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Harold, a fifty-eight year old grocery store manager, had recently been waking up in the middle of the night with abdominal pain. this was happening several nights a week. he was also experiencing occasional discomfort in the middle of the afternoon. harold decided to schedule an appointment with his physician. the doctor listened as harold described his symptoms and then asked harold some questions. he noted that harold's appetite had suffered as a result of the pain he was experiencing and as a result of the fear that what he was eating may be responsible for the pain. otherwise, harold seemed fine. the doctor referred harold to a physician that specialized in internal medicine and had harold make an appointment for a procedure called an endoscopy. the endoscopy was performed at a hospital later that week. during the procedure, a long, thin tube was inserted into harold's mouth and directed into his digestive tract. the end of the tube was equipped with a light source and a small camera which allowed the doctor to observe the interior of harold's stomach. the endoscope was also equipped with a small claw-like structure that the doctor could use in order to obtain a small tissue sample from the lining of harold's stomach, if required. the endoscopy revealed that harold had a peptic ulcer. analysis of a tissue sample taken from the site showed that harold also had an infection that was caused by helicobacterpylori bacteria. the doctor who performed the endoscopy gave harold prescriptions for two different antibiotics and a medication that would decrease the secretion of stomach acid. the doctor also instructed harold to schedule an appointment for another endoscopy procedure in 6 months. 1. list the subjective findings in this case study. 2. what is an endoscopy? (2 points) what is a biopsy? 3. how was a biopsy performed on harold? 4. differentiate between gastric and duodenal ulcers by location. 5. what role does h. pylori play in the formation of peptic ulcers? 6. define occult and frank blood. (4 points) what is a guaiac test? 7. how can peptic ulcers cause bleeding? 8. why were antibiotics prescribed? 9. why would a medication that would decrease the secretion of stomach acid be beneficial?

Mr. will, a 67-year-old patient, is postoperative day 2 after a coronary artery bypass graft operation to revascularize his coronary arteries that were significantly blocked. he has a midline incision of his chest and a 7-inch incision on the inner aspect of his right thigh where a saphenous vein graft was harvested and used to vascularize the blocked coronary artery. the surgeon ordered oxycodone 5 mg every 4 hours prn for moderate pain and oxycodone 10 mg every 4 hours prn for severe pain. a. considering the patient's age, what medication administration considerations should the nurse incorporate into the pain management plan and why? b. what measures should the nurse provide the patient to prevent adverse effects of analgesic agents from occurring? c. what nonpharmacologic pain management methods should the nurse teach to mr. will to assist with pain management?

Cj is a 53 year old african american female presenting to pharmacy for first-time certification and cmr so that she may start getting her medications at no cost. cj states that her main concern about her health is her diabetes. pmh: t2dm, htn, hyperlipidemia sh: denies tobacco and illicit drug use, occasional alcohol use (1-2 drinks/month) fh: unknown allergies: penicillin (unknown reaction; had reaction when young). medications: lisinopril 5 mg daily aspirin 81 mg daily simvastatin 20 mg daily wt 231 lbs (105 kg), ht 5’6”, bmi 37.3 (obese), ibw 59.3 kg, bp 145/80, hr 98, random blood glucose 395, a1c 11.2%, estimated 10-year ascvd risk 9.5% drug-related problems: 1. uncontrolled t2dm 2. uncontrolled htn 3. suboptimal statin intensity 1) identify two pieces of objective data included in this case: 2) what kind of monitoring needs performed for the new prescription for this patient? 3) based on your case how would you counsel the patient on the new prescription medication? provide examples of specific aspects you would include in your patient education. 4) review your patient case. identify any medications that do not have a corresponding disease state. 5) review your patient case. identify any disease states are not treated by current medications. 6) what otc (over the counter) product would you recommend for this patient (based on the patient request for an otc product? include dose, frequency of administration, route of administration, and critical counseling points.