Federation University - NURBN2010: Case Study of Loris Brooke Analysis

This case study analyzes the medical history, risk factors, and nursing considerations for Loris Brooke, a 77-year-old woman with multiple health conditions including congestive heart failure, hypertension, and arthritis. The analysis includes both modifiable and non-modifiable risk factors, such as age, family history, and lifestyle factors. The study emphasizes the importance of medication management, including drug interactions and adherence, and provides detailed information on specific medications such as Enalapril, Carvedilol, and Ivabradine. Nursing interventions are discussed, focusing on patient education, lifestyle modifications, and strategies to improve medication adherence. The case study also highlights potential drug interactions and the need for careful monitoring of vital signs and renal function. The document provides a comprehensive overview of the patient's condition and the necessary care to improve her quality of life, with references to relevant medical literature. This assignment, available on Desklib, offers valuable insights into geriatric care and pharmacology for nursing students.

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THE CASE STUDY OF LORIS BROOKE
BACKGROUND OF LORIS
 77 years old grandma
 Lives alone, temporarily with her son’s
family
 Had fall 8 months ago resulting
multiple fractures (brittle bones)
 Ambulating with assistance using a
wheelchair
 Present H/O congestive heart failure,
chronic stable angina
 Arthritis, hypercholesterolaemia,
hypertension
 Family H/O coronary artery disease
 Overweight – BMI 27. (normal 18.5 –
24.9)
 Often forgets her medications due to
multiple medications.
NON-MODIFIABLE RISK FACTORS (4)
 Gender
 Age
 Race
 Family history depicting coronary artery disease
MODIFIABLE RISK FACTORS (2,4, 6, 7, 10)
 Living environment – Suggestion for assisted living
program, aged care facility, or completely moving
with son’s family with modifications for wheelchair
access.
 Arthritis – physiotherapist opinion for low weight
bearing exercises, regular medications
 Obesity – diet changes, regular exercises for reducing
weight.
 Hypercholesterolaemia - dietician review for
increased cholesterol levels and overweight,& anti-
cholesterol medications
 Hypertension – restricted salt intake diet, regular BP
monitoring, anti-hypertensive medications.
 Congestive heart failure – regular follow ups and
medications, adequate rest and sleep
 Forgetful with medications – setting up calendar
blister pack with local pharmacy, setting multiple
reminder for medications (smart phone app
DRUG KNOWLEDGE (6)
 Enalapril – Angiotensin
converting enzyme inhibitors
 Carvedilol – Beta adrenergic
blocking agent
 Ivabradine – Anti anginal drug
(stable angina)
 Candesartan – Angiotensin II
receptor antagonist.
NURSING INTERVENTIONS (4, 5,
6)
 Consider list of medications, over counter
medicines, supplements, eye drops,
sprays, and other complementary
medicines to avoid drug interactions and
to apply quality use of medicines.
 Consult the doctor regarding drug
interaction between both enalapril and
candesartan
 Inform the doctors about Loris
medications, if she goes for surgery or
other invasive procedures because
carvedilol has drug interaction with
anesthetic drugs.
 Consider appropriate polypharmacy
(multiple medications)to achieve specific
therapeutic benefits as well as to
DRUG INTERACTION (6)
HEALTH EDUCATION FOR LORIS
(2,4,6,10)
 Consult the doctor immediately, if she feels any symptoms of
dizziness, headache, postural hypotension, edema on the face, etc
 Avoid grapefruit juice with medications.
 Explain the actions and importance of the medications to avoid
missing important doses.
 Take medicines with food.
 Not to crush or chew tablets
 Not to run out of drugs.
 Skip the missed dose and take the dose at next regular time and
avoid double doses.
 Inform the doctors about regular medicines , when new medicines
ordered to avoid drug interactions
 Keep the medicines in an original package.
 Do not store medicines in bathroom or close to window.
Temperature and moisture can alter the drug effectiveness.
 Low sodium diet, regular checkups and exercise.
 Webster package for regular intake of medicine
 Avoid Enalapril and candesartan combination due to drug
interactions
 increases risk of hypotension, hyperkalemia, and renal
impairment due to dual inhibition of the renin- angiotensin
system.
 If both combination necessary, closely monitor blood
pressure, renal functions, and serum potassium levels
 Carvedilol and Ivabradine have interaction with grapefruit
juices.
 Carvedilol contains lactose , consider when allergic to
lactose.
 Ivabradine is a heartrate lowering agent for treating stable
angina. If HR below 70/mt avoid it.
 Angioedema is the common contra indication. Report
immediately, if edema or swelling of the face, lips, jaw, and
cheek present.
Regular check of BP
(7
)
(8)
(1)
(9)

1. AIDSinfo. (2020). What is a Drug Interaction? Understanding HIV/AIDS. Retrieved 11
April 2020, from https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/95/what-is-
a-drug-interaction-
2. Davis, D., Orlu, M., Raj, R., Rawle, M., Smaje, A.,& Weston-Clark, M. (2018). Factors
associated with medication adherence in older patients: A systematic review. Aging
Medicine (Milton (N.S.W)), 1(3), 254–266. https://doi.org/10.1002/agm2.12045
3. Disabled Old Woman In Wheelchair Vector Cartoon Clipart (2018). FriendlyStock.
FriendlyStock.com
4. Hagler, D., Lewis, S. M., & Dirksen, S. R. (2017). Clinical companion to Medical-surgical
nursing : assessment and management of clinical problems (Tenth edition, PP 323 - 330).
Missouri: Elsevier. https://ebookcentral-proquest- com.ezproxy.federation.edu.au/lib/
ballarat/reader.action?docID=4747161.
5. Hughes, C. M., Cadogan, C. A., Patton, D., & Ryan, C. A. (2016). Pharmaceutical
strategies towards optimising polypharmacy in older people. International Journal of
Pharmaceutics, 512(2), 360–365. https://doi.org/10.1016/j.ijpharm.2016.02.035
6. MIMS online. (2020). https://www-mimsonline-com-
au.ezproxy.federation.edu.au/Search/Search.aspx
7. Mohammed, H., Ibrahim, B., & Cavus, M. (2018). Mobile device based smart medication
reminder for older people with disabilities. Quality & Quantity, 52(Supplement 2),
1329– 1342. https://doi.org/10.1007/s11135-018-0707-8.
8. Nurses are measuring blood pressure to an old woman, vector cart. Shutterstock.
www.shutterstock.com
9. Nurse giving health education to patient. FriendlyStock. FriendlyStock.com
10. Tan, B., Shafie, A., Hassali, M., Saleem, F., & Muneswarao, J. (2016). PCV115
Assessment of Medication Adherence and The Associated Cost of Calendar Blister Pack
REFERENCES