Comprehensive Case Study Flashcards
Hx a-fib; prevent blood clots and CVA
Warfarin
Hx HTN; lower blood pressure
Lisinopril
Hx HTN and a-fib; control HR and BP
Metoprolol
Hx T2DM; control blood glucose
Aspart
Hx T2DM; control blood glucose
Glargine
Hx rheumatoid arthritis; reduce joint inflammation
Prednisone
Hx seizures; control/prevent seizures
Phenytoin
UTI
Ciprofloxacin
Metoprolol masks s/s hypoglycemia and pt has T2DM taking insulin; aphasia and cognitive impairment
Prednisone increases BG and pt has T2DM
Phenytoin may decrease effect of prednisone
Ciprofloxacin may increase the effects of warfarin
Warfarin-check therapeutic levels of PT/INR
Should the nurse be concerned about any drug-drug, drug-disease, or drug-lab interactions?
Vital signs: Hx a-fib, HTN, infection; meds may lower HR and BP; UTI (urosepsis)
Head to toe shift assessment: routine every shift (focus on neuro, MS, cardiac, GU)
Check labs
What are the priority assessments the nurse should perform prior to administration of A.G.’s medications? Provide the rationale for each assessment.
Blood glucose: insulin therapy; BB masks s/s hypoglycemia; prednisone increases BG
Phenytoin level: blood levels should be monitored for therapeutic levels/toxicity
PT/INR: warfarin therapy
WBC: prednisone, current UTI
Kidney function: hx HTN and DM; drug toxicity
Liver functions: drug toxicity
Hemoglobin/hematocrit: bleeding risk with warfarin
What labs should be monitored? Provide the rationale for each lab.
Hypoglycemia
Bleeding
Infection manifestations
Hypotension
CNS depression manifestations
After considering the adverse effects of all the medications prescribed, what 5 adverse effects should the nurse prioritize when monitoring A.G.?
Risk for falls: CVA w/hemiparesis, cognitive impairment due to CVA, risk for urosepsis, meds cause hypotension, risk for bleeding
What is a priority nursing diagnosis for A.G.?
