Nursing Pharmacology Discussions

Mr. Toua Xiong arrived in the clinic 1 hour ago, accompanied by his wife, with complaints of difficulty swallowing and pain in his throat and mouth. Dr. Sabin has not yet seen the patient. Mr. Xiong is a 64-year-old male. He has a history of COPD, diagnosed 5 years ago, and he has been to the unit before, for chronic management of his COPD. Mr. Xiong’s wife says her husband is complaining of difficulty swallowing and pain in his throat and mouth, and that it has bothered him when eating or drinking for the last 3 to 4 days. He brought both of his inhalers and his portable oxygen tank from home, and states that he has been taking his medication as prescribed. We have taken a blood sample for ABG, CBC, and BMP as ordered; the results are pending. At his arrival his vital signs were: BP: 104/62 mmHg, HR: 97/min, RR: 19/min, and SpO2 91%. No other assessments have been completed at this point.

Mr. Xiong is waiting in exam room 2. Dr. Sabin will come to see the patient soon but asks that you take the patient history and complete the physical assessment now. Also, he said to monitor the SpO2 and titrate to keep it above 90%, but not to give more than 2 L of oxygen/min. Answer the following questions based on the information above. Respond in the corresponding discussion post. 1. The patients SpO2 is 91%. Is this normal or abnormal given the patients condition and medical history? 2. What would be your main nursing diagnosis for this patient? 3. Why does the Dr not want you to give the patient more than 2 L of oxygen/min? The patient, Danielle Young Bear, came to the clinic today with complaints of a persistent cough and fatigue that have lasted for 2 weeks. It started as a common cold, but she was concerned that it was something more serious since the cough and fatigue have not resolved yet.

The signs and symptoms are consistent with the aftermath of a common cold, so this is not a big concern. However, she is taking several different prescription drugs and is also self-medicating with OTC medication and using herbal therapies; I’m concerned about potential drug interactions. Ms. Young Bear is a 32-year-old Native American female. She is not one of our regular patients, but her usual provider is on vacation so she was referred to our clinic. She has a history of low back pain acquired at her job as a construction worker, and she is also being medicated for depression. Ms. Young Bear is alert and oriented. The lung sounds are clear bilaterally and there is a bit of redness in the throat. I also checked her back and there are no signs of serious injury. I have another patient waiting, so I would like you to take vital signs and do a focused pain assessment and assess neurological status. Please also make sure to go through all of her medications, including prescription medications, OTC medications, and herbal therapies, and perform medication reconciliation. Please notify me with your findings when you are done. Answer the following questions based on the information above in the corresponding discussion posts: 1. Why should you be concerned the patient is taking herbal therapies? 2. What questions will you ask the patient to assess her neurological status? 3. Is there anything you want to ask the patient about her cough? Explain. Yoa Li Summary Yoa Li is a 26-year-old male who was transferred to our unit this morning at 0630 from the PACU. He had an open emergency appendectomy during the night and was in the recovery room for 1.5 hours. He has no drug allergies, and is nothing by mouth (NPO) except for ice chips. While in recovery, he complained of pain 7/10 twice, and was given 4 mg of morphine by slow IV push. A PCA pump was started right before he was transferred to us, and he was given a standard loading dose of 2 mg IV bolus. The provider administered a morphine bolus 5 mg IV push at 1500 as Mr. Li was complaining about increasing pain. In the last 9 hours, he has had a total of 60 mg of morphine. I completed vital signs, pain, and sedation assessment on the patient right after the morphine bolus was administered 30 minutes ago. His vital signs were: BP: 116/62 mmHg, HR: 72/min, RR: 12/min, and SpO2 94%. He rated his pain as 3/10 and he was sleepy but easily wakened. However, he was complaining of increasing nausea. I administered 10 mg of IV prochlorperazine as ordered prn for nausea. Nursing Pharmacology Discussions

The patient is due for a follow-up check on vital signs and sedation level. Continuing patient and family education on the use of PCA is also a good idea. Answer the following questions in the Pre Conference Discussion of Yoa Li based on the above data: 1. What are potential nursing diagnosis for this patient based on the above information? 2. What will you want to monitor for in this patient? 3. How would you educate the family and patient on the use of the PCA? Rachael Heidebrink Summary I have taken care of the patient, Rachael Heidebrink, during the night and I would like to give you a report on her. Ms. Heidebrink suffered a pulmonary embolism 2 days ago and she is currently on IV heparin therapy. Ms. Heidebrink is a 22-year-old white female who was admitted 4 days ago with a fractured right greater trochanter sustained in a motorcycle accident. A right hip hemiarthroplasty was performed 3 days ago. On post-op day 1 she started complaining of severe shortness of breath, and her SpO2 dropped to 88% on room air. A VQ scan revealed a pulmonary embolism in the left lung, and she was then started on a heparin drip. Ms. Heidebrink’s SpO2 is 93% on 2 L of oxygen via nasal cannula. She has an IV line in her right arm with the heparin drip infusing at 14.2 mL/hr. She is rating her pain as 2 out of 10 right now. She had oral pain medication 3 hours ago. She has a urinary catheter draining clear yellow urine. Ultrasound scanning shows no sign of deep vein thrombosis (DVT), and her right hip dressing is dry and intact. This morning Dr. Lindley wrote orders for anticoagulation bridge therapy.

They are in the patient chart and will need to be initiated. Ms. Heidebrink also requires patient education about the change from IV to oral anticoagulant therapy. The aPPT results just came back, and you should check the orders to see if the heparin drip needs to be adjusted. Answer the following questions about Rachael Heidibringk in the corresponding discussion posting: 1. Why was patient Rachael put on an heparin drip? 2. Ms.Heidebrink’s anticoagulant medication is being changed from IV to oral.

What oral anticoagulant do you anticipate being ordered? What patient education do you want to give the patient regarding the oral medication? Patient Mary Richards I took care of Ms. Richards in the emergency department and I would like to give you a report on her. Ms. Richards is an 82-year-old African American female who was brought to the emergency department by her son this evening when he found her confused and complaining of trouble with her vision. Ms. Richards has been ill for several days with complaints of nausea, dizziness, and weakness. Ms. Richards has a history of hypertension, diagnosed 40 years ago, and heart failure, diagnosed 30 years ago. Her current medications include furosemide, amlodipine, and digoxin. Ms. Richards is complaining of slight abdominal pain and nausea. She has not vomited. Her last set of vitals are: temperature: 37.1°C (98.7°F), pulse: 58/min, respirations: 22/min, blood pressure: 96/54 mmHg, and an SpO2 of 96% on room air. She has an IV of lactated Ringer’s infusing at 100 mL/hr through a 20-gauge IV catheter in her right arm. A blood sample has been drawn for evaluation of her digoxin level. Ms. Richards is being admitted for observation and is due for a vital signs check. Nursing Pharmacology Discussions

Lab results just came back and should be reviewed. Please notify the provider about the results. Please answer the following questions about Ms. Richards based on the above information. Answer in the corresponding discussion post in the discussion section. 1. Based on her symptoms, what do you think Ms. Richards medical diagnosis is? 2. Based on her current pulse of 58. Would you administer her digoxin dose or hold it? 3. Are there any other tests you would like the physician to order? Patient B, Suzanne Morris The patient, Suzanne Morris, is a 43-year-old white female presenting with complaints of increasing abdominal cramps, stomach ache, and diarrhea that started 4 days ago. Ms. Morris arrived by private vehicle and has been here for 1 hour. Ms. Morris was diagnosed 10 days ago with peptic ulcer disease and prescribed triple combination therapy of amoxicillin, clarithromycin, and pantoprazole for H. pylori. She has been consistently taking the medications. Ms. Morris does not have any other significant previous medical or surgical history. Ms. Morris is awake and alert but complains of cramping, stomachache, and diarrhea. Her last set of vital signs was: BP: 101/61 mmHg, HR: 114/min, RR: 17/min, and SpO2 at 95% on room air. I started a 20-gauge IV in her right arm and gave her a 500 mL normal saline bolus at arrival per provider’s orders as her systolic blood pressure was less than 100 mmHg. Normal saline is now running at 100 mL/hr. I have also taken a blood sample and a stool sample to confirm suspected C. difficile infection. It has been sent to the lab. The provider put orders in the patient’s chart based on the initial assessments. The patient is due for vital signs and other assessments that you will need to implement. You should keep an eye on her blood pressure and call the provider if her systolic pressure drops to less than 100 mmHg. Also, be aware that she is on contact precautions. Answer the following questions based on the patient Suzanne Morris. 1. What medication treatment would you recommend for the treatment of CDIFF? 2. The bolus to increase her BP is not working. What medications do you suggest to the Dr to increase her blood pressure? Mr. Hadley came to the ED with his wife 1 hour ago on referral from his provider. He has a wound infection on his lower right leg, which tested positive for MRSA bacteria. Nursing Pharmacology Discussions

He has moderate pain and is very frustrated that the infection is not healing. Mr. Hadley is a 78-year-old Caucasian male who has been taking oral amoxicillin for 3 days, as prescribed by his provider, to treat a case of cellulitis caused by a feral cat bite. His provider called him this morning with the lab results showing positive for MRSA bacteria. The wound was also not getting better, and he was experiencing more pain, redness, and swelling of his leg. Mr. Hadley is alert and oriented x 3, and appears ill. There is a cat bite on his lower right leg. The bite has perforated the skin, and the surrounding skin is red and swollen.]

The wound care team will manage the wound care and have ordered no bandages. I assessed his pain and vital signs 30 minutes ago. Mr. Hadley reported a pain level of 5 out of 10, so the provider ordered a one-time dose of hydrocodone 5 mg/acetaminophen 325 mg, and acetaminophen 650-mg tablets to manage pain subsequently. Vitals signs were: BP: 125/85, HR: 91, RR: 19/min, SpO2 at 98% on room air, and temperature: 38.9oC (102oF). An IV has been inserted in his right forearm with lactated Ringer’s infusing at a rate of 125 mL/hr. The patient is due for vital signs check and pain assessment. Beware that Mr. Hadley is in contact precautions. Lab results just came back and should be reviewed. The antibiotics were also just delivered from the pharmacy and should be started, and Mr. Hadley and his wife will need patient education on the need for IV antibiotic therapy. Answer the following questions based on the information above on patient Harry Hadley. Answer in the corresponding discussion post in the discussion section. 1. Mr. Hadley is on contact precautions. Why? What will you wear into the room? 2. Mr. Hadley is already ordered oral Amoxicillin. Why do you think the Dr ordered IV antibiotic therapy? 3. If the doctor orders blood cultures, should they be drawn before or after antibiotic therapy is started? Patient B Juan Carlos The patient, Juan Carlos, has just returned after surgical debridement of a diabetic foot ulcer on his right great toe. The procedure was done under local anesthesia, and I would like to give you a report on him before I hand him over to you. Mr. Carlos is a 52-year-old Hispanic male with a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia who presented in the emergency department last night complaining of pain in a wound on his right great toe. He states he dropped a large rock on his toe several weeks ago and sustained an open wound. The pain had been increasing over the last days, and he was unable to get the pain under control. He was then admitted for surgical

debridement of what showed to be a diabetic ulcer and to receive antibiotic treatment. This morning at 0730 Mr. Carlos’s blood sugar was 225 and he received 4 units of insulin aspart, a sliding scale insulin, along with his regular medications before the surgery. It is all in the MAR. He also received his antibiotic treatment this morning as prescribed.Nursing Pharmacology Discussions

The surgery was performed under local anesthesia. He was given one tablet of oxycodone 5 mg/acetaminophen 325 mg for his pain after surgery. He now reports his pain to be 3 out of 10. He has a dressing on the toe and a right forearm IV that is saline locked. The dressing on his toe is dry and intact. He seems to be doing well, and his wife has just been here to see him. He is due for a check of blood sugar level and vital signs. The provider has just updated the orders, so please take a look at the patient chart to see all details. Answer the following questions in the corresponding discussion posting: 1. Will the patient’s high blood sugars and history of diabetes have any effect on his recovery? 2. Discuss the different types of sliding scale insulins. … Nursing Pharmacology Discussions