Week 8 Discussion: Mr. Johnson, A 78-Year-Old Male, Is Admit

Week 8 Discussionmr Johnson A 78 Year Old Male Is Admitted To The M

Mr. Johnson, a 78-year-old male, is admitted to the medical-surgical unit with a history of peptic ulcer disease (PUD) and complaints of recurrent epigastric pain and discomfort. His medical history includes hypertension, type 2 diabetes, and chronic kidney disease. He is currently taking antihypertensive medications, oral hypoglycemics, and a diuretic. Recent endoscopy confirmed a duodenal ulcer. The healthcare team has prescribed him proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs) to manage his ulcer and reduce gastric acid secretion. The nursing team must ensure the safe administration of these medications, considering his age, multiple comorbidities, and concurrent medications. This involves addressing concerns about polypharmacy, patient education, and monitoring for adverse effects.

Paper For Above instruction

Managing polypharmacy in elderly patients like Mr. Johnson requires a comprehensive approach that balances effective treatment with minimization of adverse effects. Polypharmacy, defined as the use of multiple medications, often increases the risk of drug-drug interactions, medication non-adherence, and adverse drug events, especially in older adults with multiple chronic conditions (Maher et al., 2014). Therefore, as nurses, it is crucial to evaluate the necessity of each medication, monitor for potential interactions, and educate patients about their treatment plans to promote safety and efficacy.

Addressing Concerns Related to Polypharmacy

First, a thorough medication reconciliation is essential to identify all of Mr. Johnson’s current medications, including over-the-counter drugs and supplements. This process helps prevent duplicate therapies and harmful interactions (Nace et al., 2012). Given his antihypertensives, hypoglycemics, and diuretics, careful attention should be paid to potential additive effects with PPIs and H2RAs. For example, diuretics may increase the risk of electrolyte imbalances, which could be exacerbated by certain antiulcer medications that affect electrolyte levels.

Second, clinicians should consider deprescribing unnecessary medications where appropriate, especially if they contribute to polypharmacy without significant benefit. Regular medication reviews should be part of his ongoing care plan. For antiulcer therapy, selecting the most appropriate agent, dose, and duration based on current evidence helps reduce long-term medication burden. In Mr. Johnson’s case, the combination of PPIs and H2RAs should be carefully evaluated, as concurrent use may not offer additional benefit and could increase side effects.

Lastly, employing evidence-based protocols for medication administration enhances safety. For example, timing of doses, especially around meals, and patient-specific adjustments based on renal function are critical in this population. Nurses should collaborate with pharmacists and physicians to optimize medication regimens and minimize risks associated with polypharmacy.

Patient Education on Antiulcer Medications

Effective patient education fosters medication adherence and reduces adverse effects. For Mr. Johnson, key teaching points include explaining the purpose of PPIs and H2RAs in reducing gastric acid secretion to promote ulcer healing and prevent recurrence (Lacy et al., 2017). Clarifying that PPIs, such as omeprazole, work by irreversibly inhibiting proton pumps, whereas H2RAs, like ranitidine or famotidine, block histamine receptors on parietal cells, helps demystify the medications.

It is also vital to discuss potential side effects. PPIs may cause headaches, diarrhea, nausea, and, in rare cases, increased risk of osteoporosis-related fractures with long-term use (Freedberg et al., 2017). H2RAs can lead to headache, dizziness, and, less commonly, gynecomastia. Patients should be instructed on recognizing adverse symptoms and reporting persistent or severe side effects to their healthcare provider.

Adherence strategies include taking medications as prescribed, preferably before meals for maximum effectiveness, and not discontinuing abruptly without medical advice. Emphasizing the importance of medication adherence helps prevent ulcer recurrence and minimizes complications related to non-compliance (Moayyedi et al., 2017).

Monitoring for Adverse Effects and Nursing Interventions

Monitoring is critical to ensure safe medication use, especially in elderly patients like Mr. Johnson. Specific adverse effects associated with PPIs include electrolyte disturbances (hypokalemia, hypomagnesemia), which can cause arrhythmias, and increased risk of Clostridioides difficile infection (Lam et al., 2015). Regular assessment of bowel patterns, hydration status, and electrolyte levels through blood tests are part of vigilant care.

Similarly, H2RAs have been linked to cognitive impairment and confusion in older adults (Taibi et al., 2018). Close observation of mental status changes, especially considering Mr. Johnson’s age and comorbidities, is necessary. Routine lab evaluations to monitor renal function, electrolytes, and vitamin B12 levels are essential, particularly because his chronic kidney disease may affect drug clearance.

Adjustments to the nursing care plan include dosage modifications based on renal function, increased patient education about signs of electrolyte imbalance or infection, and ensuring medication administration aligns with best practices. Collaborating with pharmacy and medical teams allows for continuous review of therapy suitability, especially if adverse effects occur or if new symptoms develop (Fusco, 2018).

In conclusion, managing antiulcer therapy in elderly patients like Mr. Johnson requires a comprehensive, patient-centered approach addressing polypharmacy concerns, providing thorough education, and diligent monitoring for adverse effects. This holistic strategy enhances treatment efficacy, minimizes risks, and supports optimal health outcomes in complex geriatric populations.

References

• Freedberg, D. E., Kim, L., Yang, Y. X., et al. (2017). The risks and benefits of proton pump inhibitor therapy. Nature Reviews Gastroenterology & Hepatology, 14(7), 375-387.
• Fusco, P. (2018). Preventing drug interactions and adverse effects in older adults. Journal of Clinical Nursing, 27(1-2), e188-e196.
• Lacy, B. E., et al. (2017). ACG Clinical Guideline: management of Helicobacter pylori infection. The American Journal of Gastroenterology, 112(2), 212-239.
• Lam, J. R., Schneider, J. L., et al. (2015). Proton pump inhibitor and risk of Clostridioides difficile infection: a systematic review. Annals of Internal Medicine, 162(3), 197-204.
• Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety, 13(1), 57-65.
• Moayyedi, P., et al. (2017). Pantoprazole for duodenal ulcer healing and recurrence prevention. Cochrane Database of Systematic Reviews, (2), CD002232.
• Nace, D. A., et al. (2012). Medication reconciliation practices in health care: a step toward safer medication use. Journal of Patient Safety, 8(4), 170-177.
• Taibi, D. M., et al. (2018). Effects of antihistamines on cognitive performance in older adults. Journal of Geriatric Psychiatry and Neurology, 31(2), 77-82.
• Williams, C. S., et al. (2016). Strategies to reduce polypharmacy-related risks in older adults. Journal of Geriatric Pharmacotherapy, 14(3), 201-210.
• Xu, H., et al. (2019). Evaluation of medication adherence in elderly patients taking antiulcer medications. Patient Preference and Adherence, 13, 1077-1085.