Oral and Parenteral Medication Administration

What clinical data do you NOTICE that is RELEVANT and why is it clinically significant? (Reduction of Risk Potential/Health Promotion and Maintenance) RELEVANT VS Data: Clinical Significance: TREND: RR: 24 BP: 142/76 O2: 93% on 4LT NC RR has slightly improved from initial (28) but is still elevated which causes stress on the heart BP is improved from original (172/88) but us still unresolved Likely putting stress on the heart PT maintains good O2 stat with supplementary O2 admin, Limits stress on the heart Slight improvement from ambulance stats, no improv. from ED admission Improvement Improvement RELEVANT Assessment Data: Clinical Significance: TREND: Coarse Crackles in base bilateral lung sounds +2 pitting edema There is fluid in the lungs, lungs cannot take in enough O2 This is an indicator of fluid retention r/t heart failure No improvement No change 1. INTERPRETING relevant clinical data, what is the primary problem? What primary health-related concept(s) does this problem represent? (Management of Care/Physiologic Adaptation) Problem: Pathophysiology of Problem in OWN Words: Primary Concept(s): Heart Failure . Heart failure is when the heart is no longer able to pump blood efficiently enough to sustain the pt metabolic needs. Impaired gas exchange Fluid volume excess 3 2. What nursing priority(ies) will guide your plan of care that determines how you decide to RESPOND? (Management of Care) PRIORITY Nursing Interventions: Rationale: Expected Outcome: Rapid and shallow breathing patterns negatively Assess pts respiratory rate, depth, and effect gas exchange due to hypoventilation effort as well as use of accessory muscles, nasal flaring, and abdominal This may alert the nurse if a potential airway breathing patterns obstruction as well as condition of the fluids in lungs Auscultate breath sounds Q2 hrs and POX if not continuous Decreased RR condition will cause PaCo2 to increase which is a sign of resp acidosis and Monitor ABGs hypoxemia. There is no sign of rapid shallow breathing or use of accessory muscles Lung sounds will be improving Pts ABG results will be within the expected limits Medical Management: Admission Medication Orders Care Provider Orders: Mechanism of Action: Expected Outcome: Administer the following home medications: Atorvastatin 40 mg PO daily -Inhibits HMG-CoA reductase and cholesterol synthes in the liver as well as enhancing LDL uptake and breakdown by increasing the number of LDL receptor On the liver in order to reduce plasma. is -Plasma will be reduced s Metoprolol 50 mg PO BID -Decreases cardiac excitability, cardiac output, and Myocardial oxygen demand by inhibiting beta-receptor Sites stimulation. -BP will most likely decrease Levothyroxine 112 mcg PO daily -Replaces endogenous thyroid hormone -Cellular oxidation rate will increase New order: Heparin 5000 units subq. BID -Inhibits factor Xa and prevents conversion of Prothrombin to thrombin which is needed for fibrin Conversion and w/o that clots can’t form. -blood clot formation will be prevented Medication Administration 1. Identify the “rights” of safe medication administration? 2. Identify essential steps the nurse must implement to safely administer ORAL medications in practice? (Management of Care) 3. What essential teaching will the nurse reinforce about these medications? (Health Promotion and Maintenance) Medications: Patient Education: Atorvastatin 40 mg PO daily Metoprolol 50 mg PO BID Levothyroxine 112 mcg PO daily New order: Heparin 5000 units subq. BID Emphasize this is a adjunt, not supplement for low-cholesterol diet, take at same time each day and take any missed doses as soon as possible, Notify provider if you experience unexplained muscle pain, tenderness, or weakness, esp w/ fatigue or fever, pt with diabetes should monitor blood glucose levels closely Take at the same time every day with food, Notify provider if pulse rate falls below 60bpm, pts w/ diabetes should check glucose often during therapy, do not stop drug abruptly Replaces a hormone normally produced by thyroid and will likely need to take for life, take at least 30 mins before breakfast, take with a full glass of water, separate antiacids and calcium or iron supps by at least 4 hours from drug, may require a few weeks to take effect, notify provider if hives or rash develop, notify provider if experiencing signs of hyperthyroidism (chest pain, diarrhea, excessive sweating, fever, headache, etc.), Cannot be taken orally, increased risk of bleeding avoid aspirin and ibuprofen, report any adverse effects. Evaluation: Two Hours Later… 1. What data do you NOTICE as RELEVANT and why is it clinically significant? (Reduction of Risk Potential/Health Promotion and Maintenance) 2. Has the status improved or not as expected to this point? Does your nursing priority or plan of care need to be modified in any way after this evaluation assessment? (Management of Care, Physiological Adaptation) Evaluation of Current Status: Modifications to Current Plan of Care: Client condition is worsening Change all assessmnets to Q2hr, ensure pt is on continuous POX Medical Management: New Orders from Primary Care Provider Care Provider Orders: Rationale/Mechanism of Action: Expected Outcome: Furosemide 40 mg IV BID Place on high flow n/c if unable to maintain O2 sat 92% on 6 liters n/c stops the loop of henle from absorbing sodium and Chloride bulls fluid out of the body and reduce BP What clinical data do you NOTICE that is RELEVANT and why is it clinically significant? (Reduction of Risk Potential/Health Promotion and Maintenance) RELEVANT Data: Clinical Significance: IV is moist, cool to touch w/ fluid leaking at insertion site when flushed Clients IV is most likely infiltrated