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Shadow Health Pharm John Larsen Patient Case 1
hello Oh, hey. im going to be administering your medications today, they are for Question 11/18/ 10:00 PM CST Statement your blood pressure. they might make you feel dizzy, but they should
be effective in about 30 minutes Oh, okay, thanks. are you in any pain today? Nah, I'm not in any pain right now. My knee was really hurting a few hours ago, probably because of the surgery. You don't get through a total knee replacement without some pain, huh? The last nurse gave me some pretty heavy stuff for it though, so, no, I'm not in pain. this medication will also effect your cholesterol levels, to help prevent stroke heart disease Oh, okay, thanks. do you have a history of liver disease? No, nothin' like that. are you having muscle tenderness?
10:03 PM
CST
Question 11/18/ 10:04 PM CST Statement 11/18/ 10:10 PM CST Question 11/18/ 10:10 PM CST Question 11/18/ 10:11 PM CST
No, nothin' like that. this medication can be taken with or without food Oh, okay, thanks. Have you had any allergic reactions to any medications in the past? Oh, hey. HAve you had any allergic reactions to any prescription medications in the past? I have an allergy to Codeine, I know that much. What happens when you take codeine? I think the last time I took it, I felt sick to my stomach and there was some vomiting involved. If you experience any allergic reactions or side effects, please make sure you let me know as soon as possible. Oh, okay, thanks. Some of the things we watch for are a rash, hives, coughing, wheezing, shortness of breath, swelling of your face, lips, tongue or throat. This could be from the Atorvastatin. Oh, okay, thanks. Statement 11/18/ 10:13 PM CST Question 11/20/ 12:41 PM CST Question 11/20/ 12:42 PM CST Question 11/20/ 12:42 PM CST Statement 11/20/ 12:43 PM CST Statement 11/20/ 12:45 PM CST
When was your last bowel movement? Oh, I probably went some time before bed last night. I didn't write it down in my diary or anything. Was it loose or solid? (No matching questions found.) Was it a normal bowel movement? (Clarified to Was your bowel movement normal?.) Yeah, it was normal. (Clarified to if my last bowel movement was normal.) Im your nurse Kara and I will be taking care of you today. Oh, hey. Can you confirm your name? It's John Larsen. Can't you see that on the forms? are you allergic to any medications? I have an allergy to codeine. So what's this? Question 11/20/ 1:45 PM CST Question 11/20/ 1:46 PM CST Question 11/20/ 1:46 PM CST Question 11/21/ 7:52 AM CST Question 11/21/ 7:59 AM CST Question 11/21/ 7:59 AM CST
This medication I am giving you is called Lisinopril. It helps lower your blood pressure. You only take this once a day with or without food. Oh, yeah, I take that one at home all the time.....I guess I was hoping you'd be bringing breakfast, not just pills! But I guess I'm not supposed to take this with food. Is that right? You can take this with or without food. Oh, okay. I guess I should have known that! And I have to ask. .I'm sure you're giving me the right stuff. .but this is okay to take with the blood thinners they're giving me, right? It is safe to take this medication to lower your blood pressure while also taking a blood thinner. Well, good. I've never had to take this many medications before so that just makes me kind of nervous. So, this is the Lipitor then? Yes. It is the generic brand for Atorvastatin. It will help lower your bad cholesterol levels and raise the good ones. It works by reducing the amount of cholesterol made by the liver. Oh sure, sure. I don't always keep the names straight. It's never caused problems for me before. So, I just keep taking this stuff and it'll do its magic for my cholesterol, huh? If you want to improve the outcomes of this medication, try to eat a heart healthy diet, exercise daily, Keep your weight within a normal healthy range as instructed by your doctor, avoid smoking and drinking alcohol. Isn't that always the way? All right, thanks, nurse. Statement 11/21/ 8:05 AM CST Statement 11/21/ 8:05 AM CST Statement 11/21/ 8:07 AM CST Statement 11/21/ 8:09 AM CST Statement 11/21/ 8:13 AM CST
CST
Nah, I'm not in any pain right now. My knee was really hurting a few hours ago, probably because of the surgery. You don't get through a total knee replacement without some pain, huh? The last nurse gave me some pretty heavy stuff for it though, so, no, I'm not in pain. Can you rate your pain level on a scale from 0-10? (Clarified to Can you rate your current pain level on a scale of 0 to 10?.) The last nurse gave me some pretty heavy-duty stuff for my pain. It's all the way down to a zero at this point--I'm not feeling it at all. (Clarified to how I would rate my pain on a scale.) Question 11/21/ 8:20 AM CST
Lisinopril: Indications
What is this? Let the patient know which medication you are giving, and what it is intended to treat. Student Response Model Response This medication I am giving you is called Lisinopril. It helps lower your blood pressure. You only take this once a day with or without food. This is lisinopril, which you are getting to help control your high blood pressure.
Lisinopril: Drug-Food Interactions
I guess I'm not supposed to take this with food. Is that right? This is an opportunity to teach the patient whether this medication should be taken with food. Student ResponseModel Response You can take this with or without food. Lisinopril can actually be taken with or without food, whatever fits your routine best. What is most important is to take this at the same time everyday.
Lisinopril: Drug-Drug Interactions
Is it okay to take this with the blood thinners they're giving me? Inform your patient whether there is an interaction between these drugs. Student Response Model Response I’m glad you asked. There is no interaction between these drugs, so It is safe to take this medication to lower your blood pressure while also taking a blood thinner. it’s okay to take them together. It’s actually very important to keep your high blood pressure well controlled while you are receiving blood thinners like warfarin and enoxaparin, which means you’ll want to keep taking your lisinopril regularly while you are on those medications.
Atorvastatin: Indications
Patient Assessment
Finding: Asked for patient identification (Found) Pro Tip: Proper identification is critical for the protection of your patient. It is recommended to check two identifiers before interacting with the patient. Example Question: Can you confirm your name? Finding: Checked vitals before giving medication (Found) Pro Tip: Assessing the patient's vitals may impact your care plan and the safe administration of ordered medications. Example Question: Finding: Asked current breathing status (Available) Pro Tip: Difficulty breathing is one of the adverse effects of enoxaparin, a medication the patient received prior to this assessment. Example Question: How is your breathing? Finding: Asked about medication allergies (Found) Pro Tip: Patients may have allergies that are not included in their documentation, so asking for verbal confirmation can prevent serious adverse events. Example Question: Do you have any allergies to medications? Finding: Asked about current pain (Found) Pro Tip: This patient has been ordered pain medication. Assessing for pain is vital to determining the efficacy of prior treatment and the need for further analgesic intervention.
Example Question: Are you having pain right now? Finding: Ask about allergic reaction to codeine (Found) Pro Tip: Assessing the reaction type and severity of a stated allergy may help inform your care plan and determine which medications are appropriate to administer. Example Question: What is your reaction to codeine? Finding: Asked about general experience with side effects (Found) Pro Tip: When administering routine medications, understanding the side effects that the patient generally experiences can shape your care plan to ensure patient safety and comfort. Example Question: Have you experienced medication side effects before? Finding: Asked about thirst (Found) Pro Tip: Thirst can be an important indicator of the patient's general comfort and recent intake. Excessive thirst may be an indicator of dehydration, which is a symptom of rhabdomyolysis, a potentially life-threatening adverse effect associated with atorvastatin. Example Question: Are you thirsty? Finding: Checked intake and output before giving medication (Found) Pro Tip: Assessing the patient's intake and output may impact your care plan and the safe administration of ordered medications. Example Question: Finding: Asked about management of prescribed medications
Finding: Asked about rash (Available) Pro Tip: Rashes are one of the most common adverse effects associated with atorvastatin. Example Question: Have you noticed a rash? Finding: Checked intake and output after giving medication (Found) Pro Tip: Assessing the patient's intake and output may impact your care plan and the safe administration of ordered medications. Example Question: Finding: Asked about heart palpitations (Available) Pro Tip: An increased heart rate, resulting in heart palpitations, is a symptom of agranulocytosis and rhabdomyolysis, which is a potentially life-threatening adverse effect associated with lisinopril. Example Question: Have you felt your heart beating abnormally? Finding: Asked about weakness (Available) Pro Tip: Weakness is an adverse effect associated with atorvastatin. Example Question: Do you feel weak? Finding: Asked about vomiting (Available) Pro Tip: Vomiting is a symptom that may be an indicator of rhabdomyolysis, which is a potentially life-threatening adverse effect associated with atorvastatin. Example Question: Have you been vomiting? Finding:
Asked about taste disturbances (Available) Pro Tip: Taste disturbance, especially bitter taste, is one of the most common adverse effects associated with lisinopril. Example Question: Have you had changes in taste? Finding: Asked about constipation (Available) Pro Tip: Constipation is one of the most common adverse effects associated with atorvastatin. Example Question: Are you feeling constipated? Finding: Asked about cough (Available) Pro Tip: Cough is one of the most common adverse effects associated with lisinopril. Example Question: Have you been coughing? Finding: Asked about dizziness (Available) Pro Tip: Dizziness is a common symptom of hypotension, which is one of the most common adverse effects associated with lisinopril. Example Question: Are you dizzy right now? Finding: Asked about fatigue (Available) Pro Tip: Fatigue is a common symptom of hypotension, which is one of the most common adverse effects associated with lisinopril. Example Question: Do you feel tired? Finding: Asked about diarrhea
Student Documentation Model Documentation Hyperlipidemia & HTN. Provided)
Notes
Student Documentation Model Documentation Patient needs to be monitored for any type of allergic reaction such as upset stomach, vomitting, rash, hives, confusion, coughing, wheezing, extreme joint pain, not able to sleep, sudden memory loss, swelling of the face, lips, tongue, throat. Watch for hepototoxicity, lowered BP. Patient not complaining of thirst, need to watch for dehydration and I/O levels have dropped in the past 24 hrs. Possible need for IV fluids to improve intake and output. Review Questions
1. A patient has been given a new prescription for warfarin. Which
statement indicates the need for additional teaching?
Correct: Aspirin increases the effect of warfarin and may cause a higher risk of bleeding; the patient should not take aspirin while on warfarin therapy. All other statements are consistent with safe use of warfarin. I will use a soft toothbrush while taking this medication I can eat moderate amounts of foods with vitamin K on a regular basis I should report unusual bleeding to my doctor I can keep taking a daily aspirin to protect against heart disease (Correct Response)
2. What is the nurse’s priority assessment for a patient receiving
heparin treatment?
Correct: While all options are relevant assessments, bruising or unusual bleeding can be a life threatening adverse effect of heparin treatment, and therefore needs to be the nurse’s priority. Assess for elevated liver enzymes Assess for inflammation at the injection site Assess for bruising or unusual bleeding (Correct Response) Assess aPTT levels
3. A patient who has been receiving oxycodone therapy for chronic pain
reports no relief after a 10mg dose. The patient is exhibiting:
Correct: Prolonged use of opioid therapy can lead to tolerance, where a patient requires a higher dose of the drug to achieve an analgesic effect. Opioid addiction Opioid tolerance (Correct Response) Drug-seeking behavior Paradoxical CNS stimulation
4. Which meal choice exhibits a lack of understanding of atorvastatin’s drug-
food interactions?
Correct: Grapefruit juice is contraindicated for patients on statin therapy and it may increase drug levels in the blood and increase the likelihood of rhabdomyolysis. None of the other choices interact harmfully with atorvastatin. Orange juice, banana, and toast Grapefruit juice and yogurt (Correct Response) Orange juice, bacon, and eggs Coffee and croissant Reflections
1. Review the model patient teaching responses above and reflect on how
your responses were similar or different.
Student Response: I offered extra information on the indications of lisinopril. I missed some opportunities on drug-food- and drug-drug interactions by not going further into depth. I offered all the necessary information on taking atorvastatin, however, when suggesting eating a heart healthy diet, I could have included suggetions such as foods low in fats and carbohydrates.
2. Explain the clinical reasoning behind the decisions and tasks you made
during interactions with the patient.
Student Response: The clinical reasoning decisions I made were to improve my patient's health, knowledge and understanding, and safety.
3. Identify how your performance could be improved and how you can apply
“lessons learned” within the assignment as a whole to your professional
nursing practice.
