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1. Nursing Pharmacology Discussions
Nursing Pharmacology DiscussionsORDER HERE FOR ORIGINAL, PLAGIARISM-FREE
PAPERS ON Nursing Pharmacology DiscussionsPlease use the attached document to answer
the discussion questions regarding each case (2-3 questions each).Nursing Pharmacology
Discussionsattachment_1Unformatted Attachment PreviewMr. Toua Xiong arrived in the
clinic 1 hour ago, accompanied by his wife, with complaints of difficulty swallowing and
pain in his throat and mouth. Dr. Sabin has not yet seen the patient. Mr. Xiong is a 64-year-
old male. He has a history of COPD, diagnosed 5 years ago, and he has been to the unit
before, for chronic management of his COPD. Mr. Xiong’s wife says her husband is
complaining of difficulty swallowing and pain in his throat and mouth, and that it has
bothered him when eating or drinking for the last 3 to 4 days. He brought both of his
inhalers and his portable oxygen tank from home, and states that he has been taking his
medication as prescribed. We have taken a blood sample for ABG, CBC, and BMP as ordered;
the results are pending. At his arrival his vital signs were: BP: 104/62 mmHg, HR: 97/min,
RR: 19/min, and SpO2 91%. No other assessments have been completed at this point. Mr.
Xiong is waiting in exam room 2. Dr. Sabin will come to see the patient soon but asks that
you take the patient history and complete the physical assessment now. Also, he said to
monitor the SpO2 and titrate to keep it above 90%, but not to give more than 2 L of
oxygen/min. Answer the following questions based on the information above. Respond in
the corresponding discussion post. 1. The patients SpO2 is 91%. Is this normal or abnormal
given the patients condition and medical history? 2. What would be your main nursing
diagnosis for this patient? 3. Why does the Dr not want you to give the patient more than 2 L
of oxygen/min? The patient, Danielle Young Bear, came to the clinic today with complaints
of a persistent cough and fatigue that have lasted for 2 weeks. It started as a common cold,
but she was concerned that it was something more serious since the cough and fatigue have
not resolved yet. The signs and symptoms are consistent with the aftermath of a common
cold, so this is not a big concern. However, she is taking several different prescription drugs
and is also self-medicating with OTC medication and using herbal therapies; I’m concerned
about potential drug interactions. Nursing Pharmacology DiscussionsMs. Young Bear is a
32-year-old Native American female. She is not one of our regular patients, but her usual
provider is on vacation so she was referred to our clinic. She has a history of low back pain
acquired at her job as a construction worker, and she is also being medicated for
depression. Ms. Young Bear is alert and oriented. The lung sounds are clear bilaterally and
there is a bit of redness in the throat. I also checked her back and there are no signs of

2. serious injury. I have another patient waiting, so I would like you to take vital signs and do a
focused pain assessment and assess neurological status. Please also make sure to go
through all of her medications, including prescription medications, OTC medications, and
herbal therapies, and perform medication reconciliation. Please notify me with your
findings when you are done. Answer the following questions based on the information
above in the corresponding discussion posts: 1. Why should you be concerned the patient is
taking herbal therapies? 2. What questions will you ask the patient to assess her
neurological status? 3. Is there anything you want to ask the patient about her cough?
Explain. Yoa Li Summary Yoa Li is a 26-year-old male who was transferred to our unit this
morning at 0630 from the PACU. He had an open emergency appendectomy during the
night and was in the recovery room for 1.5 hours. He has no drug allergies, and is nothing by
mouth (NPO) except for ice chips. While in recovery, he complained of pain 7/10 twice, and
was given 4 mg of morphine by slow IV push. A PCA pump was started right before he was
transferred to us, and he was given a standard loading dose of 2 mg IV bolus. The provider
administered a morphine bolus 5 mg IV push at 1500 as Mr. Li was complaining about
increasing pain. In the last 9 hours, he has had a total of 60 mg of morphine. I completed
vital signs, pain, and sedation assessment on the patient right after the morphine bolus was
administered 30 minutes ago. His vital signs were: BP: 116/62 mmHg, HR: 72/min, RR:
12/min, and SpO2 94%. He rated his pain as 3/10 and he was sleepy but easily wakened.
However, he was complaining of increasing nausea. I administered 10 mg of IV
prochlorperazine as ordered prn for nausea. The patient is due for a follow-up check on
vital signs and sedation level. Continuing patient and family education on the use of PCA is
also a good idea. Answer the following questions in the Pre Conference Discussion of Yoa Li
based on the above data: 1. What are potential nursing diagnosis for this patient based on
the above information? 2. What will you want to monitor for in this patient? 3. How would
you educate the family and patient on the use of the PCA? Rachael Heidebrink Summary I
have taken care of the patient, Rachael Heidebrink, during the night and I would like to give
you a report on her. Ms. Heidebrink suffered a pulmonary embolism 2 days ago and she is
currently on IV heparin therapy. Nursing Pharmacology DiscussionsMs. Heidebrink is a 22-
year-old white female who was admitted 4 days ago with a fractured right greater
trochanter sustained in a motorcycle accident. A right hip hemiarthroplasty was performed
3 days ago. On post-op day 1 she started complaining of severe shortness of breath, and her
SpO2 dropped to 88% on room air. A VQ scan revealed a pulmonary embolism in the left
lung, and she was then started on a heparin drip. Ms. Heidebrink’s SpO2 is 93% on 2 L of
oxygen via nasal cannula. She has an IV line in her right arm with the heparin drip infusing
at 14.2 mL/hr. She is rating her pain as 2 out of 10 right now. She had oral pain medication
3 hours ago. She has a urinary catheter draining clear yellow urine. Ultrasound scanning
shows no sign of deep vein thrombosis (DVT), and her right hip dressing is dry and intact.
This morning Dr. Lindley wrote orders for anticoagulation bridge therapy. They are in the
patient chart and will need to be initiated. Ms. Heidebrink also requires patient education
about the change from IV to oral anticoagulant therapy. The aPPT results just came back,
and you should check the orders to see if the heparin drip needs to be adjusted. Answer the
following questions about Rachael Heidibringk in the corresponding discussion posting: 1.

3. Why was patient Rachael put on an heparin drip? 2. Ms.Heidebrink’s anticoagulant
medication is being changed from IV to oral. What oral anticoagulant do you anticipate
being ordered? What patient education do you want to give the patient regarding the oral
medication? Patient Mary Richards I took care of Ms. Richards in the emergency department
and I would like to give you a report on her. Ms. Richards is an 82-year-old African
American female who was brought to the emergency department by her son this evening
when he found her confused and complaining of trouble with her vision. Ms. Richards has
been ill for several days with complaints of nausea, dizziness, and weakness. Ms. Richards
has a history of hypertension, diagnosed 40 years ago, and heart failure, diagnosed 30 years
ago. Her current medications include furosemide, amlodipine, and digoxin. Ms. Richards is
complaining of slight abdominal pain and nausea. She has not vomited. Her last set of vitals
are: temperature: 37.1°C (98.7°F), pulse: 58/min, respirations: 22/min, blood pressure:
96/54 mmHg, and an SpO2 of 96% on room air. She has an IV of lactated Ringer’s infusing at
100 mL/hr through a 20-gauge IV catheter in her right arm. A blood sample has been drawn
for evaluation of her digoxin level. Ms. Richards is being admitted for observation and is due
for a vital signs check. Lab results just came back and should be reviewed. Please notify the
provider about the results. Please answer the following questions about Ms. Richards based
on the above information. Answer in the corresponding discussion post in the discussion
section. 1. Based on her symptoms, what do you think Ms. Richards medical diagnosis is? 2.
Based on her current pulse of 58. Would you administer her digoxin dose or hold it? 3. Are
there any other tests you would like the physician to order? Patient B, Suzanne Morris The
patient, Suzanne Morris, is a 43-year-old white female presenting with complaints of
increasing abdominal cramps, stomach ache, and diarrhea that started 4 days ago. Ms.
Morris arrived by private vehicle and has been here for 1 hour. Ms. Morris was diagnosed
10 days ago with peptic ulcer disease and prescribed triple combination therapy of
amoxicillin, clarithromycin, and pantoprazole for H. pylori. She has been consistently taking
the medications. Ms. Morris does not have any other significant previous medical or surgical
history. Ms. Morris is awake and alert but complains of cramping, stomachache, and
diarrhea. Nursing Pharmacology DiscussionsHer last set of vital signs was: BP: 101/61
mmHg, HR: 114/min, RR: 17/min, and SpO2 at 95% on room air. I started a 20-gauge IV in
her right arm and gave her a 500 mL normal saline bolus at arrival per provider’s orders as
her systolic blood pressure was less than 100 mmHg. Normal saline is now running at 100
mL/hr. I have also taken a blood sample and a stool sample to confirm suspected C. difficile
infection. It has been sent to the lab. The provider put orders in the patient’s chart based on
the initial assessments. The patient is due for vital signs and other assessments that you will
need to implement. You should keep an eye on her blood pressure and call the provider if
her systolic pressure drops to less than 100 mmHg. Also, be aware that she is on contact
precautions. Answer the following questions based on the patient Suzanne Morris. 1. What
medication treatment would you recommend for the treatment of CDIFF? 2. The bolus to
increase her BP is not working. What medications do you suggest to the Dr to increase her
blood pressure? Mr. Hadley came to the ED with his wife 1 hour ago on referral from his
provider. He has a wound infection on his lower right leg, which tested positive for MRSA
bacteria. He has moderate pain and is very frustrated that the infection is not healing. Mr.

4. Hadley is a 78-year-old Caucasian male who has been taking oral amoxicillin for 3 days, as
prescribed by his provider, to treat a case of cellulitis caused by a feral cat bite. His provider
called him this morning with the lab results showing positive for MRSA bacteria. The wound
was also not getting better, and he was experiencing more pain, redness, and swelling of his
leg. Mr. Hadley is alert and oriented x 3, and appears ill. There is a cat bite on his lower right
leg. The bite has perforated the skin, and the surrounding skin is red and swollen. The
wound care team will manage the wound care and have ordered no bandages. I assessed his
pain and vital signs 30 minutes ago. Mr. Hadley reported a pain level of 5 out of 10, so the
provider ordered a one-time dose of hydrocodone 5 mg/acetaminophen 325 mg, and
acetaminophen 650-mg tablets to manage pain subsequently. Vitals signs were: BP: 125/85,
HR: 91, RR: 19/min, SpO2 at 98% on room air, and temperature: 38.9oC (102oF). Nursing
Pharmacology DiscussionsAn IV has been inserted in his right forearm with lactated
Ringer’s infusing at a rate of 125 mL/hr. The patient is due for vital signs check and pain
assessment. Beware that Mr. Hadley is in contact precautions. Lab results just came back
and should be reviewed. The antibiotics were also just delivered from the pharmacy and
should be started, and Mr. Hadley and his wife will need patient education on the need for
IV antibiotic therapy. Answer the following questions based on the information above on
patient Harry Hadley. Answer in the corresponding discussion post in the discussion
section. 1. Mr. Hadley is on contact precautions. Why? What will you wear into the room? 2.
Mr. Hadley is already ordered oral Amoxicillin. Why do you think the Dr ordered IV
antibiotic therapy? 3. If the doctor orders blood cultures, should they be drawn before or
after antibiotic therapy is started? Patient B Juan Carlos The patient, Juan Carlos, has just
returned after surgical debridement of a diabetic foot ulcer on his right great toe. The
procedure was done under local anesthesia, and I would like to give you a report on him
before I hand him over to you. Mr. Carlos is a 52-year-old Hispanic male with a history of
type 2 diabetes mellitus, hypertension, and hyperlipidemia who presented in the emergency
department last night complaining of pain in a wound on his right great toe. He states he
dropped a large rock on his toe several weeks ago and sustained an open wound. The pain
had been increasing over the last days, and he was unable to get the pain under control. He
was then admitted for surgical debridement of what showed to be a diabetic ulcer and to
receive antibiotic treatment. This morning at 0730 Mr. Carlos’s blood sugar was 225 and he
received 4 units of insulin aspart, a sliding scale insulin, along with his regular medications
before the surgery. It is all in the MAR. He also received his antibiotic treatment this
morning as prescribed. The surgery was performed under local anesthesia. He was given
one tablet of oxycodone 5 mg/acetaminophen 325 mg for his pain after surgery. He now
reports his pain to be 3 out of 10. He has a dressing on the toe and a right forearm IV that is
saline locked. The dressing on his toe is dry and intact. He seems to be doing well, and his
wife has just been here to see him. He is due for a check of blood sugar level and vital signs.
The provider has just updated the orders, so please take a look at the patient chart to see all
details. Answer the following questions in the corresponding discussion posting: 1. Will the
patient’s high blood sugars and history of diabetes have any effect on his recovery? 2.
Discuss the different types of sliding scale insulins. …Nursing Pharmacology Discussions