This study presents provides the details of the patient Mr. Sunny who was a 93-year-old man, who was admitted to the hospital. Mr. Sunny has been living alone independently when his wife passed away last year. He has three daughters Mia, Emma and Liane. The patient likes to watch TV, reading news, reading magazines. He likes to walk to the shops and work in his garden. The patient was diagnosed with suicidal ideation, which was driven by a sense of lack of independence, self-worth and poor quality of life. This paper discusses the pathophysiology of the diseases associated with the patient along with the pharmacology of the drugs administered.
Mr. Sunny after being admitted to the hospital experienced pneumonia along with malnutrition and atrial fibrillation. Occurrence of this acute lower respiratory tract infection is generally witnessed between 48 or 72 hours after admission to the hospital. The causative organisms of this infection includes mainly Enterobacteraciea, Haemophilus influenzae, Streptococcus pneumonia, and methicillin-sensitive Staphyloccous aureus (Fernández & Clavé, 2013). Most of the time this occurs in patients who are susceptible to these organisms due to some recent antibiotic exposures. The clinical setting in which the hospital acquired pneumonia occurs is majorly affected the causative agents that play a role in the implications of mortality and morbidity. The occurrences of HAP can be divided into the early onset phase that is arising less than 5 days into a hospital course and the late onset that is arising 5 days or later into a hospital course (Cillóniz et al., 2016).
The patient Mr. Sunny also showed symptoms of atrial fibrillation (AF) which is seen to occur while there is a rapid or focal source that is involved in discharging repetitively that conducts to the atrium. Due to the fast impulses these frequencies allow the atria to rest and to follow the pattern in an organized fashion which in turn leads to fibrillation (Torres et al., 2013).
The past medical history of the patient also showed prevalence of T2DM. This mainly occurs as a result of impaired insulin secretion which can also be described as impaired glucose tolerance (IGT). This occurs due to the reduction in the glucose-responsive early-phase insulin secretion along with the lack in additional insulin secretion that occurs after meals which is responsible for causing postprandial hyperglycemia (Nattel & Harada, 2014). There is also insulin resistance where the condition involves the insulin in the body which is not able to exert enough action that is proportional to the concentration of blood. There was also urinary incontinence which mainly occurs when there is elevation in the abdominal pressure occurring due to the action of the vesical neck and urethral sphincteric mechanisms.
For the patient the major health concern was type 2 diabetes mellitus therefore he was administered with medications including Metformin, Mirtazapine, Bisoprolol and Perindopril. For the patient Metformin will act as a first-line therapy for his type 2 diabetes mellitus. This will help to lower both the basal and postprandial plasma glucose of the patient. This drug helps to inhibit the hepatic glucose production along with the reduction of the intestinal glucose absorption. This also improves the glucose uptake along with utilization (Madiraju et al., 2014).
As the patient Mr. Sunny was also seen to be experiencing hypertension and depression as a result of his medical history of diabetes and the other mentioned health conditions, the patient was prescribed with Mirtazapine that acts as an anti-depressant and helps to manage the levels of neurotransmitters in the brain (Quimby & Lunn, 2013). This drug will help to manage the moderate depression that the patient is going through. In addition to this Mr. Sunny was also given multivitamin tablets since the patient was suffering from lack of proper nutrition.
As the patient has been suffering from heart failure along with the symptoms of atrial fibrillation, the patient was administered with drugs like Bisoprolol. This is a cardioselective β1-adrenergic blocking agent that will help to prevent the myocardial infarction (MI), heart failure, angina pectoris and mild to moderate hypertension in the patient. In the patient the drug will help to reduce the heart rest when at rest and while activities like exercise, cardiac output falls and there is a tendency of peripheral resistance to initially increase (DiNicolantonio et al, 2013).
After hospitalization, the patient Mr.Sunny underwent a complete blood examination test which showed that his haemoglobin count was quite low which was 115g/L. in addition to this the lymphocytes level was low as well which was 1.30 (1.50-3.50) (Nedogoda et al., 2013). This shows that the patient Mr. Sunny has been suffering from hospital acquired pneumonia since prevalence of low blood count is often associated with hospital acquired pneumonia. This is the case especially for patients like Mr. Sunny who older adults and often require red blood cell transfusions in the hospital setting. This also portrays that the patient has a tendency of being anemic thus it leads to the problems of malnutrition. This is the case when there is nutritional deficiency, such as iron, vitamin B12, and bone marrow problems.
The patient being suffering from urinary incontinence underwent investigations for urinalysis which revealed that the creatinine level of the patient was low which was 93mmol/L, where normal range is 95-110. Additionally the urea content is high which is 11.8. The amount of total cholesterol was also high along with high glucose level in addition to low protein and high urate. These investigations reveal that the patient is suffering from T2DM and had problems of urinary incontinence. The high amount of creatinine and urate also signals the prevalence of kidney impairment that the patient might be susceptible to (Torres et al., 2013).
While the pain chart of the patient was investigated it was observed that Mr. Sunny has been experiencing chronic pain with difficulty in mobility and weight bearing. This is mainly to the old age of the patient in addition to the conditions like malnutrition and past medical histories of heart failure. The pain was tender, sharp and throbbing which shows the symptoms of atrial fibrillation that results in the strained muscles of the heart giving rise to the pain.
The investigations also revealed decreased safety insight, where there was an evidence of fine motor skills for functional tasks, however the patient displayed slow movements with lack of balance and accuracy. The balance assessment score of the patient was noted to be 22/56. This was a result of the old age of the patient.
The recommendations for the patient Mr. Sunny involves providing of proper equipment to the patient like an enclosed footwear that will help him for better mobility. With the deterioration of the condition of the patient, he might feel dependent on the health personnel however at this point self-care along with independence is required in order to manage hypertension and depression. As a result of hypertension there are problems in the sleep pattern of the patient that needs to be managed along with care of the fluid intake by ensuring the maintenance of a proper fluid balance chart and encouraging fluids intake. Social isolation must be nit be encouraged for such patients and the patient should be made to get involved in the participation in activities. Proper mobility being an issue, the patient should be given a clear access as well as clutters must be removed. The old age had led to the impairment of the vision, hearing and speech of the person therefore it is suggested that the person wears glasses and follow the instructions of the health professionals regarding self-care to manage the problems. Massage is advised for Mr. Sunny in the neck, shoulder and the hand area of the patient atleast for 5 minutes. Steps should also be taken for pain management especially in the lower back and the left knee area for atleast 20 minutes.
References
Cillóniz, C., Civljak, R., Nicolini, A., & Torres, A. (2016). Polymicrobial community?acquired pneumonia: An emerging entity. Respirology, 21(1), 65-75.
DiNicolantonio, J. J., Lavie, C. J., Fares, H., Menezes, A. R., & O’Keefe, J. H. (2013). Meta-analysis of carvedilol versus beta 1 selective beta-blockers (atenolol, bisoprolol, metoprolol, and nebivolol). The American journal of cardiology, 111(5), 765-769.
Fernández, O. O., & Clavé, P. (2013). Oral hygiene, aspiration, and aspiration pneumonia: from pathophysiology to therapeutic strategies. Current Physical Medicine and Rehabilitation Reports, 1(4), 292-295.
Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet, 383(9922), 1068-1083.
Madiraju, A. K., Erion, D. M., Rahimi, Y., Zhang, X. M., Braddock, D. T., Albright, R. A., … & Jurczak, M. J. (2014). Metformin suppresses gluconeogenesis by inhibiting mitochondrial glycerophosphate dehydrogenase. Nature, 510(7506), 542.
Nattel, S., & Harada, M. (2014). Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. Journal of the American College of Cardiology, 63(22), 2335-2345.
Nedogoda, S. V., Ledyaeva, A. A., Chumachok, E. V., Tsoma, V. V., Mazina, G., Salasyuk, A. S., & Barykina, I. N. (2013). Randomized trial of perindopril, enalapril, losartan and telmisartan in overweight or obese patients with hypertension. Clinical drug investigation, 33(8), 553-561.
Quimby, J. M., & Lunn, K. F. (2013). Mirtazapine as an appetite stimulant and anti-emetic in cats with chronic kidney disease: a masked placebo-controlled crossover clinical trial. The Veterinary Journal, 197(3), 651-655.
Torres, A., Peetermans, W. E., Viegi, G., & Blasi, F. (2013). Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax, 68(11), 1057-1065.
Wyndaele, M., & Hashim, H. (2017). Pathophysiology of urinary incontinence. Surgery (Oxford), 35(6), 287-292.
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