A female patient diagnosed with myasthenia gravis comes to the emergency department (ED) with muscle weakness. The nurse, during the history, determines the patient has been taking double doses of pyridostigmine over the past several days.
- What would the nurses’ assessment focus on?
- What nursing diagnosis would the nurse identify?
- What nursing interventions could be used in this diagnosis?
Cite and reference any source used to answer this question.
A 64 year old woman presents with the complaint of stiff and painful joints in both hands. The health care provider has prescribed celebrex. The patient education for this condition should include the potential adverse reactions to the class of medications and when to notify the provider in relationship to these adverse reactions. The patient should also receive information on non-pharmacologic methods to reduce symptoms of the condition.
- Determine the drug classification.
- Why are the medications in this drug class the preferred drugs for the treatment of inflammation?
- What should the nurse assess prior to the patient receiving any drug from this classification?
Cite and reference any source used to answer this question.
An 88 year old patient with impaired renal function has been diagnosed with a urinary tract infection (UTI). The patient has been receiving sulfonamide, but his primary health care provider has determined that this is not an appropriate course of treatment for him. Examine the factors that support this decision and the potential adverse effects that might be expected if the treatment continues.
- What are the potential adverse effects of sulfonamides?
- What is the nurses’ role in sulfonamide therapy?
- How does sulfonamide therapy affect the patient’s intake of fluids?
Cite and reference any sources used to answer this question.
A male patient is HIV positive and was told that combination drug therapy would be more effective for this infection than a single drug. The nurse should teach the patient the rationale behind this type of drug therapy, the class of the drugs, and their individual actions. The nurse must remember that patient education must be explained in terms that the patient can understand.
- Why is combination drug therapy more effective against HIV?
- What are the drugs classes used in the combination therapy?
- What is the action of each drug?
Cite and reference any source used to answer this question.
A 57 year old obese male with a history of two heart attacks over the past 3 years has been treated with antihypertensives for hypertension. LDL cholesterol was recently measured at 109mg/dL and triglyercides were 900mg/dL. The patient does not smoke and walks 0.25 mile twice a week.
- What data can you identify from the initial assessment that would support a nursing diagnosis of Deficient Knowledge related to disease process and lifestyle implications of coronary artery disease?
- Does the clinical history warrant the implementation of antihyperlipidemic therapy? Why?
- Considering this patient’s history, what lifestyle suggestions might the nurse offer?
Cite and reference any sources used to respond to this question.
A 75 year old female has been taking enalapril and chlorothiazide for hypertension for the past 2 years. She is very compliant, taking walks daily, watching her salt intake, and eating plenty of potassium-rich foods such as bananas. Two weeks ago, her health care provider increased her dose of enalapril and switched her to spironolactone instead of chlorothiazide. She is now in the office complaining that she gets dizzy and falls over every morning when she gets out of bed, and that she feels like her heart is racing when she walks. Although her blood pressure is normal, she wants to be switched back to her previous medications.
- What assessment data lead the nurse to understand the potential cause of her dizziness? What teaching might be done to help solve this problem?
- An ECG on this patient is normal. Is there anything in her history that might be responsible for her heart complaints? What assessment information would help the nurse define her problem?
- Is it necessary to change this patient’s medication, or is it possible that her complaints could be resolved through patient education?
Cite and reference any sources used to respond to this question.
A male has just been diagnosed with early heart failure and his health care provider has prescribed hydrochlorothiazide, atorvastatin, and lisinopril. His blood pressure is slightly elevated, his blood cholestrol is marginally high, and he has stenosis of the mitral valve that seems to be worsening. Although the patient is not an athletic person, he likes to take long walks after dinner. He confides that at his age of 60 he has no intention of taking any of the medications, but intends to try Chinese herbal therapy.
- The nurse is developing a teaching plan for this patient. The nurse wants to explain the rationale for each of the medications. What information will the nurse include in the teaching plan?
- How does the nurse assess the patient’s need for alternative therapy, and what is the best response to his concern about prescription drugs?
- Knowing that health promotion is an essential nursing action, what lifestyle changes would the nurse suggest to this patient to improve his cardiac health?
Cite and reference any sources used to answer this question.
A 72 year old woman who has been treated several times for chronic heart failure, hypertension, and angina presents with a complaint of frequent and intense anginal pain. She has chest pain with minor exertion and headaches with the use of prn nitroglycerine. Her current medications are isosorbic dinitrate, nitroglyercin, atenolol, and amlodipine. Physical exam reveals the patient is alert, oriented, BP 164/92 mm/Hg, pulse 66 regular, respirations 28, skin cool, strength equal in all extremities, edema in lower extremities, and a weight gain of 7lbs in 3 weeks.
- After analysis of this patient situation, what nursing diagnoses will the nurse identify?
- What assessment data support the possibility of side effects from amlodipine?
- Why are the nitrates not relieving the patient’s pain?
Cite and reference any sources used to answer this question.
A 58-year-old male comes to the dialysis clinic three times a week. He receives epogen injections after each treatment.
- What teaching can the nurse provide to this patient regarding why he needs to receive erythropoietin?
- What adverse effects of erythropoietin should be assessed during each clinic visit?
- One of the nurse’s goals for this patient is “to promote independence regarding self-care.” What patient education is necessary for him?
Cite and reference any sources used to respond to this question.
A 50 year old man is being admitted to the hospital for the third time this year. He has a history of alcohol abuse, diabetes, and heart failure. He was brought to the hospital with a complaint of abdominal pain and vomiting bright red blood. His diagnosis is perforated gastric ulcer. The patient states that he has been taking warfarin for an irregular heartbeat and Glucophage for diabetes.
- With this limited admission history, what factors might have contributed to this patient’s acute bleeding episode?
- What nursing diagnoses and patient outcomes would be essential in this situation?
- What medications might be ordered for this patient?
Cite and reference any sources used to answer this question.
A male has been admitted to the hospital after being treated in the emergency department (ED) for an exacerbation of asthma. The patients states he has been on beclomethasone inhaler and an oral theophylline preparation for about 2 months. His last exacerbation of asthma was about 2 months ago, and he claims to be compliant with his medications. About a week ago, the patient started having a persistent cough, productive of green thick sputum. He has been short of breath and has been wheezing in the ED. The physician prescribes lorazepam and metaproterenol while the patient is in the ED. The nurse has chosen a nursing diagnosis of Ineffective Airway Clearance due to an infection process causing increased mucus production.
- Which assessment would indicate a possible infection and ineffective airway clearance?
- Which nursing interventions would need to be completed for the diagnosis of Ineffective Airway Clearance?
- Give the therapeutic rationales for the two drugs taken by the patient prior to the ED visit.
- Give the therapeutic rationales for the two drugs taken by the patient during the ED visit.
Cite and reference any sources used to respond to this question.
An elderly male is admitted with a recurrence of gastric ulcers. His wife tells you that he has been taking cimetidine as an over the counter (OTC) preparation. She tells you that he no longer complains of the gnawing pain in his stomach, but has become increasingly confused within the past 3 days. During the nurses’ initial assessment the nurse notes that the patient is oriented to person and time, but not place. He is being placed on omeprazole and antacids during this visit. In preparation for patient education answer the following questions:
- What would be an appropriate nursing diagnosis for this couple?
- What basic instruction is necessary in relation to OTC medications?
- What does this patient need to know about the timing of his medications?
Cite and reference any source used to answer this question.
A female patient is diabetic and is also a candidate for thyroid therapy because of her hypothyroid disorder. Examples of medications she night take include levothyroxine sodium, liothyronine, and liotix.
- In planning proper care, what complications of using these drugs simultaneously would the nurse consider?
- What nursing interventions would be appropriate?
Cite and reference any sources used to answer this question.
A 50 year old man is being admitted to the hospital for the third time this year. He has a history of alcohol abuse, diabetes, and heart failure. He was brought to the hospital with a complaint of abdominal pain and vomiting bright red blood. His diagnosis is perforated gastric ulcer. The patient states that he has been taking warfarin for an irregular heartbeat and Glucophage for diabetes.
- With this limited admission history, what factors might have contributed to this patient’s acute bleeding episode?
- What nursing diagnoses and patient outcomes would be essential in this situation?
- What medications might be ordered for this patient?
Cite and reference any sources used to answer this question.
Over the past 5 years, a 35 year old firefighter who smokes and is somewhat overweight has begun to develop slightly elevated blood pressure as determined by annual exams. He feels as if he should lose weight and is concerned about his energy level. At his last clinic vist, lab results revealed fasting blood glucose levels at 140 mg/dL. His blood pressure was 150/90 mm/Hg. The patient was not taking medications for any reported disorder.
- What would be expected signs of hyperglycemia in this patient?
- In planning this patient’s nursing treatment, what preliminary assessments would be needed?
- If this patient were to require oral hypoglycemic therapy, on which important teaching areas should the nurse focus?
Cite and reference any source used to answer this question.
A 70 year old male patient has diabetes mellitus type II. The nurse is performing an initial assessment.
- In planning this patient’s nursing care, which kind of diabetic therapy would he likely require?
- Explain the patient teaching needed for this patient, including difficulties that may arise.
Cite and reference any source used to answer this question.
