A patient is admitted to a medical/surgical

A patient is admitted to a medical/surgical floor on November 18th with COPD exacerbation and community acquired pneumonia. She has coronary artery disease, hypercholesterolemia, type 2 DM, and hypertension. Today’s date is November 20th Today’s labs drawn at 0400. WBC = 13,000 mm3 Platelets = 6,000 mm3 Hgb = 13.8 g/dl Hct = 41% Potassium = 2.6 mEq/L Glucose = 185 mg/dl Vital Signs at 0700 today: b/p 156/75, HR 50, respirations 16, temp 98.5 po, SpO2 93% Today’s weight 60 kg The following is the patient’s MAR for 72 hours. Image transcription text Name: Jane Doe MR# 0003487229 DOB: January 1, 1940 Allergies: Morphine Start Stop Medication Scheduled 11/1… Show more Image transcription text 11/18 Simvastatin 20 mg PO daily 2100 Given Given 11/19 Methylprednisolone succinate 0800 Given 20 mg IV BID 2000 … Show more It is currently 0800….. 1. What additional assessment data and information would the nurse want to obtain for this patient before administering medications? 2. Which medications would the nurse administer? Why? 3. Which medications would the nurse hold? Why? 4. Would the nurse need to contact the primary care provider for any reason? Explain. 5. What other medication(s) would the nurse expect this patient to be prescribed for COPD exacerbation? 6. What type of medication is Levofloxacin? Why is the patient receiving this medication? At 1400 the patient complains of increased shortness of breath, palpitations, and chest pain. The patient is alert and oriented x3. Extremely anxious. Respirations are labored and she has expiratory wheezes throughout bilaterally. Vital signs are: b/p 178/95, HR 145, respirations 24, temp 97.0 orally, SaO2 80%. Accucheck 189 12 lead EKG reveals Atrial Fibrillation with a heart rate of 145 and an acute myocardial infarction. 7. What medications available on the MAR would the nurse consider administering at this time? Why? 8. Can the nurse safely administer these medications? Why? 9. What priority actions would the nurse take at this time? 10. What new medication orders would then nurse expect to receive for this patient? Why? 11. What would the nurse evaluate before and after administration of the new medications? 12. What medications would the nurse expect to be discontinued? Why? The patient has been in the hospital 2 weeks and is now ready to discharge home. She will be discharged home on the following medications: Lisinopril 20 mg PO daily Metformin 1000 mg PO BID Insulin Lispro SubQ Sliding Scale at home before meals (sliding scale is the same as on above MAR) Methylprednisolone 10 mg PO daily Budesonide/formotorol 160/4.5 mcg/spray MDI 2 puffs BID Simvastatin 20 mg PO daily Amiodarone 200 mg PO daily Apixaban 5 mg PO BID 13. Which medications on the discharge list above are new medications for this patient? Started after her episode of SOA and new dysrhythmia on 11/20. 14. Why were these new medications started? 15. List 5 priority patient education instructions the nurse will discuss with the patient regarding her medications before discharge. 1. 2. 3. 4. 5. 16. The patient is concerned that she will be taking insulin when she did not take this medication prior to admission. What explanation could the nurse offer the patient about why she is now taking insulin? SCIENCE HEALTH SCIENCE NURSING NURS 429

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