Medication-nursing issues

  1. The following is a case study i desperately need help with. All help greatly appreciated!
    65 yr old man presented with shortness of breath and chest infection post op. Chronic frequent smoker. had open cholecystetomy 5 days ago.

    He's currently recieving Ventolin (via inhaler), Ipratropium bromide, predisolone, temazepam, amoxycillin.

    What are soem of the assessments that are a nurse must, or should make prior to administration, during administration and following the administration of the drug?

    Thanks for the help!
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  2. 12 Comments

  3. by   moia
    Well you need to ask the patient if he has any allergies before you give him anything.

    Then you need to review all the drugs he was prescribed post op and any other prescriptions he has.

    Now you have to find out what kind of pain management is in place because someone with an open choley incision is not going to be all that happy about deep breathing and coughing..pain needs to be addressed so the patient can breathe with ease ..if you don't fix the pain all those breathing treatments aren't going to clean out this guy beat up lungs.
    So if you discover he has no allergies his pain is well controlled and all these drugs are new to him you have to assess how to give the inhalers...would it be best as a nebulizer?
    Can he take deep breathes and inhale these drugs?
    You need to check his pulse before starting...ventolin can give you tachycardia..put the pulse ox on and monitor his sats.
    You have to assess his lungs before the inhalers and continue to assess lungs and resp rate/pulse all through the treatment.
    You already know the guy is most likely a COPD patient with new onset of pneumonia so you realize is breathing will always be restricted...make allowances and get the patient to describe any relief or worsening.

    Personally in this situation I would have an IV and give his other drugs IV except the temazepam...he doesn't need that..the doc can decide if he wants to treat anxiety but you don't want your patient to sleepy to breathe.

    After treatment I would encourage coughing to get a sputum for culture.
    You need to assess if this patient had been doing anything at home but lying in bed...assess cough and swallow.
    You need to assess if the treatment was successful...the patient will know but check all vitals too and listen to the lungs.
    You need to assess if the treatment is a failure and the patient is worsening and is prearrest with resp failure.

    I deliberately left out any mention of the choley because for me this is an obvious failure to thrive patient who either didn't get any post op education or decided to ignore all the teaching and went to bed and 5 days later he got an exaserbation of his COPD with a possibilty of pneumonia.
    I don't think the choley incision or the surgery itself started the infection I think in all probability the pain from the incision stopped this guy from doing a regular pulmonary toilet...he should have had better pain management.

    I can't think of anything else.
  4. by   TracyB,RN
    I am surprised that this pt is not on more medication.

    Where are his pain meds? Most COPD'ers are on some kind of anti-anxiety as well. Where is that?
    Has he been taught to T,C, DB? Has anyone been helping him with this?
    Is he using an Aerochamber with his Ventolin? My guess is that he is not correctly using his inhaler. Is the Atrovent also in inhaler form. He might be better off getting the ventolin & atrovent via neb, and correctly being taught to T,C,DB; using a pillow to splint while doing so.
    Does he use home O2? How much Prednisone has this guy been on, how long. Steroids can suppress the s/s of infection.
    I agree with the other assessments moia listed, resp status, rate, quality is not going to be up to par. I do feel that his pain & anxiety need to be controlled. But I think he could probably use that Restoril(temazepam), but a lower dose. Sleep always seems to be an issue for COPD'ers & if he isn't well rested, he is more likely to be non-compliant with other treatments...
    I would push for the ventolin & atrovent to be given via neb, & I would push for something for the anxiety that I am sure this guy presents with. If they don't go for nebs, at least get this man an aerochamber & teach him how to correctly use it. Inhaled drugs don't do squat if they aren't getting in him.
    Does he know the correct technique for pursed-lip breathing?
  5. by   happystar
    what sort of assessments should be made during the administration of prednisolone?
  6. by   jemb
    Quote from happystar
    what sort of assessments should be made during the administration of prednisolone?
    You can find that information in just about any nursing drug book, or online if you do a search.

    I'm wondering why you have all these questions about a case study. Is this for an assignment for a nursing class? You wouldn't be trying to get someone else to do your homework, would you? :wink2:
  7. by   happystar
    To Jemb-yes it is for an assignment, one which i desperately need help with. HOwever, i'm certainly not getting other people to do this assignment for me. Have u never gotten stuck on a particular assignment during the course of ur studies and required help? Despite the number of books and sites i've looked through, they didn't seem to mention the assessments that should be made during the administration of prednisolone.

    Btw, thanks to those who have helped me improve my general nursing knowledge and help with these assignment. I'm on my way to finish it.
  8. by   jemb
    Happystar, sounds like you might need help in determining what constitutes an 'assessment' rather than info about the particular drug, which can be found in any drug book. (Maybe you need to invest in a more comprehensive drug book?)

    The drug info will state adverse reactions that have been observed in people who have taken that drug. Those adverse reactions are things you will look for-- you will assess for symptoms that indicate an adverse reaction, as well as for signs that the drug is doing its job.

    I had just noticed that several of your threads dealt with needing help with assignments. That made me think that perhaps the help you needed was in how to research and/or interpret the material that you should already have available.

    I am trying to help you, even though you may not have seen it in my other post. My guess is that had you asked your instructor the same question you posed in this thread, you would have gotten an answer similar to what I just gave you. No offense intended at all.

    Good luck and keep studying!
  9. by   Rhoresmith
    Hello,
    Every student needs help with homework sometimes and I have also posted here requesting help. I am not wanting someone to do my work for me but there are times when something just does not click. I feel that accusing happystar of wanting someone to do her homework is just a little snotty on your part.
    Now happystar looking at what the side affects are is the best way to decide what assessments would need to be made while patient is taking this medication that will alway work on any medication. The Davis Drug guide is a very good book and it seems to have what I need. You can also type in asssessments for (whatever drug) in google and see what pops up. Good luck and PM me if there is more I can help you with, we students are in this togather and we need to support one another
    Rhonda
  10. by   nurseygrrl
    For prednisone I would monitor glucose levels if pt. is diabetic, they made need a bit more NPH. Watch for mood changes, monitor WBC count as steroids can mask S/S of infection. Monitor for GI symptoms...give with food. The doc may order a tummy med like pepcid or something similar to prevent stomach problems.
  11. by   BHolliRNMS
    Assess the blood sugar. You can research Prednisone and hyperglycemia to find out why.:stone
  12. by   leslie :-D
    prednisone has a host of side effects, implications and considerations. a major one being that it masks the s/s of infection. in any drug book, it should mention nsg. considerations, interactions and contraindications. and i think the response to jemb was a bit uncalled for. he's trying to get her to use some critical thinking skills.........

    leslie
  13. by   happystar
    Thanks guys, i really appreciate the help. Critical th inking is one of the things i have trouble with, so in asking for help and seeing what guys would suggest, is in a way helping me with my work. Anyway, thank you. Off to hand off my assignment now.
  14. by   Erin RN
    Quote from jemb
    Happystar, sounds like you might need help in determining what constitutes an 'assessment' rather than info about the particular drug, which can be found in any drug book. (Maybe you need to invest in a more comprehensive drug book?)

    The drug info will state adverse reactions that have been observed in people who have taken that drug. Those adverse reactions are things you will look for-- you will assess for symptoms that indicate an adverse reaction, as well as for signs that the drug is doing its job.

    I had just noticed that several of your threads dealt with needing help with assignments. That made me think that perhaps the help you needed was in how to research and/or interpret the material that you should already have available.

    I am trying to help you, even though you may not have seen it in my other post. My guess is that had you asked your instructor the same question you posed in this thread, you would have gotten an answer similar to what I just gave you. No offense intended at all.

    Good luck and keep studying!
    I agree with you, Jemb. Critical thinking is monumental to being competent as a nurse. I also noticed that most of the OPs threads were "help" questions. I think a better way to phrase these would be; this is the scenario this is what I think..critique me. When you don't know something looking around for the info will teach you the resources that are out there for when you are practicing not to mention finding different sources and reviewing them will not only give the answer, you will learn..what for, why, when, how... all of this information is critical to your success. If we answer each individual question for you we are not doing you any favors when it comes time for your boards and also when you get into the real world of nursing. If critical thinking is your weak point NOW is the time to work towards developing it..part of being able to do that is getting questions wrong.

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