Question

Case Study #2 Pharmacology Nursing Process G.M. is a 50 year-old Caucasian male who presented to the emergency department with chest pain, after playing basketball with his son. He had no significant medical history before the event and was diagnosis with a myocardial infarction. He responded well to medical management and is set to be discharged today. Your assessment notes the following: • Vital signs BP 100/65, heart rate 72 bpm, respirations 28 bpm, and temperature 98.9°F. • Normal S1 and S2 heart sounds, electrocardiogram shows normal sinus rhythm with ST wave elevation. • Skin is warm, dry, with 1+ edema noted in ankles • Lungs sounds are clear • Complains of shortness of breath when walking 100 feet. O2 saturation 94% on room air. • Complains of mild chest pain after walking 100 feet, but it is relieved after sitting down. • Complains of dizziness when going from laying to sitting and from sitting to standing. Assignment: 1. List the Subjective and Objective assessment findings 2. List two nursing diagnosis with related to and as evident by statements (one diagnosis may be “at risk for”) 3. Write two planning or outcome goals for the patient in SMART (specific, measurable, achievable, realistic, and timely) for the patient. i. One must be a short-term goal: the first this to address. ii. The other is a long-term goal, before patient is discharged. He is going home on the following medications: • Aspirin 325 mg PO daily • Nitroglycerin 0.3 mg SL prn for chest pain that is not relieved after sitting down, may repeat x if chest pain not relieved after 15 minutes. • Atenolol 50 mg PO BID. Hold if systolic blood pressure less than 90 mmHg. Assignment: 4. Name two nursing interventions for all three medications (you may not repeat any interventions) 5. Name an assessment findings (one for each medication) that indicate the medication effectiveness. 6. What side effects could that patient experience for each medication 7. What adverse effects for each medication does the patient need to report? 8. Name five teaching points for each medication to communicate before the patient’s discharge

Answer 1

Answer :

Patient complaints are

* Shortness of breath on walking

* chest pain after walking

* dizziness from sitting to standing ( arthostatic hypotension)

Assignment 1 answer :

Subjective and objectives findings are :

Subjective findings : these are what patient complaints. Those are _ breathing difficulty ( short ness of breath)

_ mild chest pain

_ dizziness

_ edema or swelling on ankles.

Objective findings : what we are observes on patients. Those are. _ oxygen saturation level 94% for breathing difficulty

_ 1 to 3 score on pain scale (visual anologue scale) it. indicates mild pain for chest pain.

_ inability to stands properly because of dizziness.

Some other objective findings includes vital signs temperature 98.9degee f, pulse :72 bpm, respiration :28 bpm, bp:100/65 my of hg.

* skin warm and dry,

* St wave elevation in each.

* ankles edema +1.

Assignment 2 Answer :

Nursing diagnoses:

1. Ineffective breathing pattern related to oxygen demand due to myocardial infarction as evidenced by client oxygen saturation level is 94%, and complaining about short ness of breath while walking.

2. Discomfort related to chest pain as evidenced by client verbalization and facial expressions of client.

3. Risk for injuries related to dizziness. ( for these we should not mention as evidenced by because we are expecting the risk)

Assignment 3. Answer :

Plans or outcome goals :

1. For ineffective breathing pattern:

short term goal : comfortable Position by providing semifowlers or sitting position or cardiac position the client can maintain normal breathing pattern as space will comes to lungs.

Long term goal : maintaining deepbreathing exercises and by avoiding streness activities the client will maintain normal breathing pattern.

2. For chest pain

Shot term goal : administer oxygen 2 lit per minute with nasal prongs because patient is having already 94 % oxygen saturation level. If he releaves pain tapper the oxygen.

Long term goal : use analgesics for pain NSAIDs like ibuprofen and aspirin and avoid to excess walking and running.

Assignment 4.Answer:

Nursing interventions.for aspirin :

* observe for bleeding. Because it is anticoagulant.

* observe for gastric irritation and nausea and vomiting. Administer anti emitics and antacids.

For nitroglycerin :

* check blood pressure before administer it because it may drops bp, if systolic bp below 90 my of hg stop it.

* provide sitting position because it may cause dizziness while stading or doing any work. It may risk for injuries.

For atenolol:

* it may effect on heart and circulation.

* it may cause orthostatic hypo tension so advice clients to take precautions while lying to sitting, or sitting to standing.

* it may cause thirst so provide water to clients.

Assignment 5.Answer:

Assessment finding of each medications

Aspirine: it is decreases the clumping action of the platelets and increases blood circulation to heart and decreases myocardial infarction.

Nitroglycerin : it relaxes the vascular smooth muscles and decreases the pain.

Atenolol : it is used to decrease the blood pressure associated with chest pain. Beta blocker.

Assignment 6. Answer :

Side effects of aspirin : nausea, vomiting, rashes, bleeding,

Stomach upset, dizziness, head ache ect

Nitroglycerin side effects : dizziness, head ache, tachycardia, weakness, nausea, vomiting, flushing.

Atenolol side effects : constipation, dizziness, indigestion, dry mouth, confusion, depression, insomnia etc.

Q. No 8 answer : for aspirin : * advice patient to observe for bleeding.

* observes for rashes on body.

* education regarding side effects of nausea and vomiting.

* take rest while taking medicine.

* take salt restriction diet.

For nitroglycerin : * check blood pressure in home it self before taking medicine.

* take adequate oral fluids.

* observe for urine output.

* maintain adequate timings to take medicine.

* avoid skipping.

* take good rest.

For atenolol :

* advice to avoid to take if blood pressure below 90 my of hg.

* and consultant doctor, immediately.

* take adequate fiber diet for constipation.

* take sips of fluids.

* encourage to do interested activities and take warm milk before going to bed, it will induces sleeping.

* because this drug may cause insomnia.