Name: Amanda McKellar

Why: Conducting this history to learn about medications and become comfortable with
ascertaining sensitive information
Where: Living room
Who: JG, female, age 72, capable of participating
I started the meeting by asking permission to ask her personal questions. She told me
she was fine with answering questions. I then explained to her that her privacy would
be protected and that she did not have to answer any questions that she was not
comfortable with.
SURGERIES
Tonsillectomy --------------------------1947
Hernia -----------------------------------1954 & 1955
Appendectomy ------------------------1957
Hysterectomy --------------------------1975
Lumpectomy -------------------------2000
Hospitalizations
Pink eye ---------------------------------1948
hospitalized for 3-4 days
Reproductive
Live, single births ---------------------1966 & 1968
Diagnoses
Diabetes --------------------------------2010
non-insulin dependent
Checks blood sugar every day, varying every other in morning and night
Degenerative Disk Disease----------2014
Arthritis ----------------------------------2005
Hands
Mild mitral regurgitation ------------2014
Moderate tricuspid regurgitation 2014
Left ventricular hypertrophy -------2014

glimepiride
Patient states:
2 mg TAB PO every day in AM for diabetes taken since 2010
(Control of blood sugar in type 2 diabetes mellitus when diet therapy fails.
Requires some pancreatic function)
Pharmacokinetics:
Well absorbed following oral administration
Distribution unknown
99.5% protein binding
Mostly metabolized by the liver; one metabolite has hypoglycemic activity
Half-life 5-9.2 hours
Peak at 2-3 hours
Duration 24 hours
Drug Interactions:
Ingestion of alcohol may result in disulfiram-like reaction
Effectiveness may be decreased by concurrent use of diuretics,
corticosteroids, phenothiazines, oral contraceptives, estrogens, thyroid
preparations, phenytoin, nicotinic acid, sympathomimetics, and isoniazid.
Alcohol, androgens (testosterone) chloramphenicol, clarithromycin,
disopyramide, flouroquinolones, fluoxetineMAO inhibitors, NSAIDS (except
diclofenac), salicylates, sulfonamides, and warfarin may increase risk of
hypoglycemia.
Concurrent use with warfarin may alter the response to both agents
(increases both initially, then decreases activity); close monitoring
recommended during any changes in dose
Beta-adrenergic blockers may mask the signs and symptoms of
hypoglycemia.
May increase cyclosporine levels.

triamterene hctz
Patient states:
37.5/25 PO every day in AM for high blood pressure taken since 2003
(Control of hypertension)
Pharmacokinetics:
30-70% absorbed
Widely distributed
80% metabolized by liver, some excretion of unchanged drug
Half life of 1.7-2.5 hours
Onset 2-4 hours
Peak 1- several days
Duration 7-9 hours
Drug interactions
Increased hypotension with acute ingestion of alcohol, other
antihypertensive agents, or nitrates.
Use with ACE inhibitors, indomethacin, angiotensin II recertr antagonists
potassium supplements, or cyclosporine increase risk of hyperkalemia.
Decrease lithium excretion.
Effectiveness may be decreased by NSAIDS
Decrease the effects of folic acid (leucovorin should be used).
May increase risk of toxicity from amantadine.

evista
Patient states:
60 mg TAB PO every day with dinner taken for cancer since 2005
(Reduction of the risk of breast cancer in postmenopausal women with
osteoporosis and those at high risk for invasive breast cancer)
Pharmacokinetics:
Although well absorbed (>60%), after oral administration, extensive firstpass metabolism results in 2% bioavailability.
Highly bound to plasma proteins; remainder of distribution unknown.
Extensively metabolized by the liver; undergoes enterohepatic cycling;
excreted primarily in feces.
Half-life of 27.7 hours
Onset and duration unknown
Peak 3 months
Drug interactions
Cholestyramina decreases absorbtion (avoid concurrent use).
May alter effects if warfarin and other highly protein-bound drugs.
Concurrent systemic estrogen therapy is not recommended.

diltiazem ER
Patient states:
120 mg CAP PO every day HS for blood pressure taken since 2012
(Systemic vasodilation resulting in decreased blood pressure)
Pharmacokinetics:
Well absorbed, but rapidly metabolized after oral administration
Unknown distribution
70-80% protein binding
Mostly metabolized by the liver (CYP3A4 enzyme system)
Half-life 3.5-9 hours
Onset unknown (PO ER)
Peak 14 days (PO ER)
Duration up to 24 hours (PO ER)
Drug interactions:
Increased hypotension may occur when used with fentanyl, other
antihypertensives, nitrates, acute ingestion of alcohol, or quinidine
Antihypertensive effects may be decreased by NSAIDS
May increase digoxin levels
May increase levels of and risk of myopathy from simvastatin and
lovastatin
Concurrent use with beta blockers, clonidine, digoxin, disopyramide, or
phenytoin may result in bradycardia, conduction defects, or heart failure
Phenobarbital and phenytoin may increase metabolism and decrease
effectiveness.
May decrease metabolism of and increase risk of toxicity from cyclosporine,
quinidine, or carbamazepine
Cimetidine and ranitidine increase levels and effects
May increase or decrease the effects of lithium or theophylline
Grapefruit juice increase levels and effect

gabapentin
Patient states:
300 mg PO every day HS for arthritis taken since 2005
(Prevents nerve pain and decreased leg restlessness)
Pharmacokinetics:
Well absorbed after oral administration by active transport. At larger doses,
transport becomes saturated and absorption decreases (bioavailability
ranges from 60% for a 300-mg dose to 35% for a 1600-mg dose).
Crosses blood-brain-barrier and enters breast milk
Eliminated mostly by renal excretion of unchanged drug
Half-life for adults 5-7 hours with normal renal function
Rapid onset
Peak 2-4 hours
Duration 8 hours
Drug interactions:
Antacids may decrease absorption
Increased risk of CNS depression with other CNS depressants, including
alcohol, antihistimines, opiods, and sedative/hypnotics
Morphine increases gabapentic levels and may increase risk of toxicity,
dosage adjustements may be required
Kava-kava, valerian, or chamomile can increase CNS depression

Concerns/Barriers
JG has not experienced any problems related to her medicines.
She is able to take her meds safely as directed because she uses a
portioned daily pill holder to keep everything in order.
When she was initially prescribed her drugs, she was instructed to take the
medications as directed and read all drug instructions. She explained to me
that when she was given the drugs, the health care provider did not
extensively explain the meds use, action, or possible adverse reactions.
She went on to tell me that all of the drugs came with packets containing
all of the necessary information.
As far as JG is concerned, her medications are doing what they are
supposed to do because her diabetes and high blood pressure are under
control. She also has not had any new cancers.
JG does not need any help taking her medications at this time.
While JG was explaining her meds, she found a mistake on her medication
sheet. One of the pills was written on the paper to take 3 hours after
supper, but when she went back in depth with the paperwork, this note
was found to be a mistake. At one point during the interview she stated I
have so many things going wrong that I may as well just roll over and die!
This made me laugh because it was her way of making light of her current
health state. This relates to Gordons functional health patterns related to
self-perception and self-concept. Also important with JG is coping and
stress tolerance. She provides care for her mother with dementia and
carries a lot of this stress. I educated her on ways to manage her stress
such as exercise and deep breathing.

Reflection
When conducting the health history, JG had questions about some of her
conditions. She would tell me about something, such as left ventricular
hypertrophy, and ask me how it would affect her long-term. With my
pathophysiology knowledge, I did the best I could to answer all of her
questions. Since JG is someone close to me, it was easy to talk openly
about personal matters. If she was a stranger, it would have been much
more challenging to complete because I would not have been as
comfortable to ask personal questions. To reduce medication errors, I
recommended to JG that using the pill holder is a fantastic idea but the
meds should still be double and triple checked before being placed in the
container and ultimately swallowed. A lot of her meds have high risk for
unfavorable consequences if taken irresponsibly. In the future, I think I will
ask for more information. For example, to get more information about her
past history I could ask about any medications that she was previously
described and how the affected her. I did well, but I think I jumped around
too much. I would jump from a med to a condition and I would remember
something important about the health history that I forgot to ask. I had to
think back to assessment to get a grip on all of the things I wanted to get
out of a medical history. I had to remember what kind of questions to ask
and how to approach sensitive topics and keep personal biases out of it. I
honestly loved this assignment. It incorporated many aspects of what we
have learned thus far in nursing school. I had to have an understanding of
assessment, medical terminology, medical abbreviations, and introductions
of pharmacology and pathophysiology. I learned in depth about the 5 meds
that my patient was taking and how they interacted together. After I was
finished, I felt like the information fit together like a puzzle and I
understood exactly how it worked.