nursing scenario

Ayvah, RN · Sep 3, 2012

I feel like part of the assignment is missing -- is the homework assignment asking why the patient was Rx'ed these medications/treatments or if they were appropriate? Or is it asking what you think her diagnosis was? Or is it asking something else?

JAIMIE1980 · Sep 3, 2012

I know right. Basically what this is is to assess my readiness and knowledge for my last clinical, she says "please come prepared to discuss client scenarios including pathophysiology, medications, nursing interventions, care plans and work plans. One of the clients we will discuss is" and that is the scenario she gave me

JAIMIE1980 · Sep 3, 2012

Im just asking for any help to get me on right track or if i am already She didnt leave me much to work with but does it make sense that she could be suffering from a right hemisphere stroke? but then why is she on digoxin when that is for artirial fib... see why i am so confused

Shjnsn · Sep 3, 2012

Well the Synthriod is for her thyroid and metaprolol is for her bp. It could be the admitting phys is thinking cva as well because they also ordered the swallow study. Pt to help her regain some strength on the affected side. I think her meds are throwing you, but it should be a combination of her home meds plus those he ordered for her while in hospital.

JAIMIE1980 · Sep 3, 2012

YA so n then could you help me to understand more of why those particular meds would be prescribed what are the helping with in the body. I know metaprolol is for bp im still confused of the action of digoxin and synthriod related to her

Please anyone i am really having a hard time with this mostly the medications understanding what they help in the body related to my patient

Kimevans711 · Sep 3, 2012

Hi Jamie 1980 yes i believe you are on the right track. Just remember that arrhythmias and heart attack can also cause a stoke or a mini stroke. But i agree with ayvah it seems like they left something out. To answer your question, yes digoxin is used to treat arrhythmias but it's also used to treat heart failure as well. The metoprolol is a BB typically used to treat HT. however if the patient has HF its used in conjunction with digoxin and a blood thinner like Coumadin to prevent blood clots. Synthroid is used only to treat hypothyroidism and immovane I believe is used to treat insomnia. So to sum it up the patient had undiagnosed hypothyroidism,arrhythmia( or HF )that caused a MI. The MI in turn caused a stroke. It's the only thing I can come up with. I hope this helps. Good luck

Kimevans711 · Sep 3, 2012

Digoxin works by increasing the force of contraction of the muscle of the heart by inhibiting the activity of an enzyme (ATPase) that controls movement of calcium, sodium and potassium into heart muscle. Calcium controls the force of contraction. Inhibiting ATPase increases calcium in heart muscle and therefore increases the force of heart contractions. Blocking the electrical conduction between the atria and ventricles, thus slowing ventricular contractions.Metoprolol is a beta-adrenergic blocking agent that is used for treating high blood pressure, heart pain, abnormal rhythms of the heart, and some neurologic conditions.Metoprolol blocks the action of the sympathetic nervous system, a portion of the involuntary nervous system, by blocking beta receptors on sympathetic nerves. Since the sympathetic nervous system is responsible for increasing the rate with which the heart beats, by blocking the action of these nerves metoprolol reduces the heart rate and is useful in treating abnormally rapid heart rhythms.Metoprolol also reduces the force of contraction of heart muscle and thereby lowers blood pressure. By reducing the heart rate and the force of muscle contraction, metoprolol reduces the need for oxygen by heart muscle. Since heart pain (angina pectoris) occurs when oxygen demand of the heart muscle exceeds the supply of oxygen, metoprolol, by reducing the demand for oxygen, is helpful in treating heart pain. Now, the Patient needs to be carefully watched because digoxin and metoprolol together can cause the patients heart rate to drop dangerously low. So starting the patient on a low doses is best.

Esme12, ASN, BSN, RN · Sep 3, 2012

I know right. Basically what this is is to assess my readiness and knowledge for my last clinical, she says "please come prepared to discuss client scenarios including pathophysiology, medications, nursing interventions, care plans and work plans. One of the clients we will discuss is" and that is the scenario she gave me

Welcome to AN! The largest online nursing community!

Your last clinical? Are you about to graduate? There is plenty to work with here.

From the symptoms given I would say she suffered from a right sided stroke but what is really confusing me is the reason she is on synthroid, Digoxin and metoprolol???

Elizabeth is an 84 yr old with a history of a fractured hip 1 yr ago. She lives at home alone. Elizabeth was admitted last night with left sided weakness and a fall. Elizabeth normally gets around well at home with a cane.

Elizabeth’s doctor’s orders include the following:

Synthroid

Digoxin

Metoprolol

Morphine

Tylenol#3

Coumadin

Imovane

Oxygen

IV fluids

Swallowing assessment

PT/OT

Foley if needed

From looking at these meds...what past medical history does she have. Your senario only said a history of a fractured hip....not that that was her ONLY history. What is a stroke? What causes a stroke? Could a small clot has been thrown from a chronic AFIB? and cause the CVA? What does a left sided weakness CVA mean? What side of the brain does it affect? How will that affect her rehab? Her speech? Her eating?

Looking at these meds..........One can assume that with the Digoxin she has a history of a rapid heart rate...possibly AFIB. The Metoprolol can be either for HTN or for a rapid heart rhythm as well. She is also on Coumadin as well which tell me she has a history of blood clots somewhere or they are preventing blood clot formation from an irregular heart rate (AFIB). Being 84 years old I am not surprised that her thyroid has slowed down and supplement is given. Imovane I had to look up as the drug is not in the US (sister drug...Lunesta).... IVF, O2, PT/OT,Swallow eval all have to do with the CVA....How do they pertain to the CVA?

What does this patient need? Are there any blood levels that need to be checked like thyroid or dig level? What would you need to think about in the care of this elderly patient with a history of a hip fracture (falls/safety) on blood thinners with a new CVA???

Do you see where this is going?

JAIMIE1980 · Sep 3, 2012

I totally see where you are going and thank you so much you have been a big help. I now feel alot more confident, ya my teacher sure didnt give much to work with really broad i guess sh

JAIMIE1980 · Sep 3, 2012

really wants test my critical thinking skills.. :) Thanks again

Esme12, ASN, BSN, RN · Sep 3, 2012

All the information you need is in the senario your teacher gave you. It is that "critical thinking" they want you to use.

What are the meds for.....look them up.

What are they used for.....?

Why is this patient on them?

What are the causes of a CVA?

Why would this patient be throwing clots?

Are there heart rhythms that have a tendency to throw clots?

Patients will come to you all the time with a list of meds and say they don't have a medical history. They feel their medical histroy is non exostant becasue they take their meds.

If you were a dective.......what would this information tell you about this patient and how would you care for them.

What do they need....