1. REVIEW CASE STUDIES
UNIT 3

2. . Mrs. James, a 53 year old married school teacher has just been diagnosed with Diabetes Mellitus, Type 2. She is in good general health, takes no medications except HRT (hormone replacement therapy) and a multi-vitamin. She usually plays tennis at least once weekly, but has stopped in the last 3 months because “I just don’t have the energy anymore.” She is started on an oral anti-hyperglycemic.
A. What time of day should she take her anti-hyperglycemic medication?
B. What can she do to increase her chances of having a normal blood sugar?
C. She asks you what differentiates Type 2 from Type 1 Diabetes; what is your best response?

3. Mr. Holmes, a 47 year old banker has had Diabetes Mellitus Type 1 since he was 11 years old. He has not taken very good care of himself, and has not absorbed much of the teaching that has been done in the past. He has many questions.
How long will I need to take insulin?
Do I have to take shots?
Will I need to watch my diet, or can I eat whatever I want as long as I take my insulin?
Is there any difference between regular insulin & NPH insulin?
Why are you telling me I need to give my injections in a different place every day?
Where should I keep the bottle of insulin I am currently using?
If I become extremely hypoglycemic, how will I be treated?

4. Mrs. Parker has just been diagnosed with pulmonary tuberculosis.
Where will she receive most of her care?
How is tuberculosis diagnosed?
She is started on INH and Rifampin; what unusual characteristics will she experience?

5. Shari has a bacterial infection and will be taking a penicillin preparation.
When must she take the medication, in relation to meals?
Her MD has ordered a C&S (culture & sensitivity). Shari asks you to explain what it is, & when her antibiotic will be started.
If she is to take Penicillin G, what special instruction should be included?
Penicillin is a broad-spectrum antibiotic; what does this mean?

6. Aaron, age 5, has just been diagnosed with ADHD.
Aaron’s parents do not want him to take a CNS stimulant; is there any other option?
If Aaron is placed on Ritalin, for what side effect will he be monitored?

7. Mr. Phillips, age 39, had surgery to remove cancer
Mr. Phillips, age 39, had surgery to remove cancer. He is scheduled to begin chemotherapy next week, and has many questions.
What side effects are most common? What causes them to be so common?
Is there anything I can do to decrease nausea and vomiting?
If my hair falls out, will it ever grow back? When?
If his chemotherapeutic agent causes bone marrow suppression, what must I include in patient teaching?
What is the least toxic antineoplastic category? Why?

8. Lillian, age 18, has had a seizure disorder for 6 years.
Now that she is in her child-bearing years, what teaching must be done?
Why is it important for her to take her anti-convulsant at the same time every day?
Why are some anticonvulsants given once daily, others twice, others 3-4 times?
If Lillian were 5 years old & taking valproic acid, what would be included in teaching?

9. You are working in an endocrine disorders clinic, where you counsel several patients with different endocrine disorders.
A patient with hypothyroidism asks you how long she will have to take her medication; what is your best answer & why?
A patient with diabetes insipidus is taking DDAVP; you expect him to be taking it by which route?

10. Miscellaneous antiinfective medications questions:
gentamycin (Garamycin) has which serious side effects?
Who should not take tetracycline preparations, & why?
The person taking cephalosporins must be taught what information?
What food &/or fluid limitations must be taught to the person taking metronidazole?
What are common side effects of Septra or Bactrim?
What is the most frequent use of acyclovir?

11. Jane, age 57, has been diagnosed with major depression
Jane, age 57, has been diagnosed with major depression. This is her first episode.
What group of antidepressants is the most effective?
Which group of antidepressants has strict dietary restrictions? What are they?
If Jane is given a tricyclic antidepressant, which common side effects may she experience?
Jane does not feel any better after taking her antidepressant for 2 weeks; what should she do?

12. Jason, age 22, has been diagnosed with a psychotic disorder.
Phenothiazines may cause which side effects?
Are there any caffeine restrictions for the patient taking antipsychotic medications? Why or why not?
Why do many patients stop taking their antipsychotic medications?
If Jason develops EPS (extra-pyramidal side effects), how will he act/look?
If Jason develops tardive dyskinesia, how will he act/look?

13. Your patient has a neurological disorder.
If he has myasthenia gravis, when must the medications be given? Why?
If he has Parkinson’s disease, which medication(s) is he most likely taking?
What do you know is true about drugs given to treat Alzheimer’s disease?
Who should take Sinemet with extra caution?

14. Your patient is scheduled to have surgery tomorrow.
When should he stop eating & drinking? Why?
What will you tell him about the effects of general anesthesia?
He will have a PCA pump after surgery. what is the object behind using a PCA pump?
In addition to pain medications, what other common drug(s) are used after surgery and why?

15. Miscellaneous CNS questions
What is lithium used for?
When should the client take his lithium & why? (PRN or on a regular schedule)
Name some common anticholinergic side effects of meds.
What can you teach the patient with anxiety or insomnia to do, in addition to taking ordered medication?
What are amphetamines approved to treat?
What are side effects of cholinergic medications?
What is a common response to an adrenergic blocker?
What response is common with atropine?