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CASE STUDY

A) What wil you be teaching Mr. Jones prior to discharge?

I will be teaching Mr. Jones in the following:

medication management skills

•drug name (generic and brand)

•intended use and expected actions

•route, dosage form, dosage, and specific administration schedule (hours


of day to take)

•special directions for storage of medication

•common side effects and adverse reactions

•what the patient should do if there is a side effect or adverse reation

•possible drug-drug, drug-food, drug-alcohol interactions

•how to refill the medication

•what to do if patient miss a dose

•special precautions when taking medication (driving and alertness)

• when to return to the health care provider

•how the patient will know the drug is doing what is should do.

Relief of Intermittent Constipation

Risk of falls due to dizziness

•when lying go to sitting position and rest for a minute then stand slowly

•do not stand for long periods of time

•increase fluid intake

•if feeling onset of dizziness, position self safely against a wall or sit in a
chair.
•take many small meal rather than large meals less often

•maintain normal salt intake

•have your B\P monitored by health care professional

•have your physician check your medication

B) Outline the nursing steps ( assessment, nursing diagnosis,


planning, implementation, evaluation)

ASSESSMENT
BIOGRAPHICAL DATA: Pt: Mr Jones Age: 81 Marital Status: Widow (2
Years) Occupation: Retired

REASON FOR ER VISIT: 1) Maroon (dark reddish colour) stools for 3 days.
2) New onset of dizziness

GENERAL SURVEY OF PATIENT: PT. is a well developed, well-nourished


man who looks younger than his stated age but is rather pale.

VITAL SIGNS: BP Lying 130<78 Pulse 84 . BP Standing 100<78 Pulse 124

PRESENT HEALTH HISTORY

•Living independently in his own suburban house several houses down


from his grandson who is very attentive, helping him with yard care
and grocey shopping in which he is limited by arthrictic pain.

•Independent with all other ADL's.

•smoker x's 40 years and stopped 10 years ago.

•lost his wife to cancer 2 years ago and since then takes pride in his
independence.

•c\o intermeittent constipation and strains when having bowel movement.

•c\o occasional heartburn when eating.

•c\o pain due to "arthritis "of his knees about 5 days of the week

Rx HISTORY

•hydrochlorothiazide 25 mg daily -- for HYPERTENSION

•Ventolin Inhaler prn -- for MILD EMPHYSEMA AND BRONCHITIS


•Tylenol 500mg as needed -- for "ARTHITIS" pain of the knees.

•Ranitidine 75mg as needed-- for heartburn.

PAST HISTORY

•Pt. has been relatively healthy throughout lifetime and never before
hospitalized.

NURSING DIAGNOSIS
At risk for falls- R\T dizziness -due to possible Postural Hypotension

Bowel elimination alteration-R\T unknown etiologly (diagnosis) as evidenced


by maroon (dark reddish colour) stool.

PLANNING

•Exhibit a normal range B\P

•Remain free of physical injury related to dizzness

•demonstrate understanding of safe drug administration

•exhibit a normal bowel elimination

IMPLEMENTATION
•8 rights to giving drugs
EVALUATION
•pt B\P is normal and dizziness has subsided

•pt is having normal BM with no staining.

C) Outline each drug and state the use, effect,side effect, adverse
effect and teaching that needs to be done with each medication?

Generic name: hydrochlorothiazide

Brand name: Apo-Hydro, HCTZ, Hydro-D, Neo-Codema, Urozide,

Classification: antihypertensives, diuretics

Use: management of mild to moderate hypertension, treatment of edema


associated with CHF.

Effects: lowering B\P in hypertensive patients, decreses edema

Adverse Reactions\Side effects: CNS dizziness, drowsiness, lethargy,


weakness, CV hypotension GI anorexia, cramping, hepatitis, vomiting DERM
photosensitivity Endo hypoglycemia Fand E hypokalemis, dehydration,
hypercalcemia, hyponatremis, hypovolemia, Hemat blood dyscrasia Metab
hyperuricemia, elevated lipids, MS muscle cramps Mis pancreatitis.

Patient Teaching:

•to take med. same time each day. if dose missed take as soon as
remembered but not if just before next. Never double dose.

•instruct pt. on use of calibrated droper when using oral suspension

•have pt. weigh selft twice wkly and report any significant wt. loss

•caution pt to change positions slowly to minimize orthostatic


hypotensiness. Increased if using alcohol.

•use sun screen and extra clothing to limit potosensitivity.

•discuss dietary potassium requirements

•advise pt to report any side effects or adverse reactions

•emphasize the importance of follow-up exams


•Hypertension: advise pt to continue taking medication but does not cure
hypertension

•advise pt to comply with additional interventions for hypertension (wt.


loss, low sodium intake, exercise, not smoking, moderate alcohol use,
stress management)

•to consult health care professionals before taking OTC medications,


especially cough or cold meds.

Brand name: Ventolin Inhaler

Generic name: albuterol

Classification: bronchodilators

Use: to control and prevent reversible airway obstruction caused by


asthma or COPD. Inhaln: very quick relief agent to open airway for acute
bronchospasm.

Effect: relaxation of airway smooth muscle with subsequent


bronchodilation.

Adverse reactions\side effects: CNS nervousness, restlessness, tremor,


headache, insomnia, CV chest pain, palpatations, angina, arrhythmias,
hypertension, GI nausea, vomiting. Endo hyperglycemia, F and E
hypokalemia Nero tremor.

Teaching Patient

•take inhalor exactly as prescribed. take missed dose when


remembered spacing remaining doses at regular intervals. Do not
double dose. Do not exceed recommended dose.

•pt to contact health professionals immediately if SOB is not relieved


by medication or is accompanied by diaphoresis, dizziness,
palpitations or chest pain.

•instruct patient to prime unit with 4 sprays before using and to discard
cannister after 200 sprays.

•advise patient to contact with Health care professional before taking


OCT meds, or alcohol with this theraphy.

•In patient that albuterol may have bad taste.


•Instrut patient in the proper use of metered dose inhaler,

•Advise pt to use Ventolin first if using other inhalers and wait 5 mins
before taking others.

•Advise pt to rinse mouth after .

•Advise pt to inform Heath care professional if no response to med. or


if canister is used in less than 2 wks.

Generic name: ranitidine

Brand name: Zantac, Apo-Ranitidine

Classification: antiulcer agent

Use: the treatment and prevention of heartburn,acid indigestion and sour


stomach.

Effects: decreased symtoms of gasstroesophageal reflus. Decreased


secretions of gastric acid.

Adverse reations\side effects: CNS confusion, dizziness, drowsiness,


headache, CV arrirhymias GI altered taste, , constipation, diarrhea,
nausea, GU decreased sperm count Endo gynecomastia Hemat Aplastic
anemia, anemia ,neutropenia.

Teaching Patient

•Advise patients taking OTC not to take maximum dose for more than
2 weeks without consulting a Health care professional.

•Inform patient smoking interferes with medication and to quit


smoking.

•May cause dissiness or drowsiness, and to alter activites such as


driving.

•Advise patient to avoid alcohol , asprin ,NSIDs, and foods that may
cause stomach up-set.

•Inform patient to increase fluid and fiber to minimize constipation

•Advise patient to report onset of black tarry stools, fever, sore throat
diarrhea, confusion rash to Health care professional.

Brand Name: Tylenol

Generic Name: acetaminophen


Classification: nonopoid analgesics, antipyretics

Use: mild pain and fever

Effects: reduces pain and fever through the CNS

Adverse reactions\side effects: GI hepatic failure, hepatotoxicity,


(overdose) GU renal failure (high doses\chronic use) Hemt neutropenia,
pancytopenia, leukopenia DERM rash , urticaria

Teaching Patient

•Advise patient to take med. as directed and do not exceed


recommended dose. Chronic use of more than 4g\day may lead to
hepatotoxicity, renal or cardiac damage. Adults should not take
longer than a 10 day period unless recommended by Health care
professional.

•Advise patients to avoid alcohol if taking more than an an occasional


1-2 doses and avoid taking concurrently with asprin or NSAID;

•Caution patients to check labels on all OTC products and avoid taking
more than one product containing acetaminophen at a time.

•Inform patients with diabetes that thid med.may alter blood glucose
levels.

•Consult Health care professional if this med. is not relieving pain or


fever.

D) What do you think Mr. Jones diagnosis is? What ia your


nursing diagnosis?

I think Mr. Jones may have a GI bleed because of the maroon stools and
sudden on set of dizziness and paleness. A postural B\P may also be the
result of blood loss.