Pharmacology Reasoning Case Study; Susan Jones is a 42- year-old African-American female w, Exams of Nursing

Download Pharmacology Reasoning Case Study; Susan Jones is a 42- year-old African-American female w and more Exams Nursing in PDF only on Docsity! pg. 1 1 Pharmacology Reasoning Case Study Susan Jones, 42-year-old female Medication Categories Concepts Antihypertensives Perfusion NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment • Management of Care 17-23% ✓ • Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% ✓ Psychosocial Integrity 6-12% Physiological Integrity • Basic Care and Comfort 6-12% • Pharmacological and Parenteral Therapies 12-18% ✓ • Reduction of Risk Potential 9-15% ✓ • Physiological Adaptation 11-17% ✓ pg. 2 2 As the nurse responsible for this patient, you promptly review the medical history and note that she has NKDA. This is her PMH and current home medications documented in the employee’s medical record: Applying your knowledge of pharmacology, to provide safe patient care, answer the following essential information: I. Initial Presentation: Susan Jones is a 42-year-old African-American female with a past medical history of diabetes mellitus type II. She works in a manufacturing plant in her hometown. While at work, she feels faint and has to sit down. The occupational nurse is contacted to assess her. Susan Jones is married and a mother of two elementary age children. She has been employed in her current position for two years. 1. What data from the present problem are RELEVANT and must be NOTICED as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance: Profile and Medical History Occupation Feels faint and had to sit down Age, race, and medical history can predispose patient to certain health related issues It is abnormal to feel faint and feel the need to sit down while at work 1. What is the RELATIONSHIP of the past medical history and current medications? Why is your patient receiving these medications? (Which medication treats which condition? Draw lines to connect) Medical History (PMH): Home Medications: Hypertension GERD Type II diabetes mellitus ASA 81 mg PO daily HTN Lisinopril 40 mg PO daily HTN HCTZ 25 mg PO am HTN Metformin 875 mg PO BID Type II DM Omeprazole 20 mg PO daily GERD 2. List each home medication from the scenario and answer the following: (NCLEX Pharmacologic and Parenteral Therapies) Home Medication: Pharm. Class: Indication(s): Mechanism of Action In OWN WORDS: Body System Impacted Common Side Effects Nursing Assessments: ASA 81mg NSAID Salicylate Treat pain, fever, and inflammation Disrupts prodeuction of prostaglandins throughout the body Cardiovas cular Circulatory Upset stomach, heartburn Monitor for allergy or bleeding Lisinopril 40 mg ACE inhibitor Hyper tension, Inhibits angiotensin converting enzyme which Cardiovas cular Dizziness, hypotension, Orthostatic hypotension, heart failure dilates vascular smooth Circulatory headache, monitor for muscle hyperkalemi confusion HCTZ 25 mg Thiazide diuretic Hyper tension, heart failure edema Inhibits the sodium chloride co-transporter system which prevents the body from absorbing salt Renal Hypotension nausea, electrolyte imbalance Monitor for toxicity and urinary retention pg. 5 5 There has been no change in Susan’s status. She currently denies feeling lightheaded. Her husband arrives, and transports her to her primary care provider’s clinic. Situation: Name/age: Susan Jones; 42 y/o BRIEF summary of primary problem: Feeling faint, low blood pressure, diaphoretic Background: RELEVANT past medical history: DM type II, HTN, FMH - coronary artery disease RELEVANT background data: Last 6 months, stopped smoking, lost 20 Lb, and altered diet Assessment: Most recent vital signs: T: 98.4 F P: 90 RELEVANT body system nursing assessment data: R:15 RELEVANT lab values: BP: 100/70 O2 sat: 99% RA Patient response: Blood glucose: 101 INTERPRETATION of current clinical status (stable/unstable/worsening): Normal assessment findings Patient is diaphoretic Recommendation: Suggestions to advance the plan of care: Diagnostic tests for perfusion, treat patient for hypotension and fluid imbalance The Primary Care Provider Orders the Following: 5. State the rationale and expected outcomes for the medical plan of care. (Pharm. and Parenteral Therapies) Orders: Rationale: Expected Outcome: Complete blood count (CBC) Basic metabolic profile (BMP) Diagnostic test are to provide information regarding circulation, perfusion, and electrolyte/fluid imbalances Patient data will be indicative of patient condition Hgb A1c Urine analysis (UA) Urine hCG 12 lead EKG Recognizing that a problem is present, use SBAR to concisely communicate your concern to the primary care provider: pg. 6 6 Complete Blood Count (CBC) WBC HGB PLTs % Neuts Bands Current: 7.0 13.1 250 55 0 Most Recent: 8.5 12.8 225 65 0 Basic Metabolic Panel (BMP) Na K Gluc. Creat. Current: 135 3.4 105 0.9 Most Recent: 137 3.7 117 0.85 Urinalysis + UA Micro Color: Clarity: Sp. Gr. Protein Nitrite LET RBCs WBCs Bacteria Epithelial Current: dark yellow clear 1.025 neg neg neg neg neg neg neg Misc. Hgb A1c Urine hCG Current: 6.4 Neg Most Recent: 6.6 n/a 6. What lab results are RELEVANT and must be NOTICED as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential) RELEVANT Diagnostic Data: Clinical Significance: TREND: Improve/Worsening/Stable: Na+ is slightly low Indicative of hyponatremia, related to "too much" water in the body. Improving Urine color is dark yellow Urine is not being dilluted properly Stable Worsening Hgb A1c is high Indicative of diabetes III. Put it All Together to THINK Like a Nurse! 1. Interpreting all clinical data collected, what is the priority problem? What is the pathophysiology of the priority problem? (NCLEX Management of Care/Physiologic Adaptation) Priority Problem: Pathophysiology of Problem in OWN Words: Hypotension related to fluid imbalance Patient is experiencing fluid imbalance related to an issue with perfusion as shown by hypotension, dark yellow urine, and diaphoresis. 12 Lead EKG is normal sinus rhythm-rate 72. The following diagnostic test results just posted in the electronic health record: pg. 7 7 Her primary care provider decreased her BP medications to Lisinopril 20 mg and HCTZ to 12.5mg. She is scheduled for a follow up visit in two weeks. Susan Jones follows up in the clinic two weeks later. She has been taking all medications as ordered. She denies any recurrent episodes of lightheadedness and has brought her BP log with her. 2. What nursing priority (ies) and goal will guide how the nurse RESPONDS to formulate a plan of care? (NCSBN: Step 4: Generate solutions/Step 5: Take action/NCLEX Management of Care) Nursing PRIORITY: Decreased cardiac output related to fluid imbalance and history of hypertension as evidenced by hypotension, diaphoresis, anf feeling of faintness GOAL of Care: Patient will demonstrate adequate cardiac output as evidenced by blood pressure and warm, dry skin. Nursing Interventions: Rationale: Expected Outcome: Assess heart rate and blood in order to monitory response to treatment Patient data will provide data inorder to plan out baseline care Patient intake and out put will be normal and not indicative of poor perfusion or fluid imbalance. Patient will have a better understanding of medications as well as condition pressure since reduced cardiac output results in Monitor intake and output reduced perfusion of the kidneys, with a Examine laboratory data resulting decrease in urine output Assess blood pressure prior to As lab datam may be indicative of condition administration of medication Since certain medications can lower blood Teach patient to monitor for signs pressure of decreased cardiac output In order to monitor patient status Evaluation: Two Weeks Later… 1. After implementing the plan of care, EVALUATE by INTERPRETING relevant clinical data to determine if patient status is improving, declining, or reflects no change. (NCSBN: Step 6 Evaluate outcomes/NCLEX: Management of Care) Assessment Finding: Improving: Declining: No Change: Denies recurrent episodes of lightheadedness Systolic BPs the last week have been between 114-130 Diastolic BPs the last week have been between 72-80 Current BP in clinic: 134/82 Heart rate: 76 (reg) 2. Has the overall status of your patient improved, declined, or remain unchanged? If your patient has not improved, what other interventions need to be considered by the nurse? (NCSBN: Step 6 Evaluate outcomes/NCLEX: Management of Care) Overall Status: Additional Interventions to Implement: Expected Outcome: Patient status has improved, as shown by increased blood pressure and denial of reccurent episodes of lightheadedness Teach patient to assess blood pressure prior to administration of medication Teach patient to monitor for signs of decreased cardiac output Patient will have a better understanding of medications as well as condition