NURS 6521 Week 4 Assignment
HL Drug Abuse and Hepatitis C
Considering HL’s symptoms, nausea/vomiting/diarrhea, history of drug abuse, and potential diagnosis of Hepatitis C, the most likely diagnosis for HL’s current symptoms an be attributed to Hepatitis C. According to Medline plus (2018), nausea/vomiting/diarrhea are common symptoms of opioid withdrawal, but are also accompanied with goose flesh, agitation, anxiety, dilated pupils, and even frequent yawning—none of which HL is displaying. The website also points out that most opioid abusers need to be screened for Hepatitis C, as they often have it. Considering this knowledge, drug therapy change suggestions will be explored.NURS 6521 Week 4 Assignment
Therapy Plan
The most appropriate therapy for HL, considering HL’s current regimen, (levothyroxine 100mcg daily, nifedipine 30mg daily, and prednisone 10mg daily), involves both a short-term and long-term solution.In the short-term, the prednisone must be tapered down and eliminated, the other two drugs can continue, and the addition of polycarbofil 1gram 4 times daily for a few days, until diarrhea subsides.The addition of po electrolyte-heavy fluids, (i.e. Gatorade), would also be encouraged to replace what is being lost by the diarrhea.In the long-term, the combination tablet ledipasvir 90 mg and sofosbuvir 400 mg (LVD/SOF), would be initiated, after a confirming diagnostic genotype test and liver fibrosis test are performed, if HL can afford the therapy (Kish, Aziz, Sorio, 2017).NURS 6521 Week 4 Assignment
Justifying Plan
According to Vallerand (2018), levothyroxine 100mcg daily is the normal therapeutic dose and only has issues with patients who have liver impairment at higher doses.With the nifedipine 30mg daily, it is recommended to keep a lowered dose with hepatic impairment, and with the normal dose being 30mg three times a day, HL is safe with this dose.However, it was shown that chronic use of prednisone can cause adrenal insufficiency, which can cause immune deficiency, and subsequent increase in live viral loads as a result.As for the polycarbofil, it is recommended over say loperamide, as this patient has a history of drug abuse/decreased liver function, and polycarbofil is simply a bulking agent that will not affect the liver.Lastly, the use of LVD/SOF can help to lead HL towards recovering from the Hepatitis C and restore liver function; however, the cost can be prohibitive and HL’s ability to afford must be assessed.
Conclusion
Having explored the medication regimen for HL, we now have a better understanding as to why it fits best with HL’s diagnosis of Hepatitis C. I would encourage any clinician to ensure drug abuse is not their automatic first response for these types of cases, as the potential medical causes can often outshine, and are generally more common sensical, as compared to opioid withdrawal. Ignoring best practice because the patient has a checkered past is never acceptable.NURS 6521 Week 4 Assignment