Nurses Notes: 0900: The client was brought

Nurses Notes: 0900: The client was brought to the ED by his partner this morning due to sharp abdominal pain. The partner reports the pain began aprx. 24 hours before presentation to the ED, and has gotten steadily worse during this time. The client has no history of past hospitalizations. The client has a medical history of asthma and seasonal allergies. Vital Signs: 98.8 Degrees F, P 104, RR 22, BP 110/60. Upon assessment, the client appears to be in pain and is grimacing. Breathing appears regular and no crackles/wheezes are noted upon auscultation. Skin is mildly warm to the touch. No diaphoresis noted. Bilateral pedal pulses are strong and regular. Cient is alert and oriented to person, place, time, and situation. The client states, “My stomach is Killing me!” 10:30: The client’s home medication list was verfied by the pharmacy and includes: Diphenhydramine (Benadryl) 25mg PO Q6hr PRN rhinitis/itching, Triamcinolone (Nasacort Allergy 24hr) two sprays per nostril Qam, Vitamin D3 2000iu PO Qam, Salmeterol (Servent Diskus) Inhalation 50mg Qam, and Carafate (Sucralfate) 1g PO Q6hr. The pharmacist stated that Carafate (Sucralfate) is a new medication ordered by the client’s PCP 7 days ago. The client has not yet filled the Carafate (Sucralfate). Q1. Arrange the following interventions as indicated or contraindicated as a nursing intervention? 1. Auscultate bowel sounds 2. Administer a PRN laxative medication 3. Please the client in semi Fowlers position 4. Assess the clients bowel pattern over the past week 5. Recheck the clients vital signs 6. Palpate the clients abdomen 7. Obtain a PRN intravenous pain medication order 8. Assess social issues affecting clients medication compliance Q2. The nurse has recieved orders from the physician. Choose the 2 orders that the nurse should perform right away. 1. Complete hemoccult. 2. Administer Ondansetron (Zofran) ODT 4mg PRN vomiting. 3. Switch the client to an NPO diet. 4. Administer Diphenhydramine (Benadryl) 25mg Intravenous PRN Q6hr for itching. 5. Toilet patient Q4hours. 6. Administer Tramadol Hydrocholoride (Ultram) 50mg Intravenous. 7. Provide a telephone update to client’s partner. 8. Consult social work to assist with obtaining home medications. SCIENCE HEALTH SCIENCE NURSING NURS 1871

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