Question

This is a Respiratory Case Study.

Gladys Young is a 68 year old female that resides in an Independent Living facility with her husband. She presents to her primary care physicians office with complaints of fever, chills, nausea and vomiting. She also states that she has had some mild hemoptysis occasionally with her persistent coughing. She has recently completed treatment with Chemotherapy for Breast cancer and is concerned that she may have an infection. You are the nurse caring for her. She is able to complete a sentence in its entirety, but she is persistently coughing during the history. She is a former smoker, she smoked ½ pack of cigarettes per day for 30 years and quit when she was diagnosed with breast cancer 6 months ago. She denies shortness of breath or chest tightness. She has not yet gotten her influenza vaccine, but did receive the Pneumovax vaccine last year. She has had problems with persistent coughing at night which has prevented her from getting a good night’s sleep for the past two weeks. She also states that she has been waking up soaked in sweat in the morning.

• Temp – 38.6 C; HR – 132 beats/min; RR—28; BP – 168/87; O2 sat – 90% on Room Air
• Auscultation: Lungs with faint crackles at bases bilaterally. No wheezing present.
• Patient is flushed and warm to touch

Please answer to the following question based on above respiratory case study:

1. What pharmacologic interventions do you expect will be ordered for this patient? What routes of administration will be best indicated for this patient? (Include mechanism of action, indication for use and desired outcomes)

Answer 1

Question : What pharmacologic interventions do you expect will be ordered for this patient?

Answer :

From the given details of signs and symptoms it is sure that Mrs Gladys Young is having Tuberculosis, so that the pharmocologycal intervention is focused on First line drugs of tuberculosis as follows

• Isoniazid
• Rifampin
• Pyrazinamade
• Steptomycin
• Ethambutol

Question : What routes of administration will be best indicated for this patient? (Include mechanism of action, indication for use and desired outcomes)

Answer :

Best route of administration : Oral

First line drugs of TB normally taken orally but may be administered intramuscularly or intravenously to critically ill patients.

Mechanism of action :

Tuberculosis drugs target various aspects of Mycobacterium tuberculosis biology, including inhibition of cell wall synthesis, protein synthesis, or nucleic acid synthesis.

Steptomycin and Isoniazid is a prodrug that inhibits the formation of the mycobacterial cell wall. Isoniazid must be activated by KatG, a bacterial catalase-peroxidase enzyme in Mycobacterium tuberculosis.

Rifampin produces the antimicrobial activity by inhibition of DNA dependent RNA polymerase (RNAP) either by sterically blocking the path of the elongating RNA at the 5′ end or by decreasing the affinity of the RNAP for short RNA transcripts

Indication : Generally anti TB drugs, that is TB medicine, is taken for the treatment of active TB or TB disease. One exception to this is when TB drugs are taken for the treatment of latent TB.

Desired outcomes : Effective management of TB symptoms and cure from Tb

The overall treatment outcome of TB was 18 (9.57%) cured, 39 (20.74%) completed the treatment, 20 (10.64%) defaulted, 24 (12.77%) died, and 87 (46.28%) transferred out. A high proportion of patients were transferred to other health facilities.

( I hope this answer is useful to you if so please give me a thumbs-up so that I can understand my answer is helpfull to you. Thanks)