolol 25 mg ER since. She was admitted to the hospital for additional testing which revealed stage 4 heart failure with less than a 35% ejection fraction. The physician determined her life expectancy to be no more than 6 months. After consultation with the family, the physician ordered hospice care. Shelly will be transitioned to SAR for 2 weeks and then to home, where hospice will provide care. .

PMH - osteoarthritis, CHF, atrial fibrillation, depression, anxiety

PSH - appendectomy (1984)

Social History - non-smoker, moderate alcohol use, widowed x 5 years, Catholic and attends mass every Sunday

Medications - Tylenol 650 mg every 4 hours PRN pain, daily multivitamin, Prozac 60 mg/day, Oxycodone 5mg PO every 4 hours PRN pain (prescribed in the hospital), Metoprolol 25mg ER/day

1. Discuss three important aspects the nurse practitioner should consider about Shelly and her transition from the acute care hospital to SAR and then to home with hospice care. Also, please answer the following questions: \

2. What drug interactions could be a concern?

3. How will the nurse practitioner coordinate care for her in the home?

4. What caregiver considerations are a concern with returning to home?

Reference no: EM133880800

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