CASE STUDY....I know everyone hates them but I need help!!!!

Nursing Students Student Assist

Published

i know that everyone dreads case studies but i am hoping that i can find some help. i have a case study that i am working on and i've been able to answer to every question, pretty well, but i have absolutely no idea on this question.

the overview is that the patient is going into thyroid storm.

here is the scenario

k.b is an 80 year old man admitted to the hospital following a 5 day "flu" with complaints of dyspnea, palpitations, chest pain, insomnia, and fatigue. his pmh includes hf, htn, requiring anti hypertensive meds that he states he has not been taking on reg. basis.

k.b was diagnosed with graves disease 6 months ago and placed on methimazole 15mg/day po. height 5 8 weight 130 appears anxious and restless, loud heart sounds, vs 150/90 104 ireg. 20, 100.2f 1+ pitting edema on lower extremities bilateral, diminished breath sounds with fine crackles. lab findings---- hgb 11.8 hct 36% esr 48 na 141 k+ 4.7 bun 33 creatinine 1.9 t4 14 t3 230.

after morning rounds, the physician leaves the following orders- propranolol inderal 20mg po q6h, dexamethasone decadron 10mg iv q6h, verapamil calan sr 120mg/day po, diet as tolerated, stat ecg, up ad lib.

the question that i can not figure out is:

which of these orders would you question and why?

i hope that someone will be able to help me because i have looked everywhere and i can not figure out why you would question any of these orders.......:confused:

Up Vote Up Vote ×
Specializes in Tele.

I don't work with adults. but it seems like a nurse would question the propanolol inderal since he is already receiving methimazole (I think it is a heart medication).

I could be wrong, so please do not quote me. But I would definitely look that up.

and also, I would look into diet as tolerated, because since he is hypertensive, I would of placed that patient on a no salt or low sodium diet.

just my two cents, but I could be wrong. Just trying to help a little.

Up Vote Up Vote ×
Specializes in Infusion, Med/Surg/Tele, Outpatient.

maybe I'm missing something too! Propranolol is contraindicated in overt heart failure? Up ad lib. This guy is obviously a fall risk!

Up Vote Up Vote ×
Specializes in ER.

Get the EKG, see if it shows changes, call doc if it does for new orders. Give one of the BP meds, wait an hour recheck BP and resp status. Give O2 prn. Double check the decadron doseage, and note that it is about twice the max dose. Call doc with update, and ask for thyroid hormone levels as well (Graves disease), and wonder if the pt needs some Lasix to get rid of fluid or does the doc think pneumonia/antibiotics are needed.

Lots of questionable orders there.

Up Vote Up Vote ×
I don't work with adults. but it seems like a nurse would question the propanolol inderal since he is already receiving methimazole (I think it is a heart medication).

I could be wrong, so please do not quote me. But I would definitely look that up.

and also, I would look into diet as tolerated, because since he is hypertensive, I would of placed that patient on a no salt or low sodium diet.

just my two cents, but I could be wrong. Just trying to help a little.

Thank you! The diet I never even thought of because i was so hung up trying to figure out the meds! :)

Up Vote Up Vote ×
+ Add a Comment