Case scenario - Multimorbidity
Patient Case: Multimorbidity: Mr Allan.
Have a look at the case below and try to complete the task outlined. You may find it useful to do this with your the other work from home student on your placement. Once you have done this you can listen to the recording below which discusses this case further. You will get much more out of this excercise if you do attempt to complete the task first, before listening to the lecture.
Case:
Mr Allan is a retired teacher who lives with his wife. He keeps active in his garden and requires no additional help at home.
Past Medical History: Hypertension, Type 2 diabetes, COPD, Osteoarthritis of knee
Regular medicines:
Amlodipine 10mg once dailyRamipril 5mg once dailyMetformin 850mg twice dailyFostair 100/6 take one puff twice a daySalbutamol 2 puffs as requiredAtorvastatin 20mg at nightNaproxen 500mg three times weekly (last issued 2 months ago when knee was painful)He no longer smokes and his blood pressure is usually under control. His last HBa1c check was 6 months ago and was 51mmol/mol and his renal function CKD3b Allan recently had a chest infection and was admitted to hospital for oxygen therapy and iv antibiotics. During admission, he developed acute kidney injury and his metformin and ramipril were stopped. His HbA1c was repeated as an inpatient and was found to be 65mmol/L. A hospital doctor suggests to Allan this increase may be due to him requiring repeat oral steroid courses over the recent winter months for his COPD.
Mr. Allan is now home and goes to see his GP, bringing his discharge letter with him. The letter asks the GP to check the patients renal function in two weeks and then:
1. Restart hypertensive and diabetic medication when renal function improved, considering any long term sequelae of AKI
2. Review both long-term COPD and diabetic management in the community.
Task: Write an evidence based management plan for Mr Allan to address the above requests
Once you have completed this task please listen to the following 20 minute recording which discusses this case further.