Question

Case Study As a nurse working on a busy Med-Surg unit, your Nurse Manager approaches you and states that you are getting a new admission. You call to get report from the ER nurse. He gives the following information: The patient's name is Lisa Trowberg. She is a 23-year-old female with NKA (No Known Allergies). PMH (past medical history) significant for seizures since 15 years of age. She was being well controlled on phenytoin (Dilantin) until recently when she began to have breakthrough seizure activity. About 2 weeks PTA (prior to admission), her significant other of 18 months broke up with her. Becoming increasingly depressed with diminished appetite resulting in significant weight loss, she started taking St. John's Wart as per a friend's recommendation. She was brought in by ambulance for a grand mal seizure with + urinary incontinence. En route, she was given diazepam (Valium) IV x 2 doses and is now postictal. In addition, she was diagnosed with strep pharyngitis 1 day ago and was put on Amoxicillin ERT (Extended Release Tablet) 775 mg to be taken once daily by mouth. Today is day 2 of this regimen. She weighs 105 lbs. D. Focus O N OP ¢ o ewe o

Answer 1

1)

• IV FLUIDS is for nutrition as she was restricted to take any food and water by mouth.
• Amoxicillin is a penicillin like antibiotic used to treat strep throat or strep pharyngitis caused by streptococcus pyogenes.
• Ethinyl estradiol/drospirenone is an oral contraceptive that is used to prevent unwanted pregnancy.
• Phenytoin is an anti epileptic drug, which is used to prevent seizures.
• St.John's Wort is a herbal product that is used for depression, anxiety etc.
• Ibuprofen belongs to class of NSAID'S(non steroidal anti inflammatory drugs). It is used to decrease pain as well as fever.

2) St. john's wort should be avoided as co administration with phenytoin causes respiratory depression or CNS depression. As this patient's respiratory rate is 14, continuing this drug might reduce the respiratory rate further.

3)Amoxicillin which is prescribed for strep pharyngitis is given for only 3 days, but to treat effectively it should be given for total of 10 days.

Ibuprofen 1000mg every 6 hours is overdose. The maximum daily dose of ibuprofen should not be more than 3200mg/day.