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 cite your source(s) and include your reference(s). ONLY TEXTBOOK LINKED
Discussion Topics:
• Scenario #1
Myrtle, a 74-year-old female, is recovering in the trauma from a major car accident. She is on a ventilator and has a central line for IV fluids and antibiotics. After 3 days. she develops gram-negative spetiecemia and pneumonia. IV gentamicin and ampicillin were prescribed.
◦ Discuss the mechanism of action and the adverse effects of gentamicin and ampicillin.
◦ During the antibiotic therapy, peaks and trough levels were ordered for gentamicin. What is the significance of these laboratory tests? When would you draw these laboratory tests?
◦ What other laboratory values and assessments would you monitor? Explain your rationale.
•
• Scenario #2
Michael is a patient who was in a major motor vehicle accident 48 hours ago, that resulted in a significant head injury. The patient was recovering without complications until he began to have increased urinary elimination. The urine volume over the past 12 hours has been 3000 mL. A urinalysis is performed, and the results include a specific gravity of 1.001. Symptoms of dehydration are present, and the patient complains of being “so thirsty.” The patient is diagnosed with diabetes insipidus. The patient’s family comes to visit the patient. One of the family members approaches the nurse and asks, “Will he need insulin now?”
◦ How will the nurse respond to the family member’s question?
◦ Which medication will be ordered for diabetes insipidus? Discuss the mechanism of actions and adverse effects of the prescribed medication.
◦ What will the nurse assess and monitor while the patient is receiving the prescribed medication?
◦ Discuss the patient teachings for the prescribed medication.
•
• Scenario #3
Laura, a 20-year-old college student, went to health department for oral contraceptives. Laura asks the nurse how to take the medication and wants to know the adverse effects of oral contraceptives.
◦ What should the nurse assess for prior to the physician prescribing oral contraceptives?
◦ How would the nurse respond to Laura’s questions?
• One month later, she started on oral antibiotics for acute bronchitis. She has taken her antibiotics for one week and she now has a vaginal yeast infection. She continues to take the oral contraceptives as scheduled.
◦ How did Laura develop a vaginal yeast infection?
◦ What medication might be prescribed for a vaginal yeast infection? Discuss the adverse effects of this medication?
◦ What patient teachings should the nurse provide while the patient is taking these medications?
•
• Scenario #4
Edna is a 45-year-old pregnant women, is admitted to the hospital for cholecystitis. She has a fever and elevated white blood cell count. The surgeon prescribes 1 gram on cefazolin every six hours and reschedules her surgery in 2 to 3 days.
◦ Why did the surgeon not prescribe a broad spectrum antibiotic for this patient? Include the rationale.
◦ The nurse should assess the patient for which possible adverse reactions of the antibiotic therapy?
◦ What assessments and laboratory results should be monitored while this patient is on this antibiotic therapy? Be specific and include the rationales.
• Scenario #5
The nurse educator is presenting a seminar on insulin to nursing students. What would the best response to the following questions?
◦ What are the similarities and differences between rapid-acting and short-acting insulins? Include the rationales.
◦ Why is regular insulin the only insulin that could be prescribed intravenously? Include the rationales.
◦ How is using detemir (Levemir) and glargine (Lantus) insulin better than using NPH insulin? Include the rationales.
◦ Some prescribed order a long-acting insulin in the morning rather than the evening. Why would they do this? Include the rationales.
◦ What should the nurse or patient do if a rapid-acting insulin vial is cloudy? Include the rationales.