Overview
◦ Read the questions/scenarios and answer the following questions.
◦ Watch for grammar and sentence structure.There must be a minimum of ONE (1) paragraph (five to ten complete sentences) per question.
◦ Please review and discuss the questions/scenarios listed below
◦ Please cite your source(s) and include your reference(s). Reference(s) must be from a credible source (i.e textbook, peer-reviewed articles, etc.). Ten (10) points will be deducted for missing or non-credible reference(s).
▪ There should be a minimum of ONE (1) paragraph (five to ten complete sentences) per response.
Discussion Topics:
Scenario #1
A 71-year-old male client was diagnosed with an ST-elevation myocardial infarction (STEMI). The only medication that he was taking before the MI was tamsulosin for benign prostate hyperplasia (BPH). The client received three doses of nitroglycerin sublingual tablets, which did not alleviate his chest pain. He was admitted to the coronary care unit with the following orders:
• Oxygen at 6 L/min via nasal cannula
• Nitroglycerin 5 mcg/min IV infusion
• Heparin infusion at 1300 units/hour for 24 hours
• Propranolol 20 mg orally every 6 hours
• Tamsulosin 0.4 mg orally once a day
• Before administering the medications, the nurse would question the provider regarding which medications? Include your rationale.
• Discuss the drug classification, mechanism of action, indication, and nursing implications (such as assessment and monitoring) for each medication listed in the orders. Be specific.
• The client's wife asks the nurse why he has to "take so many drugs," and wants to understand the purpose of these medications. What health teaching will the nurse include to help the client's wife understands the purpose of the medications? Discuss the health teachings for all the medications listed in the orders.
Scenario #2
Mara is a 56-year-old woman who was recently diagnosed with hypercholesterolemia. She has tried diet therapy and exercise, but her total cholesterol and LDL cholesterol levels remain elevated. Mara is prescribed simvastatin.
• The patient asks, “How does this medication lower cholesterol?” How will the nurse respond?
• What will the nurse teach Mara about taking this medication? Be specific.
• What should the nurse monitor for while Mara is taking this medication? Include your rationale for each finding.
Scenario #3
Marvin has been prescribed a loop diuretic and a potassium supplement daily. As you are preparing to discharge this patient, he states "I understand why I need the diuretic, but why do I have to take the potassium?"
• How would you respond to his question? Be specific with your response.
• Which adverse effects related to the potassium supplement would you advise him to watch for? Include your rationales.
• What advice would you give Marvin about his dietary consumption of potassium-rich foods while taking these medications? Be specific and include the rationales.
Scenario #4
Bradford is a 60-year-old male who presents to the emergency department (ED) with anxiety, moderate chest pain, and diaphoresis. His blood pressure is 156/90 , heart rate is 135, and ECG showed tachycardia with no ST elevations present. Bradford is transferred to the coronary care unit with a diagnosis of unstable angina and to rule out a myocardial infarction. The provider orders intravenous (IV) nitroglycerin with titration every 5 - 10 minutes based on the patient's reports of chest pain.
• Discuss the mechanism of action and the reason for the provider ordering IV nitroglycerin. Be specific.
• What pertinent assessment data should the nurse obtain before administering the medication. Include your rationales for each assessment data.
• How does the nitroglycerin infusion route differ from sublingual, oral, and transdermal? Include the rationales and steps of administration for stated medication routes.
Scenario #5
Jihyo is a 74-year-old female with complaints of pain and swelling of her right lower extremity for three days. Her right mid-calf area has 3+ pitting edema and is hot and painful to the touch. She was admitted to the hospital with a diagnosis of deep vein thrombosis (DVT) and will receive heparin therapy and pain management.
• Jihyo asks, "How soon will the heparin dissolve my blood clot?" How would you respond to her question? Be specific with your response.
• Which laboratory tests should be monitored closely will the patient is receiving heparin? Include the rationales for each laboratory test.
• What patient education should you provide Jihyo about anticoagulant therapy? Be specific and include the rationales.