Case Study 1 Bob Smith Bob is a 47-year old, who is biologically male, who also identifies as this gender. He has worked in his current job since the age of 16. His role is within an office, as a team lea

Summative Essay format: Critical discussion of a specific field case study. 2500 words.+/- 10%

NB This is a guide- you may wish to address other issues.

*Type your essay using double line space.

Introduce your essay(Written in third person) (Approx 100 words)

• Please reference the case study. (University of Northumbria, 2024 Case Study: Bob Smith /Sylvia Martin).
• Inform the reader what your essay will discuss. (It is a good idea to do this last and go through your essay highlighting the issues that you have addressed.)

Please refer to the case studies in ADULT: Assessment information.

SECTION 1- (Written in third person) (approx 500 words)

• Please reference this section.
• Introduce and summarise the patients history and information you would require assessing the patients medication needs. Think about maybe using a SBAR approach
• Age, name, sex, ethnicity.
• Provide a definition of the morbidity.
• Refer to the nursing process but focus on the assessment element only. (ADPIE) Ref this.
• Tell the reader what elements of the assessment are included. But think about what more you would like to know about i.e. over the counter medicines. How do they take the medicines.
• Identify what is missing to add to the assessment.
• Bob Smith: What other investigations would be recommended. (Ref NICE guidelines)
• Highlight blood results and what these say Bob- Hypercholesterolemia What does NICE state query Statins. Creatine levels etc.
• Does Bob or Syliva have renal or liver failure?
• Talk about the social history what does the case study tell us?
• Document the vital signs in this section. What do they tell you.
• Anything else you can think about.

SECTION 2:40%(approx. 1,000 words) This will be divided how you wish.

Choose ONEmedication from the case study chosen and use contemporary evidence to explore how this medication manages the identified condition.

Divide this section into:

Pharmacokinetics of the chosen drug:

• Give a definition of pharmacokinetics.
• Then introduce the ADME of the chosen drug. How is the drug administered.
• Absorption-
  • What do we mean by this? What is it determined by? Enteral (oral) or parenteral (IV). Define the process.
  • Cell membranes- methods of crossing
  • Explain bioavailability of the drug. Explain the GI tract on a micro level where does the medication go to? Think about any special requirements when administering the drug.
  • Think about the physiological and chemical factors
  • Factors which affect absorption.
• Distribution:
  • How is the chosen drug distributed around the body? Circulation time/Half-life. Solubility of the drug.
  • Protein binding.
• Metabolism (Biotransformation)
  • What is the function of the liver in metabolising the drug?
  • What is Cytochrome P450
  • How are drugs metabolised?
  • Phase 1 and Phase 2 reactions.
  • What do we mean by First Pass Metabolism.
  • Rate of metabolism.
• Elimination
  • How is the drug excreted. Renal, lungs etc. Discuss the anatomy how the drug is excreted.

Link to BNF, Electronic Medicines Compendium. Textbooks. Contemporary evidence. Look at the power point for links to documents and reference lists.

Pharmacodynamics of the chosen drug.

• Potential variation in individuals due to pharmacodynamics. (Genetics, Age, etc.
• Provide a definition of pharmacodynamics. The drugs mechanism of action.
• You may want to highlight Receptors. Lock and Key.
• Discuss:
• Desired effect
• Side effect
• Adverse effect.
• What are receptors?
• Contraindications

SECTION 3: 40% (approx. 1,000 words)

Identify ANethical issue relating to the chosen medicationand critically discuss the nurses role in ensuring safe and ethical administration of this medication.

• Link to ethical theory of Principlism: Beauchamp and Childress- Autonomy, Justice, Non-maleficence, Beneficence.
• What does the Law state?
• Link to NMC Standards of Proficiency
• Ethical decision making- eg Protect from harm, communication, safety.
• Link to Royal Pharmaceutical Society 5Rs
• Think about patient safety. Think about the patients best interests.
• Bob Smith Pharmacological VS Nonpharmacological methods. Ie good sleep hygiene, diet, exercise.
• Bob- patient education re Blood pressure monitoring.
• Sylvia patient education re inhaler, Five 5rs re prescribed antibiotics, patient ed re Epi pen. Etc.

Conclusion (approx. 150 words)

Summary of your main points. Do not introduce any new issues here.

References

Make sure references are in alphabetical order and in correct reference style.

Use a variety of textbooks, articles, NICE guidelines, NMC, etc.

The module team look forward to reading your submitted summative assignments.

Case Study 1 Bob Smith

Bob is a 47-year old, who is biologically male, who also identifies as this gender. He has worked in his current job since the age of 16. His role is within an office, as a team leader and data input clerk. Due to working long hours, he rarely eats at home, preferring to eat either at the office or pick up food on his drive home. He cites being single as a reason for preferring to eat out.

Bob is an avid fan of documentaries and likes to watch a few hours of TV when he gets home at night. He says this helps him chill out, however, also notes he can be up until the early hours of the morning watching these series. He notes that he sleeps around 5 hours per night on average.

He attended his GP surgery, seeing a practice nurse, due to on-going tiredness, which he was attributing to working long hours. He became more worried when after 2 weeks of annual leave he was feeling no better. Upon examination, the nurse noted an initial blood pressure reading of 163/102 (all other vital observations were within acceptable ranges). Upon a subsequent reading within the same consultation, the nurse recorded a blood pressure of 160/99. Due to this, the nurse requested Bob book in with the Phlebotomist for bloods to be taken and requested a 24-hour ambulatory blood pressure check for Bob.

Bob notes within this consultation there is no family history of cardiovascular disease or any other familial history he can think of.

ADDITIONAL INFORMATION -The blood results were as follows: FOR USE IN LECTURES/PRACTICALS IF REQUIRED

Sodium 144 mEq/L (135 145 mEq/L)

Potassium 4.1 mmol/L (3.7 5.2 mEq/L)

Urea 6.8mmol/L (2.5 7 mmol/L)

Creatinine 110 mmol/L (60 110 mmol/L)

Total cholesterol 6.9 mmol/L (< 5>

Triglyceride 2.7 mmol/L (< 1>

(<2>

HDL 1.3 mmol/L (> 1 mmol/L)

LDL 4.1 mmol/L (< 3>

Upon 24-hour ambulatory inspection, his blood pressure averaged between 150-160 systolic and 90-100 diastolic.

Upon subsequent appointment and review of the blood results, the GP prescribed Ramipril for Bob, starting with a dose of 5mg once daily (OD). Bob was also prescribed 40mg Simvastatin OD due to his high cholesterol levels upon inspection.

Due to an ongoing pandemic, Bob will be reviewed again by the GP in a fortnights time via virtual consultation. This is with a view to checking on his current blood pressure and tolerance of the medication regime