Running Head: CASE STUDY 7

Case Study #7
Pharmacology
The Robert B. Miller College
James Middleton
Angela DeVolder Blair
October 3, 2014

Case Study #7
We see many cases of an 82 year old coming into the hospital with pneumonia and UTI
with onset of confusion, lethargy, and agitation. It is important to know what the base line neuro
is of the patient before assessing them so you know if the patient is altered from normal. If the
confusion and agitation is new onset, there are many factors to rule out like systemic infection,
stroke, hypoxia, or cardiac event. As the patient is currently being treated for infection, I would
need to notify the hospitalist of the changes that have been detected in the patient since
admission.
2. The implications of a UTI acquired in a nursing facility are that of a complicated
urinary tract infection. Symptoms can range from mild to severe including systemic illness,
manifesting as a fever, bacteremia, and septic shock. Before starting antibiotic therapy, a urine
specimen should be collected with microscopic included and a culture and sensitivity of the urine
to detect the organism we are treating and what is the drug specific to the pathogen. Other things

Running Head: CASE STUDY 7

to consider when treating both her UTI and Pneumonia are liver function and kidney function.
These both affect the antibiotic choices to be used.
3. Nonpharmacological measures should be exhausted before administering Haldol to
chemically restrain the patient. The patient appears to be having a dystonic reaction to the Haldol
with oculogyric crisis, opisthotonus, and the risk of developing laryngeal dystonia which impairs
respirations. The nurse should notify the physician and prepare to administer an anticholinergic
medication. This may be administered IV or IM with symptoms resolving in 5 minutes via IV
and 20 minutes via IM.
4. Other assessment data that should be collected for the provider would include a full set
of vital signs including temperature and placing the patient on a cardiac monitor to detect cardiac
dysrhythmias. Lab tests should be obtained to monitor WBCs as Haldol decreases ones ability
to fight infections which is why the patient is admitted in the first place. The use of a patient
sitter may be considered to monitor the patient until symptoms resolve.