Case studyPharmacotherapeutics

Herzing NU 636 Unit 1 Assignment Case Study Polypharmacy

A 71-year-old thought to be developing dementia, and one detail in the history points somewhere else entirely. The colour of the curtains is not a stylistic flourish.

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Last reviewed · August 25, 2026

Written by

Maren Caldwell

MSN, RN, CNE

Medical-surgical nursing, pharmacology and NCLEX preparation

Reviewed by

Dr. Tessa Redmond

DNP, RN, CNE

Evidence-based practice and clinical education

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Assignment instructions
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Final review

Yellow-green vision in a patient on digoxin

The case is written so that one detail solves it. Mrs A is on digoxin 250 micrograms daily, she is 71, and she reports that her curtains look yellow-green: xanthopsia is a classic feature of digoxin toxicity, and confusion, fatigue and irritability are the others. The daughter's dementia hypothesis is the mistake the case is testing, and it is the one that results in nursing home admission for a woman whose problem is a drug level. Say that clearly and early, because everything else in the answer, the pharmacokinetics, the renal and hepatic discussion, the interaction analysis, is an explanation of how a reasonable regimen produced it. Frame the whole answer as a case of medication-induced cognitive change misattributed to ageing. Reading the case any other way produces a competent essay about dementia that answers none of the six questions asked. Everything else in the answer explains how a reasonable-looking regimen produced it.

Then work the regimen and the mechanisms together rather than in separate lists. Digoxin has a narrow therapeutic index and is renally cleared, so an age-related fall in glomerular filtration raises the level at an unchanged dose; furosemide can produce hypokalaemia, and hypokalaemia potentiates digoxin toxicity, which makes these two drugs an interaction rather than a coincidence; piroxicam is a long-acting non-steroidal on the standard lists of medicines to avoid in older adults and carries its own renal and gastrointestinal risk in exactly this patient; and the antacid affects absorption of what is taken alongside it. The geriatric pharmacokinetic section then has real content, in reduced renal clearance, altered body composition and volume of distribution, lower serum albumin and reduced hepatic first pass. Finish with the system answer the brief asks for: which monitoring, which review interval and which piece of patient education would have caught this before the daughter started making arrangements.

Likely learning objectives

Recognise xanthopsia with confusion as digoxin toxicity rather than dementia.
Connect renal decline to a narrow-therapeutic-index drug level.
Treat the furosemide and digoxin combination as a mechanistic interaction.
Identify potentially inappropriate medicines in an older adult's regimen.

Assignment instructions

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Review every instruction before using the planning guidance that follows.

Case Study Mrs. A is a 71 year old widow with CHF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother’s ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are: Furosemide 40 mg daily in the morning Digoxin 250 micrograms daily Paracetamol 500 mg, 1-2 tablets 4-hourly PRN Piroxicam 20 mg at night Mylanta suspension, 20 ml PRN Coloxyl 120 mg, 1-2 tablets at night Assignment Questions Critically discuss this case study in terms of the problematic nature of this patient’s pharmacological management. Herzing NU 636 Unit 1 Assignment Case Study Polypharmacy Outline some pharmacokinetic changes in the geriatric population that may affect drug disposition. Outline how changes in renal and hepatic function may affect treatment strategies. In the drug regimen presented above – discuss potential side effects and potential interactions, if any? Your response should include a discussion of the problems of polypharmacy as it is related to this case study and the assessment/management and educational strategies which could have been implemented to improve the outcome of Mrs. A. Instructions Prepare and submit a 3-4 page paper [total] in length (not including APA format). Answer all the questions above. Support your position with examples. Please review the rubric to ensure that your assignment meets criteria. Submit the following documents to the Submit Assignments/Assessments area:

Course-wide instructions that accompany this question

ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

What the case study asks

01A critical discussion of the problematic nature of this patient's pharmacological management.
02An outline of pharmacokinetic changes in the geriatric population that may affect drug disposition.
03An outline of how changes in renal and hepatic function may affect treatment strategies.
04A discussion of potential side effects and potential interactions in the regimen presented.
05A discussion of the problems of polypharmacy in relation to this case.
06The assessment, management and educational strategies that could have improved the outcome.