What additions/subtractions/titrations to the pt’s medication regimen would you recommend

Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
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Question: What additions/subtractions/titrations to the pt’s medication regimen would you recommend?

 

 

CC:  Heartburn, my pills aren’t helping anymore

HPI:  75 year old Native American female presents to the family practice clinic for routine visit.  Pt reports that over the last 3 weeks she has had increasing heartburn about one hour after eating and also some regurgitation and trouble swallowing food.  This occurs nearly every day.  c/o food getting stuck behind her breastbone.  This is a new problem.  She has been using antacids daily in addition to histamine-2-blockers to achieve relief. Despite sleeping with 3 pillows, pt has been experiencing frequent nocturnal wakings due to pain.  Reports nighttime coughing and c/o fatigue.  Denies SOB, hoarse voice, nausea, vomiting, constipation, diarrhea, abdominal pain, urinary difficulty, blood per rectum or in stool.

PmHx:  GERD x 7 years, HTN x 15 years, alcoholic cirrhosis x 2 years, hiatal hernia

SocHx:  Pt is widowed, lives alone, daughter lives in same town and checks on her regularly and takes her grocery shopping.  She is a retired teacher and volleyball coach.  Enjoys cooking, traveling, gourmet dining, and playing cards.  Drinks 5 cups of coffee daily, 6 beers with shots per week with history of heavier consumption, 55 pack year smoking history, currently smokes ¾ ppd.  Denies illicit drugs.

Meds:  Verapamil SR 120 mg PO daily

              HCTZ 25 mg PO daily

              OTC antacids

              Famotidine 20 mg PO daily at bedtime

Allergies:  Citrus fruits and juices (upset stomach), erythromycin (unknown symptoms)

Vital Signs:     T=97.9        HR=75, regular     BP=155/90        Resp=18               Ht=5’8”                Wt=195 lbs

Physical Exam:  no abnormalities

Labs:

Na

138

Hgb

13

AST

21

K

3.8

Hct

39

ALT

24

BUN

18

WBC

8.7

Alk Phos

55

Creatinine

1.3

 

 

 

 

Glucose

136

 

 

 

 

 

 

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