Case study:
Mr. James McDougal, age 68 years old was admitted on July1st, 2020 with a diagnosis of congestive heart failure,diabetes type 2, hyperlipidemia, hypertension, and cellulitis ofhis left calf. A central line was placed based on Mr. McDougal’spoor 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 telemetryfloor 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 centralline
- Augmentin 500 mg po q 8 hours, begin first dose at 8 am
- Tubersol 0.1 ml intradermal stat with reverse isolation untilnegative
- 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 4hours
- Oxycodone 325 mg po Q 4 hours as needed for mild to moderatepain q 6 hours
- Tylenol 650 mg po Q 4 hours for temperature above 100.4degrees
- Fasting blood sugar AC and HS, Sliding scale with regularinsulin for coverage as below:
- Humulin R insulin sq.; based on ac/hs blood glucose level asfollows:
- 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
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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 |
Assessment:
Mr. McDougal is admitted at 0730 to the Telemetry floor. You arehis 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 centralline which was placed in the Emergency department has no label.There is a normal saline IV infusing at 125 cc/hour in anantecubital line that was placed by the ambulance squad. His calfdressing is intact with serous drainage noted. He notes that hechanged it himself 3 days ago. The nursing assistant has performedhis morning blood glucose and reports it as 350 mg/dl. He has beenplaced in a reverse isolation room as ordered. His breakfast trayhas been placed at the bedside. Please follow through with thephysician’s orders based on this assessment.
Your responsibility is to take the doctor’s orders andfill out the downtime medication record (attached) for the patients8 am and 10 am medications and dressing changes.
that was the case study given
now look at the question to answer
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Checked accuracy and completeness of medication order (Check MARwith prescribers order) the medication is morphine |
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Assessed patient’s medical and medication history includinghistory of allergies |
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Determined compatibility of medication with othermedications |
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Verify medication with MAR minimum three times. Barcode Scanningnot considered a medication check. morphine is the medication |
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Discussed purpose of medication, action, and possible adverseeffects. |
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Perform appropriate nursing assessment and/or interventions thatare 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 usingappropriate landmarks and demonstrate technique. |
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Utilize Barcode Scanning Technology Prior to MedicationAdministration Correctly. |
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Administration oral or injectablemedication at appropriate site with gloves and using aseptictechnique
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Document administration of medication in EHR appropriately aftermedication administration to patient. (Including I&O sheet ifapplicable) |
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Proper hand hygiene, sterile technique and PPE used throughoutthe skill |
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Discuss how to evaluate the patient’s response to themedication. What is the appropriate time frame such evaluation. |
stop being lazy thats the right question
