what's wrong with this patient?

Posted
by RenKenn72 RenKenn72 (New) New

You are reading page 2 of what's wrong with this patient?. If you want to start from the beginning Go to First Page.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 42 years experience. 4 Articles; 20,908 Posts

That is what these forums are for.....I am an old haunt but I have been very ill...but all better (I hope)

I'l be here.

Double-Helix, BSN, RN

Specializes in PICU, Sedation/Radiology, PACU. Has 11 years experience. 1 Article; 3,377 Posts

I have been ill for a long time but I am better and I will be here helping students.

I missed you!

RenKenn72

RenKenn72

7 Posts

thanks for your help. It is very much appreciated. I don't know a lot about INR but i'm guessing that with a low BP and a high pulse there must be some kind of blood loss. (hemorrhage?)

RenKenn72

RenKenn72

7 Posts

I'm still not positive about this. What your saying about ruling out dehydration makes sense though. Could it be the anesthesia in response to the morphine and Tylenol 3 (narcotics) as well as being in pain.

Her confusion may also be the result of hypoglycemia, her oral antidiabetic agent may have been discontinued 1 to 2 days before the surgery and because she hasn't eaten in a while her blood sugar is low.

KRVRN

KRVRN, BSN, RN

Specializes in NICU. 1,334 Posts

thanks for your help. It is very much appreciated. I don't know a lot about INR but i'm guessing that with a low BP and a high pulse there must be some kind of blood loss. (hemorrhage?)

It also specified a high temp of 40.4 C. Those vitals could indicate infection.

KRVRN

KRVRN, BSN, RN

Specializes in NICU. 1,334 Posts

Confusion could indicate a stroke. Why did she fall? Was it just from her feet slipping or did she pass out and she has an underlying issue?

Hygiene Queen

2,232 Posts

I hope the students on here never feel too bad about tossing out a wrong answer or two. That's how we learn. I know that when I've been wrong, the correct answer has stuck with me for ever and ever afterward! That said, perhaps students need to make it clear that they are students (or pre-students) when they participate. It just helps other students measure the weight of some of these answers.

However...

All students who come here are well advised to remember that not all participants in these threads will have correct answers or will even be leading you in the right direction. Students: Take each answer with a grain of salt and fact check it for yourself.

AliNajaCat

AliNajaCat

1,035 Posts

Tylenol and Enoxaprin are both NSAIDS and with the warfarin and morphine she is high risk for bleeding.

Tylenol is not an NSAID (nonsteroidal ANTI-INFLAMMATORY) and has no influence in clotting. Enoxaparin isn't an NSAID either, it's a heparin derivative and given prophylactically to prevent clot formation.

Morphine does not increase risk of bleeding.

As to COX-inhibition, see the following. My emphasis added and feel free to look up all the terms you don't know well. This study report means that acetaminophen's COX-1 effect will not inhibit platelet function enough to be clinically significant for clotting. Just because it has COX-2 effects "comparable to NSAIDS" doesn't mean it has ALL characteristics of NSAIDS.

I hear Esme and HQ on the value of having errors corrected, and commend what are called "prenursing" people for their interest...but it's always a good idea to have a good command of your facts before you speak. You'll find this is true when you are a real nurse, too. Remember that nurses have an obligation to do patient education, and to educate younger nurses coming along, so we need to really know what we're talking about or when to call for support or go look it up before we do.

FASEB J. 2008 Feb;22(2):383-90. Epub 2007 Sep 20.

Acetaminophen (paracetamol) is a selective cyclooxygenase-2 inhibitor in man.

Hinz B1, Cheremina O, Brune K.

Author information

Abstract

For more than three decades, acetaminophen (INN, paracetamol) has been claimed to be devoid of significant inhibition of peripheral prostanoids. Meanwhile, attempts to explain its action by inhibition of a central cyclooxygenase (COX)-3 have been rejected. The fact that acetaminophen acts functionally as a selective COX-2 inhibitor led us to investigate the hypothesis of whether it works via preferential COX-2 blockade. Ex vivo COX inhibition and pharmacokinetics of acetaminophen were assessed in 5 volunteers receiving single 1000 mg doses orally. Coagulation-induced thromboxane B(2) and lipopolysaccharide-induced prostaglandin E(2) were measured ex vivo and in vitro in human whole blood as indices of COX-1 and COX-2 activity. In vitro, acetaminophen elicited a 4.4-fold selectivity toward COX-2 inhibition (IC(50)=113.7 micromol/L for COX-1; IC(50)=25.8 micromol/L for COX-2). Following oral administration of the drug, maximal ex vivo inhibitions were 56% (COX-1) and 83% (COX-2). Acetaminophen plasma concentrations remained above the in vitro IC(50) for COX-2 for at least 5 h postadministration. Ex vivo IC(50) values (COX-1: 105.2 micromol/L; COX-2: 26.3 micromol/L) of acetaminophen compared favorably with its in vitro IC(50) values. In contrast to previous concepts, acetaminophen inhibited COX-2 by more than 80%, i.e., to a degree comparable to nonsteroidal antiinflammatory drugs (NSAIDs) and selective COX-2 inhibitors. However, a >95% COX-1 blockade relevant for suppression of platelet function was not achieved. Our data may explain acetaminophen's analgesic and antiinflammatory action as well as its superior overall gastrointestinal safety profile compared with NSAIDs. In view of its substantial COX-2 inhibition, recently defined cardiovascular warnings for use of COX-2 inhibitors should also be considered for acetaminophen.

nevergiveup2016

nevergiveup2016

56 Posts

This might be a stretch but one thing that popped into my head regarding the confusion was "has she had any urine output". I don't recall seeing it but that could cause some acute delirium..

I'm so glad no one has told the student to do her or his own homework.

William2

William2

Has 4 years experience. 94 Posts

"Morphine – may increase the anticoagulant effect of warfarin?"

Since when...

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience. 5,047 Posts

I'm so glad no one has told the student to do her or his own homework.

Well the student did post her/his own thoughts first. ;)