NR 292 Jacqueline Presta & Pharmacotherapeutics Heather Lawrence

Personal and Medical History:

Married, lives with spouse. Medical history of hypothyroid, hypertension, osteoarthritis, and rheumatoid arthritis. Family history of heart issues, father passed away from heart attack. Currently in hospital post-surgery for total left hip replacement.

Nursing Diagnoses:

Risk for infection R/T broken skin as incision site. (no AEB is included with

“risk for” diagnoses)

Impaired physical mobility R/T surgical procedure AEB limited joint movement at the hip and difficulty

ambulating without assistance.

Acute pain R/T surgical procedure AEB

patients’ report of 6/10 pain.

Analysis of Individual variables influence on

medication administration:

Patient has no known allergies. Patient has

history of hypothyroidism and hypertension,

so watch for side effects of medications

affecting that. According to Pharmacology

and the Nursing Process - 7th Edition, with

increased age, medication absorption is

decreased due to decreased blood flow to

the tissues/organs and changes in gastric pH.

Be sure to factor in decreased absorption

when dosing medications. Patients’ health

beliefs, ethnicity (causation) and culture have

no noticeable influence on medication

administration at this time. Patient did not

admit to any use of alternative

therapies/herbal supplements.

Patient: L.M.

Female, age 61

NR 292 Jacqueline Presta & Pharmacotherapeutics Heather Lawrence

Medications & Nursing Implications

Generic/Trade Names

Dose

Route/ Frequency

Safety Considerations

Nursing Implications R/T Pharmacotherapeutics

Norco (Hydrocodone)

5mg PO Q4h

Patient may experience Dizziness, drowsiness, l ight-headedness, nausea, vomiting

Monitor vi tals, assess bowel movements and respiratory s tatus, and assess pain level, location and intensity. Complications could include respiratory depression and constipation. Do not use in addition with any other pain meds without fi rst checking with the provider. Take plenty of fluids with this medication, take with high fiber

foods and only take as directed.

Norvasc (Amlodipine)

5mg PO Dai ly

BP control , assess BP and electrolyte levels along

with s igns and symptoms of hypotension

Assess BP before administration, and if too low hold medication and notify provider. Inform the patient of the adverse effects such as hypotension, l ight-

headedness and dizziness. Take only as directed and monitor blood pressure daily. Take blood pressure before and 30 min a fter administration. Patient should include a low sodium, low fat diet and 6 small meals a day.

Synthroid (Levothyroxine Na)

25 mcg PO daily AC Watch for s igns and symptoms of hyperthyroidism including: chest pain,

diarrhea, fever or leg pain

Review lab work including TSH, T3, T4 and free T4 to assess that patient is gaining the full therapeutic effect of the medication. Assess vi tals before administration and hold if BP is high or i f patient i s tachycardic. Eat 6 small meals a day and take medication with plenty of fluids. Have patient follow up with primary care physician

to monitor thyroid levels.

Senokot (Senna/Docusate

sodium)

50mg PO nightly Do not give to patients experiencing diarrhea as

this could lead to compl ications of fluid and electrolyte imbalances

Monitor and assess bowel sounds, patterns, s tool consistency and frequency. Monitor patient’s fluid intake and output to ensure there’s no imbalances present.

Assess patient for abdominal bloating and discomfort. Review patients Na+ and K+ levels periodically. Contact provider for questions about additional OTC laxatives or other medications.

Protonix (Pantoprazole)

20mg PO nightly Assess the patient for s igns/symptoms of osteoarthritis &bone pain

Monitor Bowel sounds and abdominal discomfort. Monitor for patient complaints of leg pain. This medication is not meant for long term use and follow up appointments are highly recommended. This medication could potentially cause bone and joint pain; test pt’s ROM on a regular basis.

NR 292 Jacqueline Presta & Pharmacotherapeutics Heather Lawrence

References

Lewis, S. L., & Keitkemper, M.M., Dirksen, S. R., O’Brien, P. G., Bucher, L. (2007). Medical-surgical nursing. St. Louis, MO: Mosby, Inc.

Lilley, Collins, R., & Snyder. (2014). Pharmocology and the nursing process. St. Louis, MO: Mosby, Inc.