Case Study 1

A.P., a 55-year-old male, has smoked 1 pack of cigarettes daily for the last 38 years. He has a
very stressful job as a prominent marketing company executive. A.P. and his coworkers
frequently go to “happy hour” at the local bar after a long day at work. A.P. has a sedentary
lifestyle at home, lounging by the pool or watching television.
He tried to quit smoking “cold turkey” 2 years ago and remained abstinent for approximately 6
months but has never tried any pharmacologic smoking cessation aids. During his previous
attempt to quit, he became very anxious, irritable, and depressed and had trouble sleeping and
concentrating at work. He has a medical history of hypertension for the last 10 years and an
about of successfully treated depression 5 years ago after the death of his mother.
His family has been encouraging him to stop smoking for years. He is currently at the doctor’s
office for his blood pressure checkup and inquires about smoking cessation options; he doesn’t
have a definitive timeline for a quit date. Smoking habits: He smokes 1 pack daily and craves his
first cigarette about 10 to 15 minutes after awakening. He has observed that smoking his
morning coffee, drinking at the bar with his friends, and smoking after meals are triggers that
led to his relapse with his prior smoking cessation efforts. He would like to try something to
help with acute cravings.
Diagnosis: smoking cessation
Complete and be prepared to present Klingenberg 1-4 & Quezada 5-7
1. What symptoms experienced by this patient during his previous attempt to quit smoking are
consistent with physical nicotine dependence?
2. What motivational level (stage of change) is this patient in?
3. When A.P. reaches the action stage, what pharmacologic options are available for him?
4. Which smoking cessation aid would you recommend starting in this patient? Why?
5. How would your recommendation for smoking cessation aids change if the patient reported
smoking his first cigarette more than 30 minutes after awakening?
6. What adverse events could you see with the product you chose in the previous question?
7. What non-drug methods may enhance smoking cessation in this patient?
Case study 2
G.G., a 59-year-old male, presents to the clinic with complaints of cough, shortness of breath,
and increased sputum production. His medical history is significant for COPD with chronic
bronchitis, hypertension, diabetes, and hyperlipidemia. He reports that his sputum has
improved in consistency and amount over the past few days.
His last exacerbation was about 6 months ago, for which he received amoxicillin. This is his third
exacerbation in the past year. He has a 40-pack-year history of cigarette smoking and quit
smoking 3 years ago. He does not take chronic steroids. A physical exam reveals rhonchi and
expiratory wheezes. His vital signs are blood pressure 140/83 mm Hg, pulse rate 80 beats/min,
respiration rate 20 breaths/min, and temperature 98.8°F. He has no known drug allergies. A
sputum Gram stain in the office reveals purulent sputum (presence of WBCs). Chest x-ray
findings are negative for pneumonia.
Diagnosis: Acute Bronchitis
Complete and be prepared to present Ramos 1-5 & Wayland 6-9
1. List specific goals for treatment for M.V.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring the success of the therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change
therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and alternative medications would be appropriate for M.V.?
8. What lifestyle changes would you recommend to M.V.?
9. Describe one or two drug-drug or drug-food interactions for the selected agent
Case study 3
M.V. is a 53-year-old accountant who smoked a pack of cigarettes daily for 30 years. He quit
smoking 6 months ago. He presents with shortness of breath while hurrying on level ground or
walking up a slight hill but is not limited to doing any activities at home. He complains of a
chronic productive morning cough. He was treated at home for one respiratory infection last
year. During the physical exam, you observed wheezing throughout all lung fields,
hyperresonance on percussion of the lungs, and low, flat diaphragms. He has no cyanosis,
clubbing, or edema. His mMRC dyspnea score is 1. His CAT™ score is 6. Pulmonary function
studies show an FEV1 /FVC of less than 70% with an FEV1 of 72% of predicted. He has no other
medical conditions and is not taking nonprescription, prescription, or complementary
alternative medicine. He has no known drug allergies.
Diagnosis: Chronic Obstructive Pulmonary Disease
Complete and be prepared for the present Jordan 1-5 & Wilkins 6-9
1. List specific goals for treatment for M.V.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring the success of the therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change
therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and alternative medications would be appropriate for M.V.?
8. What lifestyle changes would you recommend to M.V.?
9. Describe one or two drug-drug or drug-food interactions for the selected agent
Case study 4
S.C. is a 21-year-old college student. She presents with intermittent wheezing. She had a history
of asthma as a child but had been free of symptoms until this year. She has symptoms 1 to 2
days/week but denies nocturnal wheezing. Her symptoms do not interfere with her everyday
activities. She has never taken systemic corticosteroids and has never been hospitalized for
asthma. You observed soft end-expiratory wheezing at the bases bilaterally during the physical
exam. Pulmonary function tests today show an FEV1 /FVC of 80% with an FEV1 of 90% of
predicted. She has no other medical conditions and is not taking nonprescription, prescription,
or complementary alternative medicines. She has no known environmental or drug allergies.
Diagnosis: Asthma
Complete and be prepared to present Jackson 1-5 & Lemay 6-9
1. List specific goals for treatment for S.C.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring the success of the therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change
therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and alternative medications would be appropriate for S.C.?
8. What lifestyle changes would you recommend for S.C.?
9. Describe one or two drug-drug-to-drug-food interactions for the selected agent.
Case study 5

R.R., a 58-year-old female, presents to the clinic with complaints of shortness of breath, chills, malaise,
and cough of yellowish-green sputum. Her medical history is significant for depression and
hypothyroidism. She has a 25-pack-year history of cigarette smoking. Physical examination is essential
for rales on auscultation of the chest. Clubbing of the fingernails is noted. Vital signs are blood pressure,
138/88 mm Hg; pulse rate, 96 beats/minutes; respiration rate, 26 breaths/minutes; and temperature,
100.1°F. Laboratory test results and chest x-ray findings are pending. She has a penicillin allergy, which
causes an immediate rash and shortness of breath.

Diagnosis: Pneumonia
Complete and be prepared to present Teague 1-5 & Ellison 6-9
1. List specific treatment goals for R.R.
2. What drug therapy would the nurse prescribe? Why?
3. What are the parameters for monitoring the success of
the therapy?
4. Discuss specific client education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent
that would cause the nurse to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter medications would be appropriate for R.R.?
8. What dietary and lifestyle changes should be recommended for R.R.?
9. Describe one or two drug–or drug-food interactions for the selected agent.
Case study 6
S. H., a 27-year-old female, presents with a cough that has persisted for 3 weeks. She has had a low-
grade fever off and on during that time. A native of Brazil, she has lived in the United States for 13 years.
Four months ago, she returned to Brazil for a 2-week visit with family members who live in a rural
village. She is married and has four children. Besides the current cough, she has had no major acute or
chronic illnesses. Her only hospitalizations have been when her children were born. She has had no
known exposure to tuberculosis (TB).

Assessment The patient’s vital signs are as follows: temperature 100.8°F, pulse rate 84, respiratory rate
24, and blood pressure (BP) 124/78 mm Hg. She weighs 126 pounds, a 10-pound weight loss since her
last visit.

Her physical examination is negative except for an occasional cough and decreased breath sounds in the
upper left lung. Diagnostic tests reveal the following: chest x-ray is positive for a 6 cm cavitary lesion in
the upper left lobe, purified protein derivative (PPD) skin test is 12 mm induration when read at 48
hours, sputum smear is positive for acid-fast bacilli (a culture is pending), and human immunodeficiency
virus (HIV) testing is negative.

Diagnosis: TB
Complete and be prepared for the present Venables 1-5 & Merritt 5-9

1. List specific treatment goals for S.H.

2. What drug therapy would the nurse prescribe? Why?
3. What are the parameters for monitoring the success of
the therapy?
4. Discuss specific client education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent
that would cause the nurse to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter medications would be appropriate for S.H.?
8. What dietary and lifestyle changes should be recommended for S.H.?
9. Describe one or two drug–or drug-food interactions for the selected agent.