Case Study Mr. O’Brien is admitted withprescriptions that include assessment of orthostatic
vital signs every shift and fall precautions. The nurse explains toMr. O’Brien how
to use the call light and instructs him to call before getting outof bed so that
someone can assist him with ambulation. The nurse completes a setof orthostatic
vital signs. His orthostatic vital signs are lying: BP 5 120/84,heart rate (HR) 5 73;
sitting: BP 5 114/73, HR 5 83; standing: BP 5 96/61, HR 5 92. Whenthe
assessment of orthostatics is complete, Mr. O’Brien is settled inbed. The nurse
raises two side rails at the head of the bed, and the bed alarm isturned on so that if
Mr. O’Brien tries to get out of bed without assistance, an alarmwill notify staff.
His BP is 110/62, HR is 88, and respiratory rate (RR) is 16. Mr.O’Brien was assisted back to bed with a Hoyer lift and two assists.His vital signs remained within his baseline throughout theremainder of the shift and he is afebrile. An X-ray of his righthip was negative for a fracture. There is no physical deformity ofthe right hip or other injuries apparent, but a moderate amount ofecchymosis of his right hip that extends around to his lower backand right upper buttock is noted. His health care provider, Dr.Sutton, prescribed one tablet of oxycodone/acetaminophen 5/325 bymouth (PO) that decreased Mr. O’Brien’s pain to a “2/10” within 45minutes.
At the end of the nurse reporting the incident the physician asksthe nurse to resume all home medications.
While reviewing the incident with the charge nurse, the nurserealizes that the patient has home medications that might have beenordered
incorrectly and that one particular medication mightbe contributing to the patient’s symptoms. With a background ofpharmacology and current
chapters covered in class, please answer the followingquestions.
Questions & care Plan
1. In the setting of the recent fall and A-Fib what recommendationswill the nurse make to the practitioner regarding the patient’smedications. (Review effects and side effects of medications toguide your answers).
2. What is one emergent situation that could have resulted from thefall: explain.
3. What is one urgent situation that could have resulted from thefall: explain.
4. What test(s) will the health care provider most likely prescribefor the next day as part of Mr. O’Brien plan of care?Explain.
5. Next day INR test reveals a value of 3.5. After speaking to thephysician and made your recommendations, the physician give you anorder for a new medication to treat the INR. Write a care plan onthe management of this situation: Assessment; Diagnosis and Relatedto; give three Outcome identifications/Planning (remember to usemore than medications in all nursing care plans.
6. List all medications in this case study. Give their effects,side effects, and any special administration to be noted, ifany.
