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. 9 e ا ا ال ا ه ا ال ا » )

please help with these questions thank you!

Answer 1

LAB VALUES OF THE PATIENT ARE

1.SERUM SODIUM-139MEq/l.sodium level is normal.normal range is 135-145 meq/l

2.SERUM POTTASIUM-4.1 meq/l.pottasium level is also normal.normal range is 3.5 -5.0 meq/l

3.SERUM CHLORIDE-102 Meq/l.chloride level is also normal.normal range is 96-106 meq/l

4.HCO3 LEVEL-23Meq/l.bicarbonate level is also normal.normal rangeis 23- 30 meq/l

5.BUN(BLOOD UREA NITROGEN)-18 mg/dl.bun level is also normal.normal range is 7-20 mg/dl

6.SERUM CREATININE-0.7.CREATININE LEVEL ALSO SEEMS NORMAL.NORMAL RANGE IS 0.7 TO 1.2 mg/dl

7.SERUM ALBUMIN-2.4 g/dl.SERUM ALBUMIN LEVEL IS lOW.THE PATIENT IS SUFFERING FROMNHYPOALBUMINEMIA.ALBUMIN IS A PROTEIN PRODUCED BY LIVER.THE MAIN REASON OF DECRESED ALBUMIN LEVEL IN THIS PAIENT IS BECAUSE OF SEVERE MALNUTRITION. ALBUMIN LEVELS ARE ALSO LOW IN THE CASE OF LIVER DISEASES ,SHOCK,CROHNS DISEASE,CELIAC DISEASE etc

8.SERUM PHENYTOIN LEVEL-5.4.SERUM PHENYTOIN LEVEL IS ALSO LOW.NORMAL LEVEL RANGES FROM 10 TO 20mcg/ml.NON COMPLIANCE OF PHENYTOIN CAUSES INCREASED SEIZURE THRESHOLD IN THIS PATIENT.THATS WHY PATIENT DEVELOPED AN EPISODE STATUS EPILEPTICUS.Ie GRANDMAL SEIZURES WITH URINARY INCONTINANCE.SO INCREASING SERUM PHENYTOIN LEVEL IS NECCESSARY FOR THIS CLIENT

SECTION 2.IVF RATE CALCULATION

TOTAL VOLUME=2500 ML

TOTAL TIME=24 HOURS

DROP FACTOR=15

DRIP RATE PER HOUR =TOTAL VOLUME*DROP FACTOR/TOTAL TIME IN HOUR ie 2500*15/24=1562 drops per hour or 26 drops per min.

BONUS QUESTION

1.ALTERNATE MEDICINES-patient have non complaince with phenytoin..VALPROIC ACID IS AGOOD ALTERNATIVE IN SEIZURE CONTROL

2.PATIENT TEACHING-KEEP THE PATIENT WELL HYDRATED.PROVIDE HIGH CALORIE HIGH PROTEIN DIET.ADJUST THE DOSE OF PHENYTOIN ACCORDING TO BLOOD LEVEL.FALLS PRECAUTION MUST BE TAKEN.