HLTH 518 Assignment Description

Mr Hemi Raukura is a 68-year-old Mäori man living rurally, where access to primary and specialist care is limited. He lives alone but has whānau who check on him occasionally. He was previously a labourer and has chronic pain, which he attributes to “wear and tear” from years of physical work. He finds it difficult to remember to take his medicines and does not always collect repeat prescriptions on time

Recently, Mr Raukura has been feeling increasingly tired, dizzy, and short of breath, particularly when walking to his local shop. He reports ankle swelling and night-time urination. He has a dry cough that worsened over the past month, and he has had two falls at home.

Mr Raukura was admitted to the hospital two months ago with pneumonia. On discharge, he was prescribed: Amoxicillin 500mg three times daily for 10 days (now completed). Prednisone 20mg once daily for 7 days (but he continued taking it).

Since discharge, he has noticed:

• Increased blood sugar levels (his GP checked and found them high).
• Ongoing fatigue and dizziness, which have worsened.

Medical History

• Type II diabetes (diagnosed 10 years ago, not well controlled)
• Hypertension (previously well controlled, but now BP 160/95 mmHg at last visit)
• Chronic kidney disease (eGFR 62ml/min/1.73m², stable last year but not recently checked)
• Osteoarthritis (particularly affecting knees and lower back, requiring pain relief)
• Gastro-oesophageal reflux disease (GORD)
• Atrial fibrillation (on anticoagulation, but no recent INR checks)
• Depression (history of major depressive episode 5 years ago, currently well) Current Medication List

You are a nurse practitioner reviewing Mr Raukura’s medications as part of a routine check-up. The treating clinician has asked for a comprehensive medicines review focusing on deprescribing and optimising his medicines for safety and effectiveness.

1. Complete the medication review table (see below), identifying:

• The indication and mechanism of action
• Whether the medicine is treating an iatrogenic condition
• Pharmacokinetic considerations (e.g.. metabolism, half-life, renal clearance)
• Potential interactions, adverse effects, and risks
• A decision on whether to stop, change, reduce, or continue the medicine, with justification. This decision should also consider non-pharmacological considerations influencing deprescribing decisions.
  e.g., funding, social considerations

2. Write a 600-word letter to the treating clinician summarising your recommendations. Your letter should

• Prioritise which medicines should be changed first and explain why
• Address potential dose optimisations or formulation changes
• Suggest safer alternatives where needed
• Include non-pharmacological strategies for managing Mr Raukura’s conditions
• Provide a monitoring and follow-up plan for safe deprescribing

Your table must be fully referenced (APA7 or numbered referencing style). The table and its reference list do not count towards the word count. In your letter, if you are referring the prescriber to any particular reference/ support, then this needs to be referenced.

Word count
600 words (+/-10%) for the letter. Please provide no more than one page of material in size 10-12 point font per medication in your table.

Referencing
Yes, APA7 or a numbering, reference style preferred, reference lists are not included in word count.

Submission format
Present the table in landscape and the letter in portrait.

Due date
1700 28 May 2025

Weighting
This aromatawal is worth 30% of your total grade