Will a Nurse PLEASE help me on this Case Study?

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Okay, here's the blurb:

"S.P. is admitted to the orthopedic ward. She has fallen at home and has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her:

She is a 75 year-old widow with 3 children living nearby. Her father died of cancer at 62 years of age; mother died of CHF at 79 years of age. Hit 5'3", wt 118 lb. She has a 50 pack-year smoking history and denies alcohol use.

She had severe rheumatoid arthritis with UGI bleed in 1993 and CAD with CABG 9 months ago. Since that time she has engaged in 'very mild exercises at home.' VS are 128/80, 98, 14, 37.2 degrees C.

Medications: nizatidine (Axid) 150 mg bid, prednisone (Deltasone) 5 mg PO qd, and methotrexate (Aemthopterin) 2.5 mg/weekly"

WHEW! :uhoh3:

I have two questions on this sheet that I can't figure out.

"What predisposing factor, identified in S.P.'s medical history, places her at risk for infection, bleeding, and anemia?"

and

"Briefly discuss S.P.'s nutritional needs."

Can you at least give me some clues here? I am utterly lost and hopeless in figuring these out :(

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Look at your medications... What does methotrexate do to the body, and axid? Does prednisone increase any pertinent lab values that nutrition can curve?

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Meds. Drag out that Pharm text.

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Also, look at her nutritional needs for heart problems. NAS?

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What nutrients are needed for potential treatments for the fx hip?

What nutrients are depleted in smokers?

What medication:food interactions are there?

Does a history of something increase the risk of it happening again? Why or why not?

What does prednisone do to vessel wall integrity?

THANK YOU for asking questions in a way that shows you are thinking about the assignment and not just dropping it off to be done for you :) THAT scores major points w/me :up: Glad to help (if more questions are help- LOL :) ) .

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Look at your medications... What does methotrexate do to the body, and axid? Does prednisone increase any pertinent lab values that nutrition can curve?

Let me think... the methotrexate is given for her rheumatoid arthritis, but it can definitely cause anemia.

I have no clue about the axid. Nizatidine's given for peptic ulcer disease, but does it say that's what she has?

I'm confused about this drug...

Oh! And prednisone's an immunosuppresant drug, so that definitely has to be a cause for her risk for infection going way up!

And if there's infection... I'm thinking elevated white blood cells... so would you do a WBC Count?

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
I have no clue about the axid. Nizatidine's given for peptic ulcer disease, but does it say that's what she has?

I'm confused about this drug...

Your case study indicates that the patient has a history of an upper GI bleed from 1993. Hence, she's on Axid.
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Your case study indicates that the patient has a history of an upper GI bleed from 1993. Hence, she's on Axid.

Hmm, so does that mean if her dosage of the axid is too low, she's at a risk for GI bleeding?

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What nutrients are needed for potential treatments for the fx hip?

What nutrients are depleted in smokers?

What medication:food interactions are there?

Does a history of something increase the risk of it happening again? Why or why not?

What does prednisone do to vessel wall integrity?

THANK YOU for asking questions in a way that shows you are thinking about the assignment and not just dropping it off to be done for you :) THAT scores major points w/me :up: Glad to help (if more questions are help- LOL :) ) .

I'm not too good with this one, sadly :(

For the Hip Fracture, the first thing that comes to my mind is "Vitamin D".

And for the smokers, "Vitamin C" likewise came to mind.

I ... don't know much else!

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I'm not too good with this one, sadly :(

For the Hip Fracture, the first thing that comes to my mind is "Vitamin D".

And for the smokers, "Vitamin C" likewise came to mind.

I ... don't know much else!

Calcium, protein, vit C and zinc for wound healing, iron for building up blood after surgery. Vit D is also needed, but with any surgery that involves an incision, protein for wound healing is important.

Vit C is depleted in smokers (that's obscure info- I'll give ya that one :D

You'll need to look up the drug/food interactions- there should be some site that will give those to you if you plug the meds in :)

If someone has a history of a GI bleed, and is on prednisone (which makes blood vessels fragile), she's at risk.

Methotrexate is an immunosupressant...s/s infection can be difficult to catch early; important to assess those s/s regularly.

Anemia is pretty much a given after hip surgery (which she will have at her age, general activity level, and need for it to get the optimum quality of life afterwards (and people do pretty well- my Grandma busted her hip, and then her shoulder, and rehabbed at the local SNF, had follow up home therapy, and at 97 is still living in her own home with episodic help during the week :D) Go Grandma !!

Where is your med surg book? This is a pretty easy situation (wait until you have a blind 89 y/o with diabetes, CHF, COPD, renal failure, and THEN the hip fracture...they hardly ever come in with one or two controlled pre-existing diagnoses... it gets hairy :)

Keep thinking about what's in the med-surg book :)

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Hmm, so if she's on Axid for the Upper GI bleed, and on the prednisone & methotrexate for her rheumatoid arthritis... what's she on for her CAD??

(Sorry! My instructor's making me do a concept map for this)

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Looks like no meds for the heart disease currently. A cholesterol-lowering medication might come to mind, but there has been some surprising data released over the last four years which muddies the link between cholesterol and CAD.

Check out the ENHANCE Trial and the AIM-HIGH Trial for more info about protocols which lowered cholesterol without lowering heart disease risk. Some doctors interpreted this data as indicating that the current recommended LDL levels aren't low enough, while others call the entire cholesterol/plaque/MI link into question.

As we become more cognizant of the adverse effects of many drugs, it really makes people stop and think about whether each diagnosis in a patient's chart must have a drug to go with it.

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