Reference no: EM133295469
Case: Jacob Petersen is a 78-year-old male who lives with his wife in a 1-story rancher. Mr. Petersen is a fulltime caregiver to his wife who has been diagnosed with stage IV breast cancer. He has three married children who all live out-of-state. Unless an acute situation arises, he is seen by his primary care provider (PCP) every 6 months. He currently takes 9 different medications for a variety of ailments: hypertension, insomnia, osteoarthritis, benign prostatic hypertrophy, Barrett's esophagitis, stroke, and congestive heart failure. He missed his last appointment because he could not leave his wife who is now bedridden. He has found his memory is not as good as it used to be and has written down his medications:
Hydrochlorothiazide 25mg po once a day after dinner
Cardura 2mg po once a day
Xarelto 20mg po once a day with dinner
Indocin 50mg po once a day for mild to moderate pain
Digoxin 0.25mg po once a day
Prilosec (delayed-release) 20mg capsule opened once a day and sprinkled over cream of wheat
Ambien 10mg po every night as needed
Percocet 325 mg po every 6 hours as needed for moderate to severe pain
Colace 100mg po once a day
At his PCP visit today, Mr. Petersen has lost 10 pounds since his last visit one year ago. His blood pressure is 106/66. He is surprised by his blood pressure reading because he has been experiencing frequent headaches over the past two weeks. He becomes tearful when asked by his PCP, "How is your wife doing at home?" He states he is having trouble sleeping and feels "overwhelmed" and "sad". He is uncertain how much longer he can be his wife's caregiver, but refuses to place her in "one of those homes".
He is prescribed Paxil 20mg po once a day for possible depression. Mr. Petersen mentions that he already takes so many medications, but he guesses adding another one after dinner will be fine. For his insomnia, his PCP recommends adding Tylenol PM 2 tabs every night as needed. Because this is an over-the-counter medication, Mr. Petersen is willing to try it. No further instructions were given to Mr. Petersen except to make another appointment in six months.
Question 1: Identify at least three options that might help Mr. Petersen address the concerns he verbalized to his PCP.
Question 2: Using a holistic approach, explain your rationale for suggesting each option