Case study:
Mr. James McDougal, age 68 years old was admitted on July 1st, 2020 with a diagnosis of congestive heart failure, diabetes type 2, hyperlipidemia, hypertension, and cellulitis of his left calf. A central line was placed based on Mr. McDougal’s poor vascular status.
Current Medications: Allergies:
Aspirin 325 mg po daily Penicillin & Sulfa
Digoxin (Lanoxin®) 0.125 mg po daily
Carvedilol (Coreg®) 25 mg bid
Furosemide (Lasix®) 40 mg bid
Lisinopril (Zestril®) 5 mg po bid
Simvastatin (Zocor®) 40 mg qhs
Glyburide (Micronase®) 2.5 mg daily
The physician orders are as follows:
- Admit patient to service of Dr. Monka and cardiac telemetry floor for cardiac monitoring.
- Out of bed with assistance
- Oxygen via nasal canula @ 2 L
- 2000-gram ADA diet
- Central line dressing as per hospital protocol
- Lactated Ringers 1000 cc to run over 8 hours via central line
- Augmentin 500 mg po q 8 hours, begin first dose at 8 am
- Tubersol 0.1 ml intradermal stat with reverse isolation until negative
- Wound care consult- sterile dressings to left calf daily
- CBC and Troponin level- call results to Dr. Monka
- Morphine 5 mg IM for as needed moderate to severe pain every 4 hours
- Oxycodone 325 mg po Q 4 hours as needed for mild to moderate pain q 6 hours
- Tylenol 650 mg po Q 4 hours for temperature above 100.4 degrees
- Fasting blood sugar AC and HS, Sliding scale with regular insulin for coverage as below:
- Humulin R insulin sq.; based on ac/hs blood glucose level as follows:
- glucose level 0-200 = 0 units
- glucose level 201-300 = 2 units
- glucose level 301- 400 = 4 units
- glucose level > 400 = call physician
Begin Home Medications as follows:
Aspirin 325 mg po QD
Digoxin (Lanoxin®) 0.125 mg po daily
Furosemide (Lasix®) 80 mg IV bid
Carvedilol (Coreg®) 25 mg bid
Glyburide (Micronase®) 2.5 mg po q am with breakfast
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Assessment:
Mr. McDougal is admitted at 0730 to the Telemetry floor. You are his admitting nurse. His vital signs are BP 140/80, Pulse 89, respirations 22, O2 saturation 89% on room air, temperature 101.8. Mr. McDougal reports his pain an 8 on a scale of 0-10. His central line which was placed in the Emergency department has no label. There is a normal saline IV infusing at 125 cc/hour in an antecubital line that was placed by the ambulance squad. His calf dressing is intact with serous drainage noted. He notes that he changed it himself 3 days ago. The nursing assistant has performed his morning blood glucose and reports it as 350 mg/dl. He has been placed in a reverse isolation room as ordered. His breakfast tray has been placed at the bedside. Please follow through with the physician’s orders based on this assessment.
Your responsibility is to take the doctor’s orders and fill out the downtime medication record (attached) for the patients 8 am and 10 am medications and dressing changes.
that was the case study given
now look at the question to answer
Checked accuracy and completeness of medication order (Check MAR with prescribers order)
the medication is morphine
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Assessed patient’s medical and medication history including history of allergies
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Determined compatibility of medication with other medications
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Verify medication with MAR minimum three times. Barcode Scanning not considered a medication check.
morphine is the medication
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Discussed purpose of medication, action, and possible adverse effects.
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Perform appropriate nursing assessment and/or interventions that are a prerequisite to administering the medication (Apical, BP)
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If medication is oral, position patient correctly.
If medication parenteral. Identify correct site using appropriate landmarks and demonstrate technique.
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Utilize Barcode Scanning Technology Prior to Medication Administration Correctly.
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Administration oral or injectable medication at appropriate site with gloves and using aseptic technique
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Document administration of medication in EHR appropriately after medication administration to patient. (Including I&O sheet if applicable)
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Proper hand hygiene, sterile technique and PPE used throughout the skill
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Discuss how to evaluate the patient’s response to the medication. What is the appropriate time frame such evaluation.
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stop being lazy thats the right question
Your answer
Typed answers are easier for students to read than handwritten notes
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