Module 3 In-class Case Studies
Case Study 1:Katherine Rivera
A 65-year-old patient with a 2-year history of Parkinson's disease has been experiencing
an increase in symptoms, especially muscle tremors and rigidity. The patient has been
taking carbidopa-levodopa (Sinemet CR) and selegiline (Eldepryl) since diagnosis. The
physician has chosen to add benztropine (Cogentin) to the patient's medication regimen.
The nurse is administering the first dose of benztropine and intends to provide patient
teaching about the drug and its side effects.
1. What side effects are associated with benztropine?
○ The patient might experience blurred vision, dry eyes, constipation, dry mouth, headache,
sedation and weakness. The patient might also have cardiac effects like tachycardia,
arrhythmias, hypotension, palpitation.
2. Given the effect the medication has on the pupils, what condition if present in the patient
would cause concern?
○ If the patient has angle-closure glaucoma, this medicine would not be recommended.
3. An indication that the addition of benztropine is effective in this patient would be relief
of which Parkinson's disease symptom?
○ There will be a reduction of rigidity and tremors.
Case Study 2: Katherine Rivera
The patient is a 54-year-old male with a history of schizophrenia. The patient was started
on haloperidol (Haldol) 6 months ago. Today the patient's family calls the clinic to
discuss symptoms that have occurred more frequently over the past 2 weeks. The family
describes that the patient has had stiffness, a shuffling gait, hand tremors, and a delay in
response to questions.
1. What advice will the nurse offer to the family?
○ The patient is exhibiting signs of extrapyramidal side effects.
2. The nurse anticipates that the physician will order which medication to treat these
symptoms?
○ Trihexyphenidyl or benzotropine might be prescribed to alleviate those those effects.
3. The family asks the nurse if there are any other adverse effects of haloperidol that the
family should anticipate. How will the nurse respond?
○ Other effects to look for would be seizures, blurred vision, dry mouth, agranulocytosis (where
there’s not enough granulocytes in the blood, leaving the patient vulnerable to infection),
neuroleptic malignant syndrome (call HCP if the patient has fever, respiratory distress,
tachycardia, seizures, sweating, pallor, tiredness, muscle stiffness, loss of bladder control,
hyper/hypotension).
Case Study 3: Veronica Mata
, S., age 8 years, is brought to the emergency department (ED) by her mother. S.’s mother
states that S. has a 3-year history of allergy-induced asthma. S. is in acute distress; her
respiratory rate is 38 breaths/min, and the nurse notes sternal and intercostal
contractions. S.’s mother tells the nurse that S. has received nebulizer treatments at
home and has taken several “hits” from the rescue inhaler with little relief.
1. What type of medication does the nurse expect S. will receive initially? By which route
will the medication be administered?
○ The nurse would expect for the patient to receive Beta2-Adrenergic agonists drugs such as
Epinephrine or Albuterol (Inhalation). The Epipen Auto Injector is used for immediate treatment
of anaphylaxis.
2. The patient is being discharged to home with a prescription for a new inhaler with a
spacer. The nurse asks the mother if S. has been using an inhaler with a spacer, and the
mother replies that S. has not. What will the nurse teach the mother about the benefits of
using a spacer?
○ A spacer provides more effective delivery of inhaled doses of drug so for patients with difficulty
coordinating inhalations from a metered-dose inhalers it eliminates coordinating breathing.
3. S. is also prescribed a long-term inhaler. The nurse anticipates that this inhaler will
contain the drug salmeterol. What patient teaching will the nurse provide about
this medication?
○ The nurse will instruct patient to use Salmeterol (Servent Diskus) as directed. Salmeterol is
used for relief of acute symptoms. Salmeterol is should be used in conjunction with inhaled
corticosteroids. The dosage should be taken as prescribed and never exceed the maximum of
inhalations a day. Spacing puff (1) twice daily (12 hours a part) is very important. Patient should
use bronchodilator first then wait 5 minutes before taking the second drug. The nurse should
also instruct patient to perform good equipment hygiene by ensuring that its rinsed after each
use. Also emphasizing the importance of oral hygiene (rinsing the mouth) to prevent irritation
and infection.
Case Study 4: Jorgina Villegas
J.B. is a 62-year-old male who works at a local hospital. While he is visiting with his
neighbor, who is a nurse, J.B. mentions that he is having trouble urinating. He states that
he has difficulty starting his urine stream, has to urinate often during the day, and "even
has to get up three times a night" to urinate. The nurse suggests that J.B. see his family
physician. After seeing his provider, J.B. seeks out the nurse to talk about the diagnosis.
1. What does the nurse suspect is causing J.B.'s urination problems?
○ The nurse suspects J.B. has BPH (benign prostatic hyperplasia) or an enlarged prostate,
especially because nocturia or feelings of frequent urination are symptoms seen with BPH as
well as difficulty starting a urine stream.
2. The physician prescribed tamsulosin (Flomax) for J.B. How does tamsulosin help treat
enlargement of the prostate?
○ Tamsulosin helps treat prostate enlargement by blocking the alpha-adrenergic receptors
on smooth muscle within the prostate and bladder, causing a relaxation of the muscles and
improving urine flow. (Flomax--urine will flow)
Case Study 1:Katherine Rivera
A 65-year-old patient with a 2-year history of Parkinson's disease has been experiencing
an increase in symptoms, especially muscle tremors and rigidity. The patient has been
taking carbidopa-levodopa (Sinemet CR) and selegiline (Eldepryl) since diagnosis. The
physician has chosen to add benztropine (Cogentin) to the patient's medication regimen.
The nurse is administering the first dose of benztropine and intends to provide patient
teaching about the drug and its side effects.
1. What side effects are associated with benztropine?
○ The patient might experience blurred vision, dry eyes, constipation, dry mouth, headache,
sedation and weakness. The patient might also have cardiac effects like tachycardia,
arrhythmias, hypotension, palpitation.
2. Given the effect the medication has on the pupils, what condition if present in the patient
would cause concern?
○ If the patient has angle-closure glaucoma, this medicine would not be recommended.
3. An indication that the addition of benztropine is effective in this patient would be relief
of which Parkinson's disease symptom?
○ There will be a reduction of rigidity and tremors.
Case Study 2: Katherine Rivera
The patient is a 54-year-old male with a history of schizophrenia. The patient was started
on haloperidol (Haldol) 6 months ago. Today the patient's family calls the clinic to
discuss symptoms that have occurred more frequently over the past 2 weeks. The family
describes that the patient has had stiffness, a shuffling gait, hand tremors, and a delay in
response to questions.
1. What advice will the nurse offer to the family?
○ The patient is exhibiting signs of extrapyramidal side effects.
2. The nurse anticipates that the physician will order which medication to treat these
symptoms?
○ Trihexyphenidyl or benzotropine might be prescribed to alleviate those those effects.
3. The family asks the nurse if there are any other adverse effects of haloperidol that the
family should anticipate. How will the nurse respond?
○ Other effects to look for would be seizures, blurred vision, dry mouth, agranulocytosis (where
there’s not enough granulocytes in the blood, leaving the patient vulnerable to infection),
neuroleptic malignant syndrome (call HCP if the patient has fever, respiratory distress,
tachycardia, seizures, sweating, pallor, tiredness, muscle stiffness, loss of bladder control,
hyper/hypotension).
Case Study 3: Veronica Mata
, S., age 8 years, is brought to the emergency department (ED) by her mother. S.’s mother
states that S. has a 3-year history of allergy-induced asthma. S. is in acute distress; her
respiratory rate is 38 breaths/min, and the nurse notes sternal and intercostal
contractions. S.’s mother tells the nurse that S. has received nebulizer treatments at
home and has taken several “hits” from the rescue inhaler with little relief.
1. What type of medication does the nurse expect S. will receive initially? By which route
will the medication be administered?
○ The nurse would expect for the patient to receive Beta2-Adrenergic agonists drugs such as
Epinephrine or Albuterol (Inhalation). The Epipen Auto Injector is used for immediate treatment
of anaphylaxis.
2. The patient is being discharged to home with a prescription for a new inhaler with a
spacer. The nurse asks the mother if S. has been using an inhaler with a spacer, and the
mother replies that S. has not. What will the nurse teach the mother about the benefits of
using a spacer?
○ A spacer provides more effective delivery of inhaled doses of drug so for patients with difficulty
coordinating inhalations from a metered-dose inhalers it eliminates coordinating breathing.
3. S. is also prescribed a long-term inhaler. The nurse anticipates that this inhaler will
contain the drug salmeterol. What patient teaching will the nurse provide about
this medication?
○ The nurse will instruct patient to use Salmeterol (Servent Diskus) as directed. Salmeterol is
used for relief of acute symptoms. Salmeterol is should be used in conjunction with inhaled
corticosteroids. The dosage should be taken as prescribed and never exceed the maximum of
inhalations a day. Spacing puff (1) twice daily (12 hours a part) is very important. Patient should
use bronchodilator first then wait 5 minutes before taking the second drug. The nurse should
also instruct patient to perform good equipment hygiene by ensuring that its rinsed after each
use. Also emphasizing the importance of oral hygiene (rinsing the mouth) to prevent irritation
and infection.
Case Study 4: Jorgina Villegas
J.B. is a 62-year-old male who works at a local hospital. While he is visiting with his
neighbor, who is a nurse, J.B. mentions that he is having trouble urinating. He states that
he has difficulty starting his urine stream, has to urinate often during the day, and "even
has to get up three times a night" to urinate. The nurse suggests that J.B. see his family
physician. After seeing his provider, J.B. seeks out the nurse to talk about the diagnosis.
1. What does the nurse suspect is causing J.B.'s urination problems?
○ The nurse suspects J.B. has BPH (benign prostatic hyperplasia) or an enlarged prostate,
especially because nocturia or feelings of frequent urination are symptoms seen with BPH as
well as difficulty starting a urine stream.
2. The physician prescribed tamsulosin (Flomax) for J.B. How does tamsulosin help treat
enlargement of the prostate?
○ Tamsulosin helps treat prostate enlargement by blocking the alpha-adrenergic receptors
on smooth muscle within the prostate and bladder, causing a relaxation of the muscles and
improving urine flow. (Flomax--urine will flow)
