NU141CL Unit 10 Final Case Presentation Example

From Held Home Doses to Discharge: A Final Case Presentation With Twelve Slides and Speaker Notes Following the Medications of a Composite 58-Year-Old Man Admitted With a Bleeding Stomach Ulcer

[Student Name]

Purdue University Global

NU141CL: Pharmacology for Nursing Clinical

Unit 10 Final Case Presentation

[Instructor Name]

[Date]

The patient is composite; doses and values are bracketed where illustrative, and treatment decisions belong to the prescriber.

Slide 1: Introduction

Notes: "I'm presenting Patient S, a 58-year-old landscaper admitted with a bleeding stomach ulcer. I'll follow his medicines from admission to discharge and show how each decision connects to why he bled."

Slide 2: Presentation

Notes: "He came in after two days of black, tarry stools and dizziness. His heart rate was [112] and blood pressure [98/60]. Hemoglobin was [7.6] g/dL. He was alert and oriented, pale, and said he had felt faint twice getting out of bed that morning, which is what finally brought him in."

Slide 3: Home Medicines

Notes: "At home he took aspirin [81] mg daily on his own 'for his heart,' and naproxen [500] mg twice daily for back pain from work, bought over the counter. He also takes lisinopril. Both aspirin and naproxen block prostaglandins that protect the stomach lining, and together they raise ulcer and bleeding risk (Burchum & Rosenthal, 2022)."

Slide 4: Held on Admission

Notes: "Aspirin and naproxen were held immediately. Lisinopril was also held because his blood pressure was low and the drug could worsen it and reduce kidney blood flow during bleeding."

The first medication decision was not a new drug but three held ones, and each hold had its own reason.

Slide 5: Acid Suppression

Notes: "He received an IV proton pump inhibitor, pantoprazole, as a bolus and then continuous infusion. Raising stomach pH helps clots form and stay stable on the ulcer. Current guidance favors intensive acid suppression with a proton pump inhibitor once a high-risk ulcer has been treated through the endoscope (Laine et al., 2021)."

Slide 6: Endoscopy

Notes: "Endoscopy found a duodenal ulcer with a visible vessel, which the gastroenterologist treated during the procedure so that it would not bleed again. Biopsies were taken for Helicobacter pylori."

Slide 7: Transfusion

Notes: "With hemoglobin of [7.6] and ongoing bleeding signs, he received one unit of red cells. The guideline approach favors a restrictive threshold of about [7] g/dL in most patients without heart disease. Nursing checks included two-person verification, baseline vital signs and monitoring for a reaction in the first fifteen minutes, following the transfusion procedure in our fundamentals text (Potter et al., 2023)."

Slide 8: Helicobacter pylori Result

Notes: "His biopsy was positive. He was started on a combination regimen: a proton pump inhibitor with two antibiotics for [14] days, chosen by his provider. Eradicating the bacteria lowers the chance of the ulcer coming back."

Slide 9: Nursing Monitoring

Notes: "We watched for rebleeding: heart rate, blood pressure, stool color and hemoglobin every [six] hours at first. We also checked for antibiotic side effects such as diarrhea and taste change once eradication therapy started."

Slide 10: Discharge Medicines

Notes: "He went home on oral proton pump inhibitor and his eradication therapy. Lisinopril restarted at his usual dose once his blood pressure recovered. Aspirin was not restarted, because he had no heart disease indication for it. Naproxen was stopped."

Slide 11: Teaching

Notes: "We taught him to avoid all anti-inflammatory pain relievers, including over-the-counter naproxen and ibuprofen, to use acetaminophen within the daily limit for back pain, to finish every dose of the antibiotics and to return for black stools, vomiting blood or dizziness."

Slide 11b: What Connected the Case

Notes: "If I had to put the case in one sentence, it would be this: two common pain pills he bought himself caused the bleed, and every medicine decision afterward either stopped the damage, helped the ulcer heal or removed the reason it formed. Holding aspirin and naproxen stopped the damage, the proton pump inhibitor helped healing, and the antibiotics treated the infection that made his stomach vulnerable. Seeing the medicines that way, as answers to causes, made the list easier to remember and to explain to him."

Slide 11c: What I Would Do Differently

Notes: "On admission I recorded his home medicines from his answer to 'what prescriptions do you take,' and naproxen did not come up until his wife mentioned his back pills on day two. Next time I will ask specifically about pain relievers, sleep aids and anything bought at a store, because the drug that caused this admission was one he did not count as medicine. I also learned to explain why aspirin was not restarted; he had assumed it was protecting his heart, and he needed to hear why stopping it was safe for him."

Slide 12: Questions for Discussion

Notes: "Two questions. How do we find out about over-the-counter drugs like his naproxen earlier, since he didn't think of it as a medicine? And how would we handle restarting aspirin in a patient who does have a heart reason for it?"

References

Burchum, J. R., & Rosenthal, L. D. (2022). Lehne's pharmacology for nursing care (11th ed.). Elsevier.

Laine, L., Barkun, A. N., Saltzman, J. R., Martel, M., & Leontiadis, G. I. (2021). ACG clinical guideline: Upper gastrointestinal and ulcer bleeding. The American Journal of Gastroenterology, 116(5), 899-917. https://doi.org/10.14309/ajg.0000000000001245

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.