Case Study: Naomi's Heart Failure, Kidney Disease and Medications

This case study analyzes the case of Naomi, an 82-year-old patient with myocardial infarction and chronic kidney disease, exploring the links between her heart failure and kidney disease, and examining the roles of aspirin and atorvastatin in her treatment. The study delves into the impact of her renal function on the metabolism of fluoxetine, addressing her nauseous condition in relation to the medication, and discusses the adverse reactions of morphine and its management. The assignment provides a comparative analysis of medications, their potential benefits, and the implications of kidney function on drug metabolism, offering insights into the complexities of managing multiple health issues in elderly patients. The study also highlights the side effects of the medications and their impact on the patient's well-being.

Case study

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Explain the links between Naomi's heart failure and chronic kidney disease.............................1
Comparative roles of aspirin and atorvastatin with their potential benefits for in Naomi's case2
Impact of Naomi's renal function on metabolism of her fluoxetine............................................3
Response about fluoxetine in context of Naomi's nauseous condition.......................................4
Adverse reaction of of morphine in Naomi's case and its management.....................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

INTRODUCTION
Patients are suffering from various kinds of disease which are prevented by specific
medications and treatment procedure. It includes to analyse and determine causes of different
health problems with the help of carrying out desired diagnosing activities like blood test, MRI,
ultrasound and so on (Uemura and et. al., 2016). The present report is based on case of Naomi
having age of 82 years and suffering from myocardial infarction and chronic kidney disease. Her
blood pressure is measured to 135/85 and glomerular filtration rate (GFR) has been calculated to
be 50 ml/minute. This assignment will focus on link between heart failure and chronic kidney
disease along with roles of aspirin as well as atorvastatin with their benefits. It will also include
impact of renal function and adverse action of morphine in given case.
MAIN BODY
Explain the links between Naomi's heart failure and chronic kidney disease
Heart failure can be described as a condition in which it is not able to render tissues with
adequate blood for metabolic requirements and cardiac relevant elevation of pulmonary or
systematic venous pressure may result into organ congestion. It includes several conditions such
as narrowed arteries of heart (coronary artery disease) or high blood pressure, gradually leave
heart too weak or stiff to fill and pump efficiently (Zhang and et. al., 2016). However, it has been
analysed that increase in fat is responsible for deposition of fat molecules inside the arteries
which reduce way of blood flowing that results into high blood pressure.
Naomi is also facing problem of high blood pressure and myocardial infarction which is
responsible for creating her condition of heart failure. This condition has various symptoms
including dyspnea, fatigue, weakness, edema, rapid or irregular heart beat, cough, wheezing,
increased need to urinate, swelling in abdomen, very rapid weight gain from fluid retention,
nausea and many more. (Ebner and et. al., 2016) Chronic kidney disease can be considered as a
condition in which damaged kidney tissues are present or reduced glomerular filtration rate. In
case of Naomi, the problem of nausea, cough, wheezing and fluid retention is present as the
glomerular filtration is low as compared to normal. Her GFR is measured to be 50 ml/minute
whereas the normal GFR is around 90 to 120 ml/minute. At the other hand, it has been evaluated
that health issue of heart failure and chronic kidney disease are connected in case of Naomi
because heart & kidney perform functions together.
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The connection is established between heart failure and chronic kidney disease by their
functions as the heart has a main function to supply oxygenated blood to all the body parts in
body continuously. Whereas kidney is responsible for filtrating the blood, extract waste in the
form of urine and helps to regulate water and salts to maintain levels for controlling the blood
pressure. In case of Naomi, the heart failure create an abnormal condition that it is not capable to
supply blood to other body including kidneys which develops metabolic problem for performing
its functions for pulling out waste from blood. It is responsible for decreased GFR in case of
Naomi which is measured to be 50 ml/minute.
Comparative roles of aspirin and atorvastatin with their potential benefits for in Naomi's case
Medications has different salts and components in it which are helpful to solve particular
type of health problems. Every medication is responsible for reducing symptoms of specific
disease of an individual which make patient feel relived and comfortable (Schefold and et. al.,
2016). In context of Naomi, several medications are used such as aspirin, atorvastatin, irbesartan,
frusemide and fluoxetine having their own role for improving her condition. The comparative
discussion among aspirin and atorvastatin is given below.
Basis Aspirin Atorvastatin
Uses Aspirin can be utilised for
reducing problem of fever and
relieve mild to moderate pain
including muscles aches,
toothaches, common cold and
headaches.
Atorvastatin is prefer with
proper diet to reduce bad
cholesterol (LDL,
triglycerides) & fat and
facilitate to raise good
cholesterol (HDL).
Precautions People with several conditions
such as peptic ulcer,
haemophilia, allergy, asthma,
uncontrolled hypertension,
liver or kidney issues, risk of
haemorrhagic stroke, drink
alcohol daily and undergoing
dental or surgical treatment
Patient having health issues
like liver problems, muscle
pain or weakness, kidney
disease, diabetes, thyroid
disorder and intake more than
2 alcohol beverages daily are
required to tell doctor
immediately. Feeding baby
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should take precautions before
taking aspirin.
while taking astorvastatin is
harmful for the new born.
Side effects It has few of side effects
including upset stomach and
heart may occur. It also consist
several serious effects like
easy bruising/bleeding,
difficult hearing, ringing in
ears and symptoms of kidney
problems (Dahal and et. al.,
2016).
Atorvastatin has number of
side effects including mild
memory problems and
confusion that requires
immediate consultation of
doctor for reducing them.
Potential benefits of Aspirin – The medication of aspirin plays an important role for
interfering with small blood components i.e. platelets less sticky and prevent blood clots or
clumps. It has a function to prevent heart attacks and strokes due to which it is potentially
beneficial in case of Naomi to facilitate proper functioning of blood flowing which main her
blood pressure to make her feel relieved.
Potential benefits of Atorvastatin – This medication has a potential benefit for Naomi as
it facilitate to reduce bad cholesterol and raise good cholesterol in body. It is helpful to reduce
chance of occurring heart attacks and stroke.
Impact of Naomi's renal function on metabolism of her fluoxetine
Renal function in case of Naomi is diagnosed to be inappropriate as kidneys are not able
to filter waste in proper way. The term of renal function can be described as as that how well
kidneys are working in human body. However, kidneys plays an important role of removing
waste and extra slats from blood in the form of urine and maintain balanced amount of certain
chemicals including sodium, potassium and calcium in body (Cobo and et. al., 2016).
Meanwhile, it is also provide support to prepare hormones that helps to maintain blood pressure
and stimulate bone marrow in respect of forming red blood cells. Moreover, the renal function is
known as kidney performance which is not appropriate in case of Naomi. In addition to this,
normal kidney function facilitate normal glomerular filtration rate (GFR) which is measured to
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be 90 to 120 ml/minute approximately whereas GFR diagnosed in case of Naomi is 50
ml/minute. Furthermore, it has been analysed that abnormal glomerular filtration rate is
reflecting about inappropriate renal function in her body which is required to be improved with
the help of providing desired medication to her.
Fluoxetine refers to an effective medication which is a selective serotonin reuptake
inhibitor (SSRI) that can be provided to patients having a problem of depression. It can be
considered as very efficient medicine that can provided depressed individual in proper dose in
terms of making patient relieved from the depression (Jungbauer and et. al., 2016). Naomi is
facing depression because of her brother's death due to lung cancer then prescribing fluoxetine is
favourable for her to overcome with the mental health issue. However, this medication make her
feeling relaxed and facilitate mental peace in order to remain comfortable. Patient can easily
overcome with the condition of depression and gain mental peace. In addition to this, it has been
evaluated that fluoxetine will not impact on treatment and process of renal function. Meanwhile,
it is observed that abnormal renal function in case of Naomi has no effect on metabolism of
fluoxetine in order to reduce the problem of depression. Fluoxetine can be considered as an
appropriate medication in given case scenario for making patient mentally well being.
Response about fluoxetine in context of Naomi's nauseous condition
Fluoxetine can be described as selective serotonin reuptake inhibitor (SSRI) which is
known as an antidepressant that affects brain chemicals that may unbalanced in people due to
presence of several problems. It can includes certain mental health issues such as panic, anxiety,
depression and obsessive compulsive symptoms. However, it has been analysed that fluoxetine is
also prescribed by physicians in several other severe disorders including major depressive
disorder, eating disorder (bulimia nervosa), panic problem, premenstrual dysphoric disorder
(PMDD) and obsessive compulsive disorder (Thomas, Cooper and Zimmet, 2016). Moreover, it
is observed that the medication of fluoxetine can be utilised together with other medicines like
olanzapine (Zyprexa) which is favourable to treat the problem manic depression which is caused
due to bipolar disorder. According to given case scenario of Naomi, it is determined that
fluoxetine is provided to her which is much effective for treating the problem of depression. She
was faced depression due to death of her brother because he was suffering from lung cancer.
After the intake of fluoxetine medication, Naomi complains that she feel nauseous from that time
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while she has started taking fluoxetine. It is necessary to analyse about actual cause of her
nauseous condition in order to apply effective treatment to make her feel better.
At the other hand, it is observed that people remain careful and immediately consult to
doctor before taking fluoxetine in certain health related conditions. It consist various situations
such as cirrhosis in liver, kidney disease, diabetes, narrow angle glaucoma, seizures or epilepsy,
bipolar disorder, a history of suicidal thoughts or drug abuse and ever took treatment with
electroconvulsive therapy (ECT). Naomi is suffering from kidney disease as her renal function is
not normal which has been analysed through diagnosing glomerular filtration rate (GFR) that is
measured as 50 ml/minute whereas that normal GFR is calculated around 90 to 120 ml/minute
respectively. But presence of kidney disease has no impact on metabolic activity of fluoxetine in
case of given patient (Nguyen, Sing and Bozic, 2016). Moreover, there are several side effects of
in taking fluoxetine like tunnel or blurred vision, eye pain or swelling, hallucinations, fever,
vomiting, slurred speech, severe weakness, loss of coordination nausea and many more.
Furthermore, it is evaluated about the main reason is that fluoxetine has a side effect of nausea in
case of Naomi so that she feels nauseous which should be treated by doctors in appropriate way.
Adverse reaction of of morphine in Naomi's case and its management
Morphine refers to an opiate drugs that can be utilised by care practitioners for treating
moderate severe pain. It is a medication which is available in several forms such as liquid,
tablets, injectable and continuous pump infusion. However, it is mostly used in number of
condition including pain, fibromyalgia, breakthrough pain, kidney stone and pain in lower back.
Moreover, it has various side effects after using like constipation, drowsiness, nausea, itching,
dizziness and sleepiness. In addition to this, it has been analysed that morphine plays an
important role to relief severe pain by taking it it suitable amount (Ellingsrud and Agewall,
2016). It is necessary for physicians to remain careful while prescribing morphine a a medication
because it is a kind of drug which is mostly prefer by individual for drug abuse. In case of
Naomi, administration of morphine is suitable as she was feeling severe acute pain due to having
a problem of urinary tract infection.
Considering administration of morphine in case of Naomi, it is helpful to reduce severe
pain but this medications has few adverse effects on the condition of patient. It is observed that
the main adverse reaction of using morphine is constipation in given case which is difficult to
treat because kidneys are not functioning in proper way. However, the situation of constipation
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can be treated by providing proper dietary fibre to Naomi and prescribe to drink enough water.
Moreover, doctors can provided laxative in order to manage this adverse effects condition of
patient.
CONCLUSION
From the above report, it has been concluded that different health problems requires
specific medications and treatment to make an individual. It consist that suitable medications
should be provided to different patients because same medicine for similar issue is not always
favourable due to dissimilar efficiency of their immune system. However, it is necessary to
monitor side effects of prescribed medication to manage them immediately to make person well
being as in given case.
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REFERENCES
Books and journals
Cobo, G. and et. al., 2016. Sex and gender differences in chronic kidney disease: progression to
end-stage renal disease and haemodialysis. Clinical science, 130(14), pp.1147-1163.
Dahal, K. and et. al., 2016. Stroke, major bleeding, and mortality outcomes in warfarin users
with atrial fibrillation and chronic kidney disease: a meta-analysis of observational
studies. Chest, 149(4), pp.951-959.
Ebner, N. and et. al., 2016. The impact of iron deficiency and anaemia on exercise capacity and
outcomes in patients with chronic heart failure. Results from the studies investigating
co-morbidities aggravating heart failure. International journal of cardiology, 205, pp.6-
12.
Ellingsrud, C. and Agewall, S., 2016. Morphine in the treatment of acute pulmonary oedema—
why?. International journal of cardiology, 202, pp.870-873.
Jungbauer, C.G. and et. al., 2016. N‐acteyl‐ß‐D‐glucosaminidase and kidney injury molecule‐1:
New predictors for long‐term progression of chronic kidney disease in patients with
heart failure. Nephrology, 21(6), pp.490-498.
Nguyen, L.C.L., Sing, D.C. and Bozic, K.J., 2016. Preoperative reduction of opioid use before
total joint arthroplasty. The Journal of arthroplasty, 31(9), pp.282-287.
Schefold, J.C. and et. al., 2016. Heart failure and kidney dysfunction: epidemiology, mechanisms
and management. Nature reviews Nephrology, 12(10), p.610.
Thomas, M.C., Cooper, M.E. and Zimmet, P., 2016. Changing epidemiology of type 2 diabetes
mellitus and associated chronic kidney disease. Nature Reviews Nephrology, 12(2),
p.73.
Uemura, Y. and et. al., 2016. Clinical benefit of tolvaptan in patients with acute decompensated
heart failure and chronic kidney disease. Heart and vessels, 31(10), pp.1643-1649.
Zhang, L. and et. al., 2016. Trends in chronic kidney disease in China. New England Journal of
Medicine, 375(9), pp.905-906.
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