Answered step-by-stepMedication Grid: Include all scheduled
Answered step-by-stepMedication Grid: Include all scheduled medications and any PRNs…Medication Grid: Include all scheduled medications and any PRNs given during your shift. This includes continuous infusions. Add rows as needed. Generic/Trade Name:Drug class:Dose/Route/Frequency: Why is your patient receiving it? What assessments are required to determine if it is safe to give this medication?*Provide actual patient assessment data/values List the priority nursing considerations for this medication (ex: side effects, drug interactions, administration, etc.) How do you know the medication is effective? Must be measurable.*Provide actual patient assessment data/valuesPotassium chlorideElectrolyte30ml feeding tube PRN Low potassium levels Pt. recent mg level 2mg/dlNo dysrhythmias You should not use this medicine if you have high levels of potassium in your blood (hyperkalemia), or if you also take a “potassium-sparing” diuretic Not effective currently Pt. potassium level is low at 3.4mmol/l.Dexmedetomidine hydrochloride/ Precedex 400 mCg + Sodium Chloride 0.9% 100 mL Sedation,intubation No known drug allergies, no signs of respiratory depression BIS index between 40-60 Monitor for slowed breathing; slow or irregular heartbeats, monitor blood pressure, dry mouth, nausea,fever dizziness. Pt. remained adequately sedated during intubationFentanyl /Duragesic Potent synthetic opiate agonist2,500 mCg + Sodium Chloride 0.9% 250 mL10ml/h The management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate No known drug allergies,no signs of respiratory depression Monitor for hypersensitivity or known intolerance to this drug. Severe respiratory depression, severe obstructive lung conditions Pt. Pain score of 0/10Folic acid/FolviteVitamin supplement1mg orogastric tube tablet daily Pt. RBC count is low , which signifies anemia No known allergies RBC blood test: 2.40 million/cumm Monitor for hypersensitivity to any of the ingredients. GI disturbances,bromchospams This medication is not effective because the Pt. anemia is not controlled Current RBC: 2.3million/cummHeparin/Hepaleananticoagulant5,000 units SUBQ , injection q8h Management of venous thrombosis This medication is safe for a patient who are at risk of venous thrombosis The most common adverse reaction was hemorrhage. This medication is termed effective when it is used to manage venous thrombosis and gives a positive patient feedback.Insulin NPHRecombinant Human Insulin 16 units,subcutaneous injection Q6H Management of diabetes No signs of hypoglycemiaPt.Glucose :120mg/dl Monitor blood glucose levels every hour. Insulin can cause redness of the eyes or itching on the injection site Pt. blood sugar is controlled (below 150) Lactulose/Constulose Osmotic cathartic30ml/orally/TID Management of hepatic encephalopathySerum ammonia level : 83mCml/l (High) This medication is safe for patients assessed and diagnosed with abdominal distention or mental illness. Monitor for diarrhea , which is an indication of overdose. Severe diarrhea may lead to hypovolemia, hypokalemia, and hypernatremia, especially in elderly or acutely ill patients. If diarrhea develops, the dosage should be reduced When the patient ammonia level concerning hepatic encephalopathy is positive, then we can say that the medication was effective.Lansoprazole/PrevacidProton Pump inhibitor10ml/orally/Daily Prevent stress ulcers This medication is safe for the patients diagnosed with too much acid in the stomach. No hypersensitivity. Monitor for abdominal pain, benign fundic gland polyps, constipation, diarrhea, dry mouth, flatulence, nausea, stomachache, vomiting Absence of any stress ulcersLevocarnitine/CarnitorNeutraceutical20ml/orally/BID Carnite defiency A patient with low level of carnitine is safe to use Levocarnitine Hypersensitivity to any of the ingredients This medication is essential and effective when controlling carnitine deficiency and hence, a patients’ positive feedback shows its effectiveness.Melatonin/Advanced Sleep Melatonin3mg/orally/at bedtime daily Regulate sleep and wake cycle A patient with issues of depression and fatigue are safe to use Melatonin. Possible side effects includes ; daytime drowsiness depressed mood, feeling irritable,stomach pain, headache,or dizziness During assessment pt. was agitated and irritable . Medication did not effectively work.Piperacillin-tazobactam/Zosyncombination penicillin antibiotic3.375 GM/IVPB injection/Q8H12.5ml/hr/infuse over 4H Treat infection No known allergiesPrevious WBC : 23.3 piperacillin or any other penicillin antibiotic hould not use if allergic to Current WBC: 17.6Rifaximin/XifaxanSemisynthetic, nonsystemic rifamycin antibacterial agent550mg/orally/BID Hepatic encephalopathy used to maintain long-term remission from pt. diagnosis of hepatic encephalopathy peripheral edema, nausea, dizziness, fatigue, and ascites The effectiveness is seen through positive feedback on hepatic encephalopathy.33Acetaminophen/TylenolAnalgesic650mg/orally/Q8H/ PRN Mild pain and fever NKANo concurrent use of anti-coagulants.Renal dysfunction present: Hx acute liver failure, BUN = 46, Creatinine = 2.55 Monitor renal functioning tests and I/O. Overdose side effects: N/V/D, stomach pain/swelling/tenderness. Decrease in pain 0/10Magnesium sulfate/Magnesium Sulfate-Sodium Chlorideanticonvulsant2GM/IVPB infusion/PRN Treat low magnesium level No signs of respiratory depression, abnormal potassium level is being treated as well Hypersensitivity reactionsIrritation and pain at the injection site Pt. Mg level : 2mg/dlMidazolam/Short-acting benzodiazepine2mg,IV Push injection/Q30min/PRN Treat anxiety /agitation Make sure you have oxygen and resuscitation equipment ready in case of severe respiratory depression before delivering the medication. Patient reaction to medicine and amount of drowsiness should be monitored and recorded. Extravasation should be constantly monitored at the location. Keep an eye out for any negative responses. Midazolam can slow or stop your breathing, especially if you have recently used an opioid medication, alcohol, or other drugs that can slow your breathing The effectiveness is seen in the management of anxiety in a patient.Norepinephrine/LevophedVasopressor 6.9973 mCg/min IV Injection13.12ml/hr Hypotension Pt. Hymodynamic status at 8amBP : 95/65HR/Rhythm : 89/NSRRR: 18SAT:96Urine output: 50ml Serious side effect such as a cold feeling anywhere in your body, blue lips or fingernails, trouble breathing, little or no urination, irritation or skin changes where the medicine was injected, slow heart rate, sudden numbness or weakness, severe headache, or problems with vision, speech, or balance Pt. Hymodynamic status at 1pmBP: 100/66HR/Rhythm:69/NSRRR:22SAT:96Urine output : 100ml Lab/Diagnostic Grid: List all current labs and relevant diagnostic tests performed during this hospitalization. If not completed for your patient, grey out the row. Add more rows as needed.Lab/Diagnostic Test(Use Pagana Diagnostic & Lab Test Reference) Current Result (indicate if High, Low, or Normal) Most Recent Result (indicate if High, Low, or Normal) Rationale (for any abnormal result include what the test measures and why it might be abnormal for your patient Include citation)CBC/HematologyWBC (H) 17.6 (H) 23.3 An increase WBC count “usually indicates infection, inflammation, tissue necrosis, or leukemic neoplasia.” (Pagana & Pagana, 2012, pg. 974). Dr stated that this is because of recent surgery.RBC (L) 2.3 (L) 2.40 Measures the number of circulating red blood cells. Routinely performed as part of a CBC. Normal values vary with gender and age. When values are low the patient is said to be anemic. Anemia is caused by decreased bone marrow production, increased blood loss, or increased red blood cell destruction (Pagana & Pagana, 2012, pg.396 ).Neut. % Hgb (L) 7.1 (L )7.5 Part of CBC. Measures total hemoglobin in blood; also indirect measurement of RBC count. Decreased hgb could indicate anemia. Increased hgb could indicate erythrocytosis. (Pagana & Pagana, 2012, pg. 252).Hct (L )22.9 (L )24.5 Part of CBC. Indirect measurement of RBC number and volume. Decreased hct may result from an increased plasma volume (hemodilution) or from reduced red blood cell volume (true anemia) (Pagana & Pagana, 2012, pg.249). Platelets (N )242 (N) 220 PT/INR (H) 17.4 /(H) 1.49 (H) 18.4/(H) 1.60 A prolonged PT/INR means that the blood is taking too long to form a clot. This may be caused by conditions such as liver disease, vitamin K deficiency, or a coagulation factor deficiency (Pagana & Pagana, 2012,pg.934) APTT Electrolytes/Renal/LiverNa (N) 137 (N)136 K (L) 3.4 (N) 3.7 Routine lab evaluation; part of serum electrolytes package. Evaluates fluid and electrolyte balance. Measures potassium in blood. Decreased potassium could be a side-effect of insulin, trauma, increased renal excretion. (Pagana & Pagana, 2012, pg. 370)Cl (H) 110 (H) 113 Routine lab evaluation; part of serum electrolytes package. Evaluates fluid and electrolyte balance. Measures chloride in blood. Increased chloride could indicate an electrolyte disorder such as metabolic acidosis or respiratory alkalosis. (Pagana & Pagana, 2012, pg.137)Phos Calcium (L) 7.8 Routine lab evaluation; part of serum electrolytes package. Measures total amount of calcium in blood; important for renal failure monitoring.Decreased calcium levels could indicate vitamin D deficiency, malabsorption, fat embolism, or hypothyroidism. (Pagana & Pagana, 2018, page 122)BUN (H) 46 (H) 47 Routine lab evaluation. Measures renal function and GFR. Interpreted with creatine in renal function studies. Directly affected by patient’s kidneys not being able to remove urea from the blood, which increases BUN levels. (Pagana & Pagana, 2012, pg.454) Creatinine (H) 2.55 (H)2.68 Routine lab evaluation. Measures creatinine in blood. Interpreted with BUN levels in renal function studies. Complication from the patient’s condition of Acute liver failure, which would increase creatinine levels. This level indicates severe renal impairment. (Pagana & Pagana, 2012, pg.172)Glucose (H) 142 (H) 120 Routine lab evaluation for diabetic patients. Measures glucose in blood. Stress and infection could increase glucose levels. (Pagana & Pagana, 2012, pg. 229)Protein (L) 6.1 Albumin (L) 1.6 Hypoalbuminemia is thought to result mainly from malnutrition, inflammation and cachexia (Pagana & Pagana, 2012).ALT (N) 37 AST (H) 92 This test is used in the evaluation of suspected hepatocellular diseases. Disease that affect the hepatocytes cause elevated levels of this enzyme. In Acute liver failure, AST level can rise to 20 times the normal value(Pagana & Pagana, 2012, pg.122).Amylase Lipase Other Labs (ex: lipids, cultures, UA) *May add rows as neededLactic acid (H) 3 When there is enough oxygen, cells produce CO2 and H2O. But when oxygen level is low, cells produce lactic acid (Pagana & Pagana, 2012, pg. 551). This lab was done as Pt. developed hypoxia and O2 sats was less then 80%Ammonia (H) 83 Ammonia is used to support the diagnosis of severe liver diseases. Also used in diagnosis and follow up of hepatic encephalopathy. With severe hepatocellular dysfunction, ammonia cannot reach the liver to be catabolized. So the ammonia levels in the blood rises(Pagana & Pagana,2012, pg.43).Diagnostic Tests (ex: x-rays, CT, MRI, scope procedures, echo, etc.) *May add rows as neededName of Diagnostic Test Findings Purpose of TestEKG Sinus Tachycardia previous . Currently Normal sinus Rhythm EKG is graphical representation of the heart electrical impulses and help identify any abnormal heart rhythms (Pagana & Pagana, 2012, pg. 342-344).Chest X-Ray Bilateral infiltrates Complete evaluation of the pulmonary and cardiac systems. Much information can be provided by CXR images(Pagana & Pagana, 2012, pg.229). Clinical Reasoning Case Study paper IntroductionClinical reasoning is defined as a process in which a clinician or nurse gathers and processes information and signs about a patient, develops a clear understanding of the issue or problem the patient is facing, establishes and implements interventions, evaluates the outcomes, and then reflects on and learns from the process ( ). As a result, nurses must ensure that patient information is effectively utilized in order to promote patient-centered care. Mrs. T.K, a woman diagnosed with Acute liver failure, Hepatic encephalopathy, and Hypoxic respiratory failure, will be discussed in this paper, as well as how she is managed in the hospital through proper clinical reasoning. Patient’s Diagnosis/Pathophysiology and Health HistoryMs. T.K. is a 40-50-year-old African American female who was discharged on February 1st after being admitted for chronic pancreatitis flare and alcohol hepatitis. She was given steroids and was told to come back in a week for a checkup. Unfortunately, when she returned home not long after, her family realized that she was becoming more disoriented, and they found her going outside to stroll in the cold without any pants on, so they called 911 and she was taken to the emergency department. She was found to be hypoxic, requiring 4 liters of oxygen, afebrile, with a white blood cell count of 18 K/cumm, potassium 2.2 mmol/L, and magnesium 1.4 mmol/L on presentation. An x-ray of the chest revealed bilateral infiltrates. On the 10th of February, she was admitted for additional evaluation, and was found to have a diagnosis of acute liver failure, hepatic encephalopathy, and hypoxic lung failure. Acute liver failure (ALF) is a potentially fatal condition marked by acute and sudden liver cell malfunction, coagulopathy, and hepatic encephalopathy (Urden et al., 2022, p.715). ALF is connected with a 40% death rate and usually arises in patients who have no prior liver illness. It’s marked by a loss of synthetic function manifested as jaundice and coagulopathy, as well as the onset of hepatic encephalopathy. Multiorgan failure (MOF) develops over time, finally leading to death (Dong). Hepatic encephalopathy is thought to be caused by the liver’s failure to metabolize numerous compounds in the blood, and it can be exacerbated by metabolic and electrolyte abnormalities (Urden et al., 2022, p.715). Confusion, difficulty concentrating, and easy agitation are all symptoms of this condition, which affects brain function (harding). Lastly, acute lung failure (ALF) is a clinical condition in which the pulmonary system fails to maintain adequate gas exchange. The most prevalent type of organ failure encountered in the intensive care unit is this one (Urden et al., 2022, p.466). Hypoxemic lung failure occurs when there is insufficient oxygen in the circulation, but carbon dioxide levels are near to normal. On February 23rd, I had the pleasure of working with patient T.K. Her admissions chief complaint and diagnosis grabbed my attention, and I began to investigate the clinical reasoning behind the underlying issues. Ms. T.K. has a medical history that includes altered mental status, hypokalemia, chronic pancreatitis aggravated by pancreatic insufficiency and pancreatic pseudocyst, alcoholic hepatitis, alcohol use disorder, hypertension, tobacco smoker, and hepatic encephalopathy, but no prior surgical history. The Interconnectedness of Diagnosis, Pathophysiology, and Health HistoryMrs. T.K.’s clinical symptoms include confusion, disorientation, and the difficulty to walk outside in the cold without wearing apparel. Acute liver failure, hepatic encephalopathy, and hypoxic respiratory failure, among other diseases, are linked to these symptoms. Mrs. T.K. has a white blood cell count of 18 K/cumm, a potassium level of 2.2 mmol/L, and a magnesium level of 1.4 mmol/L, all of which are signs of her current condition. The patient’s medical history indicates that her current state is the result of her chronic pancreatitis and previous severe alcohol intake. The patient was released about a week after being admitted to the hospital for a flare-up of pancreatitis and alcohol-induced liver damage.Unfortunately, when she returned home, her symptoms became more severe, leading her family to call 911 and have her sent to the emergency room. The patient was taken to the hospital to be monitored. She had infiltrates on both sides of her lungs on her chest x-ray.She was diagnosed with acute liver failure, hepatic encephalopathy, and hypoxic lung failure, all of which were life-threatening conditions. The patient’s clinical presentation is in line with the diagnosis she was given. Her hypoxia is a result of her respiratory failure, and her elevated white blood cell count implies infection (Pagana & Pagana, 2012, pg. 974). The liver’s inability to adequately metabolize a high number of substances in the blood results in electrolyte imbalances, which cause potassium and magnesium abnormalities. Finally, according to the findings, the bilateral infiltrates on the chest x-ray are suggestive of ALF.Health ScienceScienceNursingNURS 474Share
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