NURBN 2023 - Pathophysiology and Pharmacology

Assignment Task

Overview:

The objective of this task is to explore and explain the pathophysiology and pharmacology of the scenario. This should include the pathophysiology, treatment and individual considerations raised in the case study.

Case study

1. A 65-year-old patient, John Brown a retired coal mine worker, with a history of COPD presents to a clinic in Warragul Hospital emergency department with complaints of worsening shortness of breath, cough with clear-white sputum production, and fatigue. The patient reports a 4 kilogram weight loss in the last month and increased dyspnoea with activity. Vital signs are as follows: blood pressure 130/80 mmHg, heart rate 92 beats per minute, respiratory rate 24 breaths per minute, temp 37.0o C and oxygen saturation of 88% on room air. The patient appears tired and uncomfortable, using pursed-lip breathing. Mr Brown’s usual medications are salbutamol 4 times a day (and prn) and Budesonide 2 times a day. Mr Brown doesn’t use a spacer because “I am not a child!”. After medical review, the diagnosis is exacerbation of COPD. The recommendations are oxygen via nasal specs at 2L and sputum specimen for investigation. Mr Brown is commenced on nebulised salbutamol QID, Ipratropium bromide BD and Budesonide BD,

2. A 49 year old patient, Nicole Mettaring, identifies as a Wadawurrung woman. Mrs Mettaring was admitted to the emergency department with sudden onset of right-sided weakness and slurred speech. Her medical history includes hypertension and Atrial Fibrillation. She currently takes atenolol 25mg mane and warfarin 3mg daily. Upon assessment, Mrs. Smith was found to have right-sided weakness and reduced sensation. She was also found to have slurred speech and difficulty in understanding language. Her blood pressure was elevated at 160/90 mmHg, HR of 86 bpm, RR 14, temp 37.0 and SpO2 of 97% on room air. She also confides in you that she sometimes forgets to take her warfarin. Her INR is 1.5 Mrs Mettaring is given alteplase IV and recommenced on oral warfarin 5mg once a day with daily INR. 5 NURBN 2023 – Video essay

3. Parampreet (Preet) Singh, 55 years old with hyperlipidaemia history pravastatin 20mg nocte has presented to the emergency room with sudden onset of chest pain radiating to the left arm. He also reported shortness of breath and diaphoresis. a past smoking history. This incident started while he was at the gym. On physical examination, Mr. Singh appeared uncomfortable and was clutching his chest. His vital signs showed a heart rate of 110 beats per minute, blood pressure of 160/100 mm Hg, and respiratory rate of 20 breaths per minute. Lung sounds were clear. A 12-lead ECG was taken (see picture below). Blood tests were drawn to check for cardiac biomarkers, and results showed elevated levels of troponin T. Mr Singh was diagnosed with a myocardial infarction. GTN sublingual spray was provided and was placed semi-fowler on 2 litres oxygen. Morphine 2.5 mg was given intravenously.

4. Mrs Yelena Kozlov is a 78 year old woman who emigrated to Australia when she was 22. She is widowed, and her children live interstate. She presented to her GPs office with increased shortness of breath and “heavy feet”. He has a history of hypertension, but no other significant cardiac history. She is currently on Atenolol 50mg BD. On physical examination she has dyspnoea, her ankles are oedematous and she mentions she has been sleeping in her chair. Vital signs 72 bpm, blood pressure of 140/90, resp rate of 28 bpm, SpO2 of 92% on room air. After review and an ECHO cardiography, Mrs Yelena was diagnosed with heart failure and commenced on frusemide 40mg BD and digoxin 62.5 mcg.

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