Question

Mr. Walter, a 39-year-old man who is opioid naive and weighs 60 kg, He has an order for Morphine Sulfate 30mg PO Daily. During your visit to his house his BP is 135/86, P is 90, RR is 22, and his O2 saturation is 98%. Preoperatively he indicated that he had a very low tolerance for pain. His goal for therapy was no pain and he thought he could tolerate pain at only a level of 1 on a 0-10 scale.

A.What would you do and why?

B.When you question him about how much pain he has, he reports his pain is a 9 on the 0 to 10 scale. What should you do?

His orders are for Percocet 1 tab for pain 3 to 6/10; Percocet 2 tabs PO for pain 7 to 10/10.

C. What would be your first action?

D. What dose would you administer and why?

E. Thirty minutes after administering one dose, his pain is rated as a 7 on 0-10 scale. What do you do now?

F. Three hours after administering the medication dose, he rates his pain a 3 on 0-10 scale. Now what would you do?

G. How would you document this episode?

2. Ms Penny is a 69-year-old female with congestive heart failure. Her activity level and her energy level were declining over the past four weeks. She is mildly short of breath while performing her house chores. The cardiologist just added Digoxin 0.125 mg to her drug regimen. This is your first time administering this medication to Ms Penny.

A. What would be your first action?

B. Is there any specific assessment required for this type of medication, if so what is it?

C. What dose would you administer and why?

D. How would you document this episode?g

E. Three weeks later you return to Ms Penny’s house. What, if any, changes are you expecting to see?

Answer 1

2.A. Assess allergy to digitalis.

B. Check Apical pulse 1minute before administering the drug. If pulse less than 60per min, withhold the drug and notify the cardiologist.

C.lower end of dose in geriatric and lean body mass

D. Tab.Digoxin 0.125mg administered at 8 am, before meals, after checking Apical pulse.

E. Weight gain, pedal edema, hypokalemia.