Health Medical Homework Help

Katia Gedeon

                                                             Clinical Experience         

This week during my clinical experience  I mostly handled patients who came for a follow-up visit, medication review, annual visits, and those who needed medical clearance for various surgeries among others. It was an opportunity to experience the real clinical situation and handle different types of patients. The experience did not come without its share of challenges. One challenge I experience was convincing other patients that there was a need for them to change the medications they were taking. Some patients were skeptical and asked several questions. Some even thought that maybe they had been accidentally given the wrong medication at the initial visit.

One case was that of 66 years old white female who had come to the clinic for an annual medication review. She said she did not have any concerns about her medications and was always taking her tablets on time. Further, she had attended her annual hypertensions review the previous month. Her height was 165cm and her weight was 64kg. Besides, her BP and most recent blood tests such as lipids, electrolytes, erythrocyte sedimentation rate, and urea were all normal.

Medical History

-Polymyalgia rheumatic that began 8 months ago

-Coronary heart disease and hypertension primary prevention that was coded for 5 years

-Depression which she had been treating for 16 months.

The family history included maternal hip fracture at 70 years old. Her current repeat medications indicated that there was a need for some changes to medication. First, aspirin was no longer advisable in primary prevention, and hence the patient needed to stop aspirin so that it reduces the risk of gastric bleeding (Burns et al., 2017). Moreover, fluoxetine and prednisolone might lead to gastric irritation which eventually increases the risk of gastric bleeding. Additionally, this patient was 66 years old yet senior age is another increase of the risk factor. Prednisolone needs to be prescribed in the morning since taking corticosteroids during the day might affect her sleep. The patient had been taking the steroids for about 4 months without bone protection which put her at risk of steroid-induced osteoporosis.

The patient’s FRAX results indicated a 9-year risk of main osteoporotic fracture of about 25%. That meant the patient should be considered for the treatment. The first-line treatment was to be oral bisphosphonate, vitamin D supplementation, and suitable calcium (Chowdhury et al., 2020). Furthermore, losartan was changed to 100mg tablet so that it could minimize the prescription cost and simplify the dosage. Fluoxetine was prescribed in the quantity of sixty capsules that equated to two month’s supply. The other regular medication was supplied in monthly quantity.

I discussed all these changes and options with the patient and eventually updated the repeats as follows:

• Losartan 100mg tablets- a tablet daily for 28 tablets
• Paracetamol 500mg tablets- 2 tablets 4 times daily for 224 tablets
• Fluoxetine 20mg capsules- one capsule per day for 30 capsules
• Prednisolone 5mg tablets- one tablet every morning for 28 tablets
• Simvastatin 40mg tablets-one tablet every night for 28 tablets
• Adcal D3 tablets-one tablet two times a day for 56 tablets
• Omeprazole 20mg capsules- one capsule daily for 28 capsules
• Alendronate 70 mg tablets- one tablet every week for 4 tablets

Through this experience, I learned how to discuss various medical changes and options with the patients and let them understand why there was a need to change different medications. I also learned how to effectively discuss different times that the patient needs to take medication.

References

Burns, R. B., Graham, K., Sawhney, M. S., & Reynolds, E. E. (2017). Should This Patient Receive Aspirin? Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Annals of internal medicine, 167(11), 786-793. https://www.acpjournals.org/doi/abs/10.7326/M17-2162 (Links to an external site.)

Chowdhury, E. K., Nelson, M. R., Ernst, M. E., Margolis, K. L., Beilin, L. J., Johnston, C. I., … & ASPREE Investigator Group. (2020). Factors associated with treatment and control of hypertension in a healthy elderly population free of cardiovascular disease: a cross-sectional study. American journal of hypertension, 33(4), 350-361. https://academic.oup.com/ajh/article/33/4/350/5661095?login=true