Question

please read the scenario and answer each of the questions the questions below in a typed form I just need idea or information how to answer the questions then I will document it online.

PMH: Ms. Lupin has a history of early onset dementia, atrial fibrillation, COPD, insulin-dependent DM, an MI, a pacemaker, and an ORIF of a left hip fracture in 2011.

Social History: Ms. Lupin lives alone in a 2-story home. She has 2 cats. Her primary source of support is her neighbor.

HPI: Ms. Lupin was admitted to the hospital with dehydration secondary to community-acquired PNA. She was sent from the USM Rehabilitation Center. Ms. Lupin had recently been hospitalized due to a fall at home and had spent 4 days in the hospital. When released from the hospital last week, she was transferred to the USM Rehabilitation Center in hopes getting stronger so she could go back home and live independently.

Assessment: You are working the 0700 to 1500 shift and receive report. You perform your morning assessment on Ms. Lupin and find no major issues or concerns. Throughout your shift, you receive the following information:

Blood glucose at 0730 was 130 mg/dL. She ate 28 grams of carbs for breakfast.

Blood glucose at 1130 was 183 mg. She ate 52 grams of carbs for lunch.

V/S at 0830 were: 38, 56, 26, 128/70, 94% on RA

You have the following medication orders:

1000 ml 0.9% NS, IV, 75 ml/hr, continuous

Aricept, 5 mg, PO, daily at 2100

Atenolol, 50 mg, PO, daily at 0900, HOLD dose if HR less than 60 BPM   

Calcium carbonate 600 mg, PO, TID at 0900, 1500, and 2100

Coumadin, 2.5 mg, PO, daily at 1800

Lipitor, 40 mg, PO, at bedtime

Lispro Insulin - prandial:

Give 1 unit of Lispro insulin, SQ, for every 10 grams of carbs consumed, TID after meals

Lispro Insulin – correctional for daytime:

Blood glucose 180 - 220: Give 2 units of regular insulin SQ

Blood glucose 221 - 250: Give 4 units of regular insulin SQ

Blood glucose 251 - 280: Give 6 units of regular insulin SQ

Blood glucose 281 - 310: Give 8 units of regular insulin SQ

Lyrica, 50 mg PO, TID at 0900, 1500, and 2100  

Nitroglycerin patch, 0.2 mg/hr, daily at 0900   

Piperacillin-tazobactam, 4.5 g in 100 ml of 0.9% NS, IV, q12h at 1100 and 2300

Symbicort 80/40.5, 2 puffs, BID at 0900 and 2100

Timoptic 0.25% opthalmic drops, 1 drop to both eyes, BID at 0900 and 2100  

Multivitamin, 1 tablet, PO, daily at 0900

Ms. Lupin’s IV bag ran dry; you hung a new 1000 ml bag at 1030.

Instructions:

In Ms. Lupin’s chart, document the medications that would be administered to Ms. Lupin from 0700 to 1200 only. Make sure you are administering the medications due during this time only! Read your medication orders carefully.

To document the medications, go to the “MAR” tab. Find the medication you want to give and click in the box that corresponds to the time you want to give the medication. You will have to choose a reason why you didn’t scan the patient’s name band before administering the meds.

Make sure that you document the time in the scenario that the drug would have been given (i.e. 0900 or 1000 or 1100). You can adjust the time in the “Date/Time” box. If a medication was due at 0900 but you didn’t give, click on the “Actions” box and change to “Not Given”. Fill in the appropriate dose and/or rate information.

If you are administering prandial insulin, please write in the “Comments” section how many units of insulin you are giving. Please following conventional rounding techniques and round your insulin up or down to a whole number.

IV fluids are charted in the MAR only when a new bag is hung. IV fluids are charted in the I&O every that they are infused (you don’t need to chart I&O for this assignment).

Answer 1

1.The medications that would be administered to Ms Lupin from 0700 to 1200 are :-

- Atenalol 50mg PO daily at 0900

- Calium carbonate 600 mg PO TID at 0900

- Lispro insulin 1unit post prandial for every 10gm of carbohydrates TID

- Lyrica 50mg PO TID at 0900

- Nitroglycerin 0.2mg / hr daily at 0900

- Piperacillin -tazobactum 4.5gm in 100ml 0.9%NS IV at 1100

- Symbicort 80/40.5 ,2puffs BD at 0900

- Timoptic 0.25 % opthalmic drops ,one drops in both eyes BID at 0900

- Multivitamin ,1tablet PO daily at 0900

- 1000ml 0.9%NS new bag at1030 ,at the rate of 75ml/hr continuous drip.

2.Reason for not scanning the patients band before administering the medications because the nurse directly asked the patient about her details and cross-checked with the patient medical record sheet.