Examine the image below to learn more about the client to write an appropriate and individualized prescription.
Rishi Agarwal, a 70-year-old male client (DOB: 2/15/1954), presents with complaints of pain and swelling in both knees for several months. He states the pain worsens after movement, and his knees feel stiff when he wakes up or sits for a long time. He has been taking acetaminophen (Tylenol) over the counter without relief.
An X-ray was ordered to help confirm a diagnosis. At the follow-up appointment, Rishi was diagnosed with OA in both knees based on the X-ray findings and clinical manifestations. On exam, edema is noted around both knees, otherwise the physical exam and lab results are within normal limits. The NP orders physical therapy and considers appropriate pharmacotherapy.
Physical Exam
HEIGHT: 6’2″
WEIGHT: 190 lbs
BMI: 24.4
BP: 124/80
HR: 67
RR: 17
02 Sat: 96% on RA
TEMP: 98.5 oral
Rishi Agarwal Image Description
Write an appropriate prescription for this client in the activity below. Click the “Show Answers” option that will appear once all fields are complete to compare your response with the correct answer.
An appropriate prescription for Rishi is:
Client Name: Rishi Agarwal
Date of Birth: 2/15/1954
Date Prescribed: Current Date
Rx: naproxen (Naprosyn) 250mg
Dis: 90
Sig: Take one tablet by mouth every 8 hours as needed
Refills (0-4): 2
Dispense as Written:
Generic Substitution Permitted:
- Either Dispense as Writtenor Generic Substitution Permitted should be checked on every written prescription depending on what is best for each client. Refer to the week 1 lesson for criteria.
Rationale: The CPG strongly recommends oral NSAIDs as the initial oral medication choice for clients with (OA) in the knees. Oral NSAIDs are cornerstone in the pharmacologic management of OA due to their proven short-term efficacy in numerous trials (Kolasinki et al., 2020). Since Rishi does not have cardiovascular disease or gastrointestinal (GI) conditions, oral NSAIDs are appropriate. First-generation NSAIDs are first-line NSAID therapy; therefore, second-generation NSAIDs were not selected (Rosenthal & Burchum, 2021). NSAIDs have different side effect profiles. Naproxen is well-tolerated by most clients and is the preferred pharmacotherapy choice for Rishi. Two refills are provided and a follow up appointment is scheduled to ensure no adverse side effects from the medication.
- Describe your assigned client’s situation. Why are they presenting to the clinic? What medications are they currently taking?
- Assess the applicable clinical practice guideline (CPG) for your assigned client. What treatment is recommended by the CPG for your client’s situation?
- Discuss your personal professional assessment of the client’s situation provided in the scenario. What pharmacological treatment is necessary and why?
- Reflect on additional questions you have about your assigned client that may influence treatment. What else do you need to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?
