Question

Please read the following case study. Submissions should follow the Case Study Rubric (see below).

M.R., a 59-year-old man, has been seen several times complaining of tremor in his hands that eventually made it difficult for him to work as a computer programmer. A diagnosis of essential tremor was made, and he was prescribed propranolol (Inderal) 20 mg twice daily. M.R. had good effects with the drug and had no further problems until the following June, when acute respiratory distress developed while he was picnicking in a state park with his family. On the way to the emergency room, he suffered an apparent respiratory arrest. He was admitted to the hospital and placed in the respiratory intensive care unit. It was found that M.R. had a history of hay fever and allergic rhinitis during the pollen season but had never experienced such a severe reaction.

Question 1: Why did M.R. have such a severe reaction?

Question 2:  What appropriate measures should be taken to ensure that M.R. recovers fully and does not re-experience this event ?

Question 3: What might you want to teach M.R. about this drug and its potential adverse effects?

Question 4: Using layman's terms, how do you explain to M.R. what happened; and how this situation will be avoided in the future.

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All of the following requirements must be present to potentially receive full points for the Case Studies:

Include:

• Introduction
• Statement / Summary of the Problem
• Solutions or Recommendations / Answers to the questions
• Minimum of 3 scholarly references (less than 5 years old)

- Must be a minimum of 2 pages (not including title page or reference page)

Answer 1

 

1) patient (M.R) had been taking propanolol for tremor. Using this medicine for some patients who are allergic to foods, pollen ,animals and preservatives increases the risk of breathing problems. Besides,patient had history of hay fever ,which is the another contributing factor for respiratory distress. Some allegens like pollens trigger immune system and produces antibodies to defend your body and produces inflammatory chemicals like histamine. Allergens can be indoors or outdoors seasonally or year long.  

2) a) patient has to inform doctor about any allergies to pollen, preservatives or animals before taking propanalol medication, which may worse the respiratory problems . b) avoid to visit outdoor places during spring because pollen is more common at that time . c) wash hands and wearing eye glasses prevent pollen from coming in . d) Take medications at proper time and don't miss the dose. e) some medications may trigger the symptoms so patient has to keep specific  time duration for other medications.

3) propanolol is a beta blocker used to treat high blood pressure, irregular heartbeats and other conditions . Side effects : 1) cough producing mucus 2) difficulty with breathing 3) tightness in the chest 4) abdominal or stomach pain 5) body aches or pain 6) congestion 7) confusion 8) decreased urine output .   

4) explain the patient about the effects of drug in the body and the things  which trigger the symptoms and complications . Teach the patient about how allergies and other conditions interact with propanolol and the situations which need immediate medical attention . Tell the patient to avoid pollen ,dust or other things that increases the severity of the condition and advise him to take precautions. Advise the patient to take proper medications and avoid visiting outdoors .Inform the doctor if patient has asthma .