Module 7 Case 6

Mrs.P. is an 80-year-old woman recently discharged from a 24-hourobservation stay at the hospital after being diagnosed with acutebronchitis. She has a history of heart failure, hypertension,osteoarthritis, GERD, and hyperlipidemia. She has no history of smoking.While in the hospital she was prescribed doxycycline, prednisone 15 mgto taper, and a tiotropium inhaler. Her current list of dailymedications prior to hospitalization includes metoprolol succinate 12.5mg, pantoprazole 40 mg, atorvastatin 10 mg, lisinopril 10 mg, furosemide40 mg, potassium chloride 20 meq bid, acetaminophen 650 mg bid for painand tramadol 25 mg as needed. She lives alone but will residetemporarily with her daughter while she recovers. Her discharge reportindicated resolving bronchitis, no exacerbation of heart failure, andstable arthritic pain. Today she reports 1 week after discharge with herdaughter for a primary care appointment, and they both were concernedabout the number of medications she was prescribed and wanted hermedications reviewed. In further review, she was found to have lostweight over the past 6 months of 5 lbs and her current BMI is 25. Shestates that the weight loss may be due to a change to a healthier dietand reducing sodium as instructed. She also reports no symptoms of GERDfor the past 6 months and minimal arthritic pain because of regular useof acetaminophen and daily walking in the halls of her independentliving facility. Upon examination her lungs are clear to auscultationand no evidence of lower extremity edema.

Discuss the following:

1) In reviewing her medication list and current symptoms and clinical signs, which
medication could the nurse practitioner consider de-prescribing.

2) Once the patient has completed the prednisone taper, which medication could the nurse
practitioner begin to reduce given the patient’s reported symptoms.

3) Given the absence of an exacerbation of heart failure and compliance with a reduced
sodium diet, what other medication(s) adjustments could the nurse practitioner consider at
this time.

Submission Instructions:

• Your post should be at least 500 words, formatted and citedin current APA style with support from at least 2 academic sources.