Question

Mrs. Tyler is an 84-year-old white woman with a past medical history of breast cancer, mastectomy, dementia, osteoporosis, depression, and a right hip fracture and repair 1 month ago. She also has a history of anxiety. Her home medications include Prozac (fluoxetine hydrochloride), 20 mg qd; Os-Cal (calcium carbonate), 500 mg tid; Aricept (donepezil hydrochloride), 10 mg qd; Zantac (ranitidine), 150 mg qd; Ecotrin (aspirin EC), 81 mg qd; Mellaril (thioridazine HCl), 10 mg qd; and Valium (diazepam), 10 mg at bedtime daily. She has no known drug allergies. Mrs. Tyler was admitted to the emergency room after a fall at her assisted living facility. She suffered a fractured left hip. She was admitted to your nursing unit with the new fracture and constipation. Medications ordered on admission included: normal saline IV at 75 cc hour; Hep-Lock (heparin), 5,000 mg sq q 12 hours; MSIR (morphine), 2 mg IV push q 3-4 hrs prn pain; MS SR, 15 mg po bid; Oscal (calcium carbonate), 500 mg po tid; Mellaril (thioridazine HCl), 10 mg qd; Protonix (pantoprazole), 40 mg qd; Aricept (donepazil HCl), 5 mg qd; and Prozac (fluoxetine), 20 mg po qd. Fleet (sodium phosphate) enema 2 and Citro-Mag (magnesium citrate) 150 ml 1 were ordered to treat the constipation. Protonix (pantoprazole sodium), 40 mg qd, was also ordered for GI prophylaxis. Postoperatively, Mrs. Tyler was put on Demerol (meperidine) per PCA pump, with promethazine as needed. Three days later, she presented with altered mental status and hallucinations. Her urine and blood cultures were negative for infection. The daughter states that Mrs. Tyler has never acted like this before and that she is very concerned about her mother's condition.

1. What home medications may have contributed to Mrs. Tyler's fall?

2. What symptoms does Mrs. Tyler display that may be drug related?

3. Would you alter Mrs. Tayler's hospital drug regimen in any way?

Answer 1

#. Home medication that have contributed to her fall is Valium . Valium is a benzodiapine with common side effects of dizziness , drowsiness , tiredness , blurr d vision ,unsteadiness .

Serious side effects, including: mental/mood changes (such as memory problems, agitation, hallucinations, confusion, restlessness, depression), trouble speaking, trouble walking, muscle weakness, shaking (tremors), trouble urinating, yellowing eyes/skin, signs of infection (such as sore throat that doesn't go away, fever, chills)

#. Altered mental status and hallucinations are the symptoms which are drug related displayed by Mrs. Tyler .

#. I would alter the dose of demerol Because it's a opioid analgesic and the most frequently observed adverse reactions includes lightheadedness, dizziness, which again can cause severe complications