Narcotics or Sepsis?
Pharmacology Clinical Reasoning Case Study
Brian Sanders, 34 years old
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory 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% ✓
, History of Present Problem:
Brian Sanders is a 34-year-old male who was evaluated in the emergency department (ED) earlier this morning for an
abscess that was drained from his left thigh. He was given two tablets of hydrocodone-acetaminophen 5-325 mg and sent
home with a prescription for #10 hydrocodone-acetaminophen 5-325 mg tablets to be taken PRN for pain every 4 hours.
Eight hours after being discharged from the ED, his mother became concerned and called 911 because he was more
lethargic and she had difficulty arousing him. The paramedics who brought him to the ED report that he took his scheduled
alprazolam 0.5 mg PO after returning home from the ED. He arouses and opens his eyes to loud verbal commands, but
falls back to sleep several seconds later. His last set of vital signs per paramedics were:
• P: 50 regular
• R:16 regular
• BP: 92/50-MAP 64
• O2 sat: 98% on room air
Personal/Social History:
Brian is currently unemployed and lives with his parents. He has struggled with bipolar depression, anxiety,
schizoaffective disorder and ETOH abuse in the past but denies current ETOH use.
Allergies:
NKDA
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
• Abscess of left thigh, drained • Abscess could result at risk for infection.
• Given Hydrocodone-Acetaminophen 5- • Opioid pain medicine
325 mg
• Sent home after medication administration • No nursing monitoring
• New order:#10Hydrocodone-
Acetaminophen 5-325 mg to be taken
• Patient is to control medication administration
PRN q4 hrs
• 8 hours after discharge, new symptoms
• Time frame when new symptoms developed
• Lethargic and difficulty arousing
• Impaired cognitive function
• Blood pressure and pulse are low
• CV system/ cardiac function is affected
• Took Alprazolam after returning home
• Use of benzodiazepines and opioids together is not
recommended. Could result in profound sedation,
respiratory depression, coma and even death.
RELEVANT Data from Social History: Clinical Significance:
• Bipolar disorder, anxiety and schizophrenia • Some people with mental health disorders misuse drugs to
diagnosis. get high or to self-medicate; Can have severe mood
swings
• ETOH abuse • The use of ETOH with opioids, antipsychotics can cause
extreme side effects.
• Unemployed, lives with parents • May affect mood, mental health
What is the RELATIONSHIP of the past medical history and current medications? Why is your patient receiving these
Pharmacology Clinical Reasoning Case Study
Brian Sanders, 34 years old
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory 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% ✓
, History of Present Problem:
Brian Sanders is a 34-year-old male who was evaluated in the emergency department (ED) earlier this morning for an
abscess that was drained from his left thigh. He was given two tablets of hydrocodone-acetaminophen 5-325 mg and sent
home with a prescription for #10 hydrocodone-acetaminophen 5-325 mg tablets to be taken PRN for pain every 4 hours.
Eight hours after being discharged from the ED, his mother became concerned and called 911 because he was more
lethargic and she had difficulty arousing him. The paramedics who brought him to the ED report that he took his scheduled
alprazolam 0.5 mg PO after returning home from the ED. He arouses and opens his eyes to loud verbal commands, but
falls back to sleep several seconds later. His last set of vital signs per paramedics were:
• P: 50 regular
• R:16 regular
• BP: 92/50-MAP 64
• O2 sat: 98% on room air
Personal/Social History:
Brian is currently unemployed and lives with his parents. He has struggled with bipolar depression, anxiety,
schizoaffective disorder and ETOH abuse in the past but denies current ETOH use.
Allergies:
NKDA
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
• Abscess of left thigh, drained • Abscess could result at risk for infection.
• Given Hydrocodone-Acetaminophen 5- • Opioid pain medicine
325 mg
• Sent home after medication administration • No nursing monitoring
• New order:#10Hydrocodone-
Acetaminophen 5-325 mg to be taken
• Patient is to control medication administration
PRN q4 hrs
• 8 hours after discharge, new symptoms
• Time frame when new symptoms developed
• Lethargic and difficulty arousing
• Impaired cognitive function
• Blood pressure and pulse are low
• CV system/ cardiac function is affected
• Took Alprazolam after returning home
• Use of benzodiazepines and opioids together is not
recommended. Could result in profound sedation,
respiratory depression, coma and even death.
RELEVANT Data from Social History: Clinical Significance:
• Bipolar disorder, anxiety and schizophrenia • Some people with mental health disorders misuse drugs to
diagnosis. get high or to self-medicate; Can have severe mood
swings
• ETOH abuse • The use of ETOH with opioids, antipsychotics can cause
extreme side effects.
• Unemployed, lives with parents • May affect mood, mental health
What is the RELATIONSHIP of the past medical history and current medications? Why is your patient receiving these
