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Gero Unfolding Project - Coggle Diagram

- - - - Low albumin is a result of decreased protein intake that is related to malnutrition. Critical low levels of albumin can cause kidney disease.
  - - - Normal White Blood Cell Count Range: 3.5-10.5 Patient Value: 4.2 (low end of normal range)
        
        Diabetes is a disease that affects the immune system and decreases its overall function. Decreased immune function can lead to an inability for the body to fight infection and decreased WBC. With decreased WBCs, the body is more susceptible to infection and also less likely to heal when infected (diabetic ulcer).
        
        Clindamycin: 400mg PO BID: for infection
        
        WBC are on lower end so patient is at greater risk for an infection because not enough cells coming to 'fight'
        
        for diabetic foot ulcer and some other meds that he is taking cause immunosuppression (steroids) --> preventing infection
        
        Acidophilus: 100mg PO daily - probiotic
        
        to replace good bacteria that antibiotic is getting rid of
        
        aids digestion
        
        Patient is taking Clindamycin 400mg PO BID which can decrease WBC Counts. Monitor patients lab values each day. Is at stable level currently.
      - Normal Red Blood Cell Count Range: 3.9-5.0 Patient Value: 3.9 (low end of normal range)
        
        This borderline level of anemia can contribute to decreased blood flow to lower extremities and therefore decreased wound healing. The oxygen and nutrients that should be delivered to the wound to promote healing are reduced with lower RBC levels.
        
        Normal Platelet Count: 150-450 Patient Value: 120 (critical low indicates thrombocytopenia)
        
        Thrombocytopenia is a common result of diseases that affect the entire immune system. It can be related to decreased RBCs. Thrombocytopenia can make it more difficult for bleeding injuries to clot and in turn heal.
        
        clotting times still normal
        
        Normal INR (0.9-1.1): 1.1 (within normal limits)
        Normal PT (10-13 sec): 12 sec
        (within normal limits). Normal PTT (25-35 sec): 27 sec
        (within normal limits)
        
        coagulation times within normal limits
        
        Normal Hemoglobin levels: 12.0-15.6 Patient Value: 13.8 (within normal limits)
        
        patient has adequate tissue perfusion
        
        Normal Hematocrit Range: 36%-46% Patient Value: 40% (within normal limits)
        
        normal amounts of red blood cells in the body
      - Normal Sodium Level Range: 135-145 Patient Value: 136 (within normal limits)
        
        Sodium helps maintain normal blood pressure, but when blood pressure is high, then tissue perfusion is decreased, therefore worsening wound healing
      - Normal Blood Glucose Range: 70-110 Patient Value: 148 (high value)
        
        High blood glucose contributes to decreased blood flow and damaged nerve vessels because of the increased glucose in the blood stream. Increased glucose levels cause poor circulation thus leading to susceptibility for infection and later diabetic ulcers. The poor circulation decreases wound healing.
      - Hemoglobin A1C Ranges: Diabetic Indication: >6.5% Pre-diabetic Indication: 5.7-6.4% Patient: 8.0 (indicates diabetes)
        
        Diabetic is a test that tests HgA1C levels over the course of the past three months. His average A1C level high and thus indicative of diabetes. This high level is caused by consistently high blood sugars that are uncontrolled. (--> diabetic ulcers, diabetic retinopathy --> Glaucoma, etc)
    - - Latanoprost (Xalatan): 1 drop each eye daily prostaglandin analog: reduces intraocular pressure
    - - Normal Sodium Level: 135-145 Patient Value: 136 (within normal limits)
        
        Helps maintain normal nerve function
    - - Insulin resistance can be due to a variety of reasons such as excess body fat, lack of physical activity, and family history of type 2 diabetes.
      - Georges mother had type 2 diabetes. He also has high blood pressure which is known to cause insulin resistance. He does not note any physical activity that he pursues. It can be assumed that he did not have the best diet in place based off him stating that he drinks too much soda pop.
      - Insulin resistance impairs glucose disposal, resulting in a compensatory increase in beta-cell insulin production and hyperinsulinemia.
      - Metformin (Fortamet): 500 mg PO BID biguanide class: increases insulin sensitivity and lowers cAMP
        
        Side Effects: GI upset, bloating, gas, decreased appetite, side/lower back pain, cramping, hypoglycemia
        
        BEERS: risk for kidney issues, give lower dose decrease of decreased renal function
        
        Use: uncontrolled type 2 diabetes
        
        Nursing Considerations: give with meals, if suspected lactic acidosis discontinue medication immediately, monitor glucose levels, discontinue temporarily if pt is NPO
        
        Don't give to patients with low eGFR, don't give with beta blockers (hard to recognize hypoglycemia)
        
        BBW: use with radiologic contrast dye can cause acute renal failure, don't drink alcohol, can cause lactic acidosis
        
        Decreases B12 and hemoglobin levels
    - - Atrovastatin (Lipitor): 40 mg PO Daily Statin: decreases cholesterol production in liver
        
        Use: hyperlipidemia
        
        BEERS: gait disturbances --> falls, muscle complications leading to rhabdomyolysis
        
        Side Effects: GI upset, N, C, indigestion, insomnia, rhabdomyolysis, muscle spasms
        
        Nursing Considerations: Fall risk education, watch for signs of myopathy (dark urine, spasms, etc)
        
        Don't take with grapefruit juice
        
        Labs: increases LFT and CK levels
    - - Normal BUN Range: 5-20 Patient Value: 29 (abnormal high value)
        
        can be increased with uncontrolled diabetes and cause kidney problems
      - Creatinine normal limits: 0.8-1.3 Patient Value: 1.3 (high end of normal range)
        
        it is on the higher side of normal which could indicate declining kidney function
      - Furosemide (Lasix) 20 mg PO q day
        
        Pharm Class: Loop diuretics
        
        What's it for: Decreases Na, Cl, and K reabsorption in the kidneys. Dilutes urine because water is retained in the tubule when it reaches the distal tubule.
        
        Why's he taking it: Decrease fluid and electrolyte retention that has resulted from patient's diabetes diagnosis and decreased kidney perfusion.
        
        Side Effects: Pancreatitis, headache, dizziness, hypokalemia, hypocalcemia, hypomagnesemia, jaundice, thrombocytonpenia, anemia, SJS
        
        Drug interactions/contraindications: Interacts with celecoxib (antihypertensives), chlorothiazide, hydrochlorothiazide, NSAIDS, salicylates. Any food may decrease furosemide serum levels. Used cautiously in patients with cirrhosis and those allergic to sulfonamides.
        
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  - - - Within normal limits - rules out acidosis
- - - - unable to take care of himself
      - Fluoxetine (Prozac): 40mg PO Daily
        
        What's it for: Blocks reuptake of serotonin to treat depression
        
        Why he's taking it: Patient is taking for situational depression diagnosis.
        
        Side Effects: insomnia, anxiety, GI upset, sexual dysfunction, dry mouth, prolonged QT interval, chest pain, amnesia, hyponatremia, loss of coordination, bleeding --> fall risk
        
        Drug interactions/contraindications: Contraindicated in those taking St. John's Wort. Taking these two in combination can cause too much serotonin in the body leading to serotonin syndrome. It interacts with benzodiazipines, beta blockers, antiplatelet agents, and amphetamines. Alcohol use may increase CNS depression (discourage use together.)
        
        Beers Criteria: Not on the 2023 Beers Criteria
        
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        Pharm Class: SSRI
      - Chlordiazepoxide (Librium) 10mg PO QAM
        
        Pharm Class: benzodiazepine
        
        What it's for: anxiety, withdrawal symptoms of acute alcoholism, preoperative apprehension and anxiety
        
        Why he's taking it: anxiety
        
        side effects: confusion, drowsiness, nausea, constipation, jaundice, altered libido, agranulocytosis, extrapyramidal reactions
        
        drug interactions and contraindications: decreases cimetidine clearance, and increases risk of adverse reaction, may enhance adverse effects of clozapine, may increase CNS depression especially with use of CNS depressants, disulfiram may decrease clearance and increase half-life (consider dosage adjustment) avoid pairing with -azole ending drugs can increase CNS depression, and psychomotor impairment, can increase adverse effects of both levodopa, and olanzapine Boxed Warning with Opioids, can slow or cause difficulty breathing, sedation,
        
        Beers Criteria: the American Geriatric Society names this medication as potentially inappropriate for use in older adults because the use of benzodiazepines exposed users to risk of abuse and misuse.
        
        Nursing Considerations: Boxed Warning monitor patient for signs of respiratory depression and sedation monitor hepatic, kidney, and hematopoietic function periodically this drug may lead to abuse and addiction, don't withdraw abruptly
        
        Lab Values: this drug may affect liver function as it is metabolized in the liver. ALT, AST, and PT can be monitored
  - - - decreased K can contribute to heard problems/rhythm abnormalities
    - - BUN 29 (normal range 6-24) indicating poor kidney function, possible from dehydration
      - decreased creatinine clearance: poor kidney function
      - decreased K indicating poor kidney function
- - - - increased glucose, decreased albumin, decreased WBC/RBC/platelets contributes to decreased wound healing
        
        Assess and check patients glucose upon arrival!
        
        Obtain patients labs! Do not use IV, stick them, as could falsely show bacteria that could be in the IV site and not systemic in the bloodstream
      - Chart assessment findings!
      - BP 165/95 - hypertensive. Assess when was the last time medications were taken, how often takes, does he have access to a blood pressure reader at home
      - Respiratory Assessment: RR=15, even and unlabored, shallow. LS (lung sounds) diminished in BLL (bilateral lower lobes)
        otherwise CTA (clear to auscultation).
      - Cardiac Assessment: HR=92, BP=165/95, pulses 2+BUE (bilateral upper extremities), pulses 1+, thready to BLE
        (bilateral lower extremities), toes pale & cool to touch. Non-edematous.
      - GI Assessment: BS x4. c/o Occasional stomach upset. “I get full so easy and my food takes forever to move and I
        get heartburn”.
        
        Famotidine (Pepcid) 20 mg PO q bedtime
        
        Pharm Class: H2 Receptor antagonists
        
        What's it for: Famotidine blocks the action of histamine on the parietal cells --> reduced acid secretions in the stomach.
        
        Why's he taking it: Patient is taking to treat the upset stomach caused by excessive acid related to stomach ulcers.
        
        Side effects: Headache, dizziness, irritability, constipation, diarrhea
        
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      - Neuro Assessment: A&Ox3, c/o NT to both feet (esp. my toes), c/o occasional dizziness. Gait steady. MoCA score 19
      - Vital Signs: HR-92, BP 165/95, RR-15, SpO2=95% on RA, T=36.4
    - - Patient is taking clindamycin to prevent infection such as osteomyelitis of the bone that could contribute to an amputation had he not been started on antibiotics.
    - - Inspect foot, measure ulcer
      - check capillary refill
      - Check pulses bilaterally
      - Check skin temperature and color
      - Daily
      - Skin assessment - would see the ulcer and be sure to chart the measurement and appearance or characteristics
- - - - see if patient can function without diuretic
        
        Use: hypertension, fluid overload caused by heart failure
        
        Side Effects: hypokalemia, muscle twitching, spasms, dizziness, headache, pancreatitis, renal failure, thrombocytopenia, hypomagnesemia, respiratory distress
        
        BEERS: heart, liver, and kidney dysfunction (adjust dosing)
        
        nursing considerations: give with food, give in the morning to prevent nocturia, strict I+Os, daily weight, check BP and electrolyte levels
        
        interacts with metformin --> increased risk for hypoglycemia
        
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  - - - Lab Values if it Alters: N/A
  - - - What it's for: it is used for moderate to severe chronic pain. it binds to opioid receptors and inhibits noradrenaline and serotonin reuptake.
        
        Why he is taking it: treatment for chronic pain
        
        Side effects: headache, constipation, dry mouth, fatigue, dizziness, anxiety, depression, agitation, constipation, nausea, and chills
        
        drug ineractions/constraindictions: if taken with anticholinergics it may increase risk of urine retention or severe constipation and paralytic ileus. if taken with benzodiazepines or CNS depressants it may cause slow or difficult breathing, sedation, and death
        
        Beers criteria: Beers says that is it a concern because of CNS adverse effects - their recommendation is to do immediate release and reduce the risk
        
        Nursing considerations: tramadol exposes patients to the risk of addiction, abuse, and misuse, which can lead to an overdose and death. Reassess pain level after administration. Carefully monitor vital signs.
        
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  - - - What it's for: it stops the production of enzymes that cause pain and inflammation
        
        Why he is taking it: it is used to treat some types of arthritis
        
        Side effects: diarrhea, headache, heartburn, swelling, redness, or unusual sensations of temperature
        
        No drug interactions or contraindications were found
        
        Beers criteria: start with the lowest dose
        
        Nursing considerations: do not use on skin that has any problems. Do not use more than you're told or for a longer period of time
        
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  - - - What it's for: supplement for vitamins the patient is not getting in their diet
        
        Why he is taking it: dietary supplement
        
        Side effects: constipation, diarrhea, GI upset
        
        Drug interactions/contraindications: this has interactions with a lot of meds that the patient is taking (chlorothiazide, antibiotics, PPIs, ect)
        
        Beers Criteria: no concerns listed
        
        Nursing considerations: may give rise to dizziness, faintness, and possible irritation
        
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  - - - What it's for: it inhibits prostaglandin synthesis, impending cycooxyrgenase-2, to produce anti-inflammatory, analgesic, and antipyretic effects
        
        Why he is taking it: it is used to relieve signs and symptoms of osteoarthritis
        
        Side effects: headache, dizziness, diarrhea
        
        Drug interactions/contraindications: ace inhibitors, ARBs, and beta blockers may decrease antihypertensice effects. Monitor BP. Nsaids can increase risk of serious CV thrombotic events
        
        Beers Criteria: nothing of note
        
        Nursing considerations: may cause kidney problems. watch for signs and symptoms of overt and occult bleeding and abnormal clotting
        
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  - - - What it's for: maintenance of healing of erosive esophagitis
        
        Why he's taking it: Gastroesophageal reflux disease (GERD)
        
        Side effects: dizziness, headache, edema, pharyngitis, abdominal pain, leukopenia, hyperglycemia
        
        Drug Interactions/contraindications: may decrease absorption of ampicillin, ketoconazole. may decrease plasma levels of -azole antifungals. may increase methotrexate concentration, and the risk for toxicity. enteric-coated salicylates may dissolve more rapidly increasing gastric reactions. Warfarin: may increase INR and prolong PT, monitor closely. Prolonged oral use may lead to vitamin B12 deficiency
        
        Beers Criteria: the American Geriatrics Society Beer Criteria deemed this drug as potentially inappropriate medication in older adults because of the risk for CDiff infections, pneumonia, GI malignancies, bone loss, or fractures. It's recommended to avoid use for over 8 weeks
        
        Nursing Considerations: prolonged use can cause low magnesium levels, monitor for signs such as abnormal heart rhythm, palpitations, and fatigue. may increase the risk of developing CDiff, don’t crush, chew, or split tablets, give 30-60 minutes before meals
        
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  - - - What it's for: hypersensitivities, allergies, motion sickness, nighttime sleep aid
        
        Why he's taking it: may be taking it as a nighttime sleep aid
        
        Side Effects: drowsiness, sedation, dizziness, confusion, headache, palpitations, hypotension, tachycardia, tinnitus, nausea, vomiting, diarrhea, dysuria, diaphoresis, thrombocytopenia
        
        Drug interactions and contraindications: caution use with CNS depressants,
        
        Beers Criteria: The 2023 Beers Criteria strongly recommends to avoid this medication has it can lead to confusion, increase risk of falls, delirium, and dementia. use for acute treatment of severe allergic reactions would be fine, but not for maintenance
        
        Nursing Considerations: give with food or milk to reduce GI distress. If given for motion sickness or as a sleep aid, given 30 minutes before.
        
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  - - - Whats it for: acts as a serotonin reuptake inhibitor to increase the concentration of serotonin
        
        Why he's taking it: taking for situational depression diagnosis
        
        Side effects: diarrhea, stomach cramps, gas, insomnia, anxiety, dry mouth, fatigue, headache, sexual dysfunction
        
        Drug interactions/ contraindications: SSRIs such as fluoxetine, other antidepressants involving serotinin including nefazodone, as well as schizophrenia, biopolar disorder and Alzheimer disease are contrindicated for St Johns Wort
        
        Beers criteria: not on the 2023 beers criteria
        
        Nursing considerations: do not combine St John Wort with antidepressants to avoid life threatening increased levels of serotonin, do not take if pregnant to avoid birth defects, avoid eating smoked meats, yeast, cheese and pickled hering when taking this medication
        
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  - - - What's if for: Promotes sleep, has an anti-diabetic effect, regulates blood sugar, enhances immunity, and protects the liver.
        
        Why is he taking it: taking for diabetes management
        
        Side effects: gas, bloating, feelings of fullness
        
        Drug interactions/contraindications: do not take if celiac or have gluten intolerance, excessive amounts contraindicated while taking warfarin, causes high levels of vitamin K
        
        BEERS criteria: not on the 2023 beers criteria
        
        Nursing considerations: exercise with caution if celiac, monitor Vitamin K levels
        
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  - - - What's it for: Can improve immune system function, can improve blood pressure, and can improve symptoms of congestive heart failure
        
        Why he is taking it: taking for high blood pressure
        
        Side effects: upset stomach, loss of appetite, nausea, vomiting, diarrhea
        
        Drug interactions/contraindications: may interact with antihypertensives and chemotherapy drugs, may increase the risk of blood clots in people who take warfarin by decreasing warfarin effectiveness
        
        Beers criteria: not lister on 2023 beers criteria
        
        Nursing Considerations: unknown if safe for breastfeeding or pregnancy, may lower blood sugar, may lower blood pressure
        
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