[Expert Solution]: Patient Details · 76yo male, from…

Patient Details · 76yo male, from Edinburgh, Scotland. Lives with wife – no services. · Moved to London 6 years ago when fully retired to be closer to family. Current medical history · Chronic lymphocytic leukaemia – Binet stage C – pancytopenia, weight loss, hepatosplenomegaly. · Develops urinary retention · Benign prostatic hypertrophy – awaiting TURP · Hypertension · Atrial fibrillation Results (Blood results etc)FBC · Hb 95g/l · WBC 130 x 10 9/l · Neuts 5.3 x 10 9/L · lymph 121 x 10 9/L · Biochemistry · Na 141 mmol/L · K 4.0 mmol/L · Cl 104 mmol/L · Urea 4 mmol/L · Creatinine 79 umol/L · Albumin 26 g/L · LFTs normal · LDH 380 u/l · CRP 8 mg/L · CT prior to starting treatment (8 weeks earlier) shows splenomegaly of 16cm, mild hepatomegaly only · No significant lymphadenopathy · Bulky prostate · Few small gallstones in otherwise contracted, thin gallbladder · Renal cyst on right side, but otherwise normal Observations: Respirations – 16 breaths/min Spo2 – 97% on air BP – 141/87 HR – 92 bpm Temp. – 36.8 Lifestyle · Normal diet and fluids · Enjoys a daily walk · Retired offshore worker · Non-smoker · Alcohol – only on special occasions · 59 kgs • Penicillin (causes rash) · Current Medication · Obinutuzumab 1000mgs · Venetoclax 50-400mgs (as per protocol) · Digoxin 62.5mcg od · Apixaban 5mg bd · Bisoprolol 2.5mg od · Tamsulosin 400mcg od · Omeprazole 20mg Main complaint/current situation · Noted to have lower abdominal pain, along with reduced/ absent urination · Bladder scan in clinic shows 1400mls post void volume Most Recent Consultations/Follow up · Approach to current medication in terms of immediate management · Approach to chemotherapy both in terms of renal dysfunction, but also with regards to other pre-existing medications – what dose adjustments, drug substitutions should be considered Look at polypharmacy and drug optimisation specific to your chosen patient. For this section you must refer to the Polypharmacy Guideline Realistic Prescribing 3rd Edition (2018) – · More specifically, within this guide, you need to address the 7 steps of medicine review to appropriate polypharmacy: · What matters? · right medicine? · Unnecessary medicine? · Effective medicine? · Harmful medication? · Cost-effective medicine? · Agree and share medicine plan? Remember, when addressing polypharmacy, you must discuss whether polypharmacy is appropriate or inappropriate for this patient and all of the drugs your patient is on. Ensure that you apply all 7 steps of the medicine review and discuss all of the patient’s medications, identifying potential drug-to-drug and drug-to-disease reactions, potential ADRs and the nursing responsibilities in that. Lastly, discuss social prescribing.