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.......