You are the primary-care provider in an assisted living facility.

Case Study 2

You are the primary-care provider in an assisted living facility. While you are reviewing the weekend reports, you see that an 81-year-old male resident was transported to the emergency room over the weekend. You are seeing the resident this morning for a follow-up visit. You are very familiar with this resident, who is normally very active with no cognitive deficits and who maintains a driver’s license. The resident has a history of heart failure, prostate cancer (which is in remission), and hypertension managed with medication.

The in-house report states that an ambulance was called when a housekeeper found the resident sitting on the floor in a hallway, appearing very lethargic and confused. The resident smelled of urine and was agitated when the housekeeper attempted to help him. The emergency room physician noted that the resident was diagnosed with dehydration and a possible adverse drug reaction. When you review the dietary report, you note a slight decline in intake and a few missed meals; however, the resident sometimes leaves the facility for meals. A review of the resident’s listed medications does not reveal any changes, making the emergency room physician’s theory of that adverse drug reaction is causing the symptoms unlikely; however, you will address this with the resident at this visit.

Case Questions

You know that the medications prescribed currently to the resident have not changed, and the slight decline in nutritional intake would not explain the sudden change in health. During the follow-up visit, you review the medication list with the resident and ask whether anything is missing from the list. The resident responds by saying that he hasn’t seen any other doctors, but he started taking some new vitamin supplements a month ago that were suggested by a person at the health-food store. What should you say to this resident about the use of herbal supplements or other over-the-counter medications?
The resident says he started taking Yohimbe for erectile dysfunction because he isn’t able to take Viagra. Given Yohimbe’s indications, could this supplement have contributed to his health episode?
The resident brought the bottle of Yohimbe along with other prescriptions he is currently taking to the appointment. You ask whether he followed the instructions on the bottle of Yohimbe, to which he replies, “I think so.” While the resident has no cognitive issues, he seems unsure of whether he followed the dosage instructions correctly. Why is this considered common among older patients?
Concerned about the resident’s safety, as well as attending to his desire to seek assistance with erectile dysfunction, you perform a medication reconciliation. What does this entail?
In order to prevent future adverse drug reactions with this resident as well as with others, you develop an educational program that focuses on the dangers of drug interactions and on identifying risks associated with polypharmacy for the health-care providers at the center based on the American Geriatric Society (AGS) Beers Criteria. How can this be helpful?

ANSWER

It would be important to inform the resident of the dangers that come with the use of over the counter drugs, especially when he is still taking other prescribed medication. It is the nurse’s responsibility to notify him of the adverse effects that come with drug interactions some of which could help in accounting for his mysterious symptoms such as the change in his mental state of mind, which was not an issue in the first place.

The resident must understand that the use of Yohimbe does come with some side effects especially if the supplier of the drug is not selling the approved drug. Some reports suggest that using the Yohimbe drug has some adverse side effects such as it can lead to gastrointestinal issues, high blood pressure and even some life-threatening events (Izzo et al., 2016). Hence making it a likelihood that the use of the Yohimbe triggered his health episode.

The loss of short term memory is considered common among older patients because their brain’s ability to repair and protect the brain cells is declining. Additionally, they tend to experience a decreased amount of blood flow to their brains. Therefore, limiting their ability to retain information no matter how important it is.

The medication reconciliation process requires the nurse to get a record of all the drugs the patient may be taking then, whether prescribed or acquired over the counter (Rodrigues, 2019). After this, the nurse has the responsibility of identifying the possible drug interactions that may occur as well as identifying the medication the patient should stay away from to prevent a repeat of the health incident. Creating an educational program that informs patients and the staff about the dangers of drug interactions will help a great deal in ensuring that the patients take only their prescribed medication (Rodrigues, 2019). In addition, it will help i…