Mrs. Schwartz is an 89-year-old lady who has come to your long term care facility. She has Type II diabetes. She has also recently been diagnosed with Alzheimer’s disease. So far, she has exhibited mild cognitive impairment, as she is oriented to person, but not place or time. She is generally alert, and occasionally has episodes of “sun-downing.” Her medications are as follows: metformin 500 mg po bid, galantamine 4 mg po bid, lisinopril 5 mg po bid, bupropion SR 100 mg po od, calcium carbonate 400 mg po od, ferrous fumarate 100 mg po od, Betoptic 0.25% 2 gtt OS bid, Seroquel 100 mg po prn hs and Percocet i-ii tablets po prn q6h, docusate sodium 100 mg po od.
Seroquel is referred to as a trade name because the name given by the producing company is known as quetiapine (Kizior & Hodgson, 2018). Additionally, the drug is produced by the same ingredients as that quetiapine.
The most common side effect of Percocet is constipation. It refers to a condition where there are reduced bowel movements, and thus it becomes difficult to pass stool. The condition is caused by less fiber intake and dietary changes (Kizior & Hodgson, 2018). Docusate sodium is administered to the patient to treat constipation. This medication works by softening the stool; the effect of softening is enhanced by increasing water reabsorption in the alimentary canal, thus facilitating the stool to be soft and for an easy passage throughout the alimentary canal.
The patient is administered galantamine, which is a drug used to treat mild confusion. Regarding the case study, the patient had mild confusion due to a lack of orientation of place and time. The drug works by balancing neurotransmitters such as acetylcholine elevated in the brain (Kizior & Hodgson, 2018). The medicine does not cure Alzheimer’s disease but rather reduces the symptoms such as confusion, memory loss, and capacity to perform daily activities that manifest due to the Alzheimer’s disease process.
Betoptic works by altering the functions done by the sympathetic nervous system. Lowering the eye pressure prevents optic nerve damage and blindness that precedes and becomes harmful to patients who have increased intraocular pressure in the eyes resulting from glaucoma (Kizior & Hodgson, 2018). Additionally, the drugs lower the intraocular pressure that is found in the eye. The reduction of intraocular pressure has achieved the drug preventing watery fluids’ movement that fills the front eye between the cornea and crystalline lens.
The healthcare provider should monitor blood pressure, heart rate, and if the patient is tolerating oral food intake. If the patient has increased blood pressure, raised heart rate, and no sign of diarrhea, then the patient should be administered the drug.
Poor transferability is related to perception impairment as evidenced by the patient’s disorientation to place and time, exhibiting ‘sundowning,’ moderate cognitive impairment, and taking lots of medication (Ladwig et al., 2019).
The patient taking bupropion insinuates that the patient may be suffering from depression which can be major or persistent depressive disorder. Bupropion is classified as antidepressant medication regarding the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Cognitive behavior therapy is the other care that l will recommend for Mrs. Schwartz. Psychotherapy entails the patient having short sessions that allow her to share information with the psychotherapist and identify factors that contribute to depression, which are not logical, leading to depression (Kizior & Hodgson, 2018). Prevention techniques such as controlling thoughts that are not logical, how to adjust to challenging situations, and evaluating a problem before any action, among other contributing factors, will help in depression management.
The letters ‘SR’ means sustained-release, which is also referred to as controlled release. Administering of bupropion sustained-release will need a nurse to know more about technology and be informed about the rate through which drug concentration levels are assessed and evaluated in advance. The nurse is expected to be familiar with the formulas of ingredients that make up the drug. Stroke causes lesions that affect the function of the thalamus’s structures, limbic system, basal ganglia, and cortex. Additionally, lesions formed in the thalamus lead to the disconnection of the thalamic circuits. The disconnection, therefore, leads to loss of connection of transmitting signals, thus tampering with nerves that transmit information within the central nervous system. (Kizior & Hodgson, 2018). Affected nerves will lead to interference of administration and actions of the bupropion sustained-release pathway.
Sources
Kizior, R. J., & Hodgson, B. B. (2018). Saunders nursing drug handbook 2019 e-Book. Elsevier Health Sciences.
Ladwig, G. B., Ackley, B. J., & Makic, M. B. (2019). Mosby’s guide to nursing diagnosis. Elsevier Health Sciences.