LM is an 89-year-old female resident of a long-term care facility who has been experiencing multiple falls, some resulting in injuries such as bruising and skin tears. Over the last 6 months, her ambulation status has declined from independent to wheelchair level. She complains of pain in her legs when walking more than short distances across the nursing unit.PMH:HTNAlzheimer’s diseaseHypothyroidismOsteoarthritisDiabetesMEDICATIONS:Amlodipine 10 mg QDDonepezil 10 mg QHSLevothyroxine 0.88 mg QAMCelecoxib 200 mg QDFurosemide 40 mg QAMMetformin 500mg, 1 BIDGlyburide 5mg, 1 BIDALLERGIES: NKASOCIAL HISTORY:Widowed with 2 adult children living in town, retired photographer and owner of an art supply storeVITALS: LABS:Weight: 129 lbs TSH 2.45 Free T4 0.98Height: 64 inches Na 135, K+ 3.8, Cl 99, CO2 25,BP: Supine = 177/82 Glucose 101, SCr 0.9, BUN 42HR: 78 bpm WBC 7.0, RBC 4.5, Hgb 11.9, Hct 34.1Plt 255Cr: 1.6 UA: CleareGFR: 45 ml/minPE:HEENT: Normocephalic, no evidence of trauma, PERRLA, EOMI, Dry mucous membranesCV: RRRRespiratory: Clear to auscultation bilaterallyAbdomen: Soft, non-tender, no masses or guardingG/U: Skin intact, assisted with toileting and personal hygiene by staffExtremities: Bilateral 2+ edema to lower extremities; skin dry, dark bruising and skin tear to right elbow and forearmNeuro: Alert and oriented to person only. MMSE 18/30, stable over last 12 months.PAIN ASSESSMENT:Faces pain scale: No pain occurs at rest, upon walking, pain is moderate to severe2- to 3-page and following:Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvementReferences x 3 including :Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier
