Treatment plan for vascular dementia, PTSD, diabetic HTN and past CVA?
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I am a nurse just writing a case study for one of my assistant living manager students. Are there any parameters I should add for the Toprol XL. She has to write a service plan similiar to a nursing care on the resident who had multi - infaract / vascular dementia, PSTD, Diabetic HTN and past hx of CVA , Osteoporosis, and depression. Just looking up meds for those dx. I am looking to add meds tha need monitoring by parameters Thanks
Posted Sat, 8 Mar 2014 in Medicines and Side Effects
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer: I would love to be of assistance Detailed Answer: Hello sir/ma'am and welcome. Thank you for writing to us. I would love to be of assistance and shall try my best to address each condition from the history of this patient. 1. Vascualr dementia: For which you have added aricept, and which will also be helped by baby ASA. This treatment is good, and modifications are made only if the patient does not respond to these medications. 2. PTSD: I see from the drug history that you have chosen antipsychotics to treat PTSD. But usually, the first line of treatment advised are either sertraline or paroxetine. Although antipsychotics can also be used, as anti-psychotics will aid in treating the PTSD and the depression, but only if the patient has been diagnosed with MDD (major depressive disorder). In such a patient, second generation of ant-psychotics should be used. Seroquel (quetipine) is a good medication for this. Other medications from the group include: -Aripiprazole -Olanzapine -Risperidone -Ziprasidone -Paliperidone I would personally recommend olanzapine, quetipine or risperidone. 3. Diabetes: I would recommend adding blood glycemic parameters to the case history, along with HbA1c values, to prove whether or not the metformin (which will also help in promoting weight loss) is effectively controlling diabetes or not. If you chose to add values which show inadequate control, choose to add another OHD or even insulin. 3. HTN: Toprol XL. Similarly, show blood pressure readings and a diet chart (preferably TLC diet) 4. CVA: Baby ASA and lipitor are being used to address this condition. But as baby ASA is being used, I would also advise the use of clopidogrel. Do consider adding this to the treatment chart 5. Osteoporosis: Denosumab, vitamin D, and calcium are being used for this. Good treatment 6. Depression: Lexpro and seroquel. Should help in good management. But if you plan on making changes to this condition and changing it to MDD, then do not forget to add 'Psychotherapy' to the treatment chart as this is the first-line of treatment. I think the treatment chart is all in all quite good. I hope you find my response helpful. Please feel free to write back to me for any further clarifications, or in case I have forgotten to address any aspect of your query. I would be more than happy to help. Best wishes.
Follow-up: Treatment plan for vascular dementia, PTSD, diabetic HTN and past CVA? 3 hours later
Thank you so much Dr. XXXXXXX I will make the adjustments on the treatment plan of care and see if they get it correct in their service plands. XXXXXXX
Answered by Dr. Shoaib Khan 10 minutes later
Brief Answer: Best of luck Dear XXXXXXX Detailed Answer: Hello once again XXXXXXX I am glad I could be of assistance XXXXXXX Do not hesitate to write back to me for any further clarifications, I would be more than happy to help. Best of luck with your case.