Description
there are 3 concept map in the med surg class, the practice class
there are 3 concept map, you can checks , choose the patients
and the 7 case studies are in doc sharing
please let me know if you see it
Explanation & Answer
Hello there,First, I am sending to you the study cases which are the same as the one sent to your classmate since you stated that you don't have to submit them.
An explanation can be represented by the fact that the patient didn't clearly understand what
amount of sodium he is allowed to intake. She might have avvoided the usable salt for cooking
but not other foods which are high in Na such as fast foods. Nevertheless, the quantity of salt
which is allowed might have not been understood by the patient.She might have thought that
she followed the instructions given by the nurse, but it was not sure which instructions were that.
More specific details should be offered to the patient.
The medication which contributed to the heart failure symptoms is Pioglitazone ( part of
the Thiazolidinediones class) which is known of causing weight gain and also peripheral
edem.The medication is frequently used in keeping under control diabetes type II.
Correct answer: A,B,D
A major way it acts is by stopping the formation of angiotensin II which
is one of the strongest vasoconstrictors.As a result of this, systemic
vasodilatation takes places. This will reduce the volume which reaches
the heart (preload) and also the volume which the heart will eject
(afterload).
The explanation for this is represented by the fact that the patient has edema. This
means that the patient is overloaded with fluid and the physician has to decrease the
volume as soon as possible. More than this, heart failure can reduce the amount of
blood which reaches the gastrointestinal system which can lead to slower absorption in
case of P.O medication which can ultimately reduce the effectiveness of the oral drug.
1. There will be an increase in the output of urine as furosemide is a diuretic => more urine is
eliminated. As a nurse, it is important to assess the intake and output of liquids for the patient
2. As the edema is reduced, is expected for the patient to lose weight. This is a parameter which
can be followed especially in case of oral dosages for longer periods of times.
3. Decreases shortness of breath => this is a subjective symptom which can be notified once
the excess fluid is eliminated.
4. Assess the blood pressure of the patient. In some situation, diuretics can also be used for
controlling hypertension which means that this parameter should also be checked
Correct Answer : A,B,D,E
Correct Answer: D
Answer: C
Answer : A
Normal serum potassium level is equal to 3.5 - 5.2 mEq/L. In this state of hypokalemia, the
drug will be able to easily bind to the ATPase pump where it will be able to have a stronger
inhibitory effect.
1 mcg = 0.001 mg
125 mcg = 0.001 * 125 mg
125 mcg =0.125 mg
Euvolemic State= Normal fluid level in the body. It is important to
maintain the normal weight value, monitor intake and outtake and also
the presence of symptoms (such as dyspnea). It is also important to
monitor vital signs such as blood pressure and heartbeat
It is important to focus on elements which are realistic and take into
consideration the quality of life of a patient. It is useless to ask for
exaggerated requests which will lower the quality of life. MAWDS
Instructions:
M= The medications need to be taken as instructed and avoid
forgetting taking the pill. It is better if the patient is able to take the
medication at the same time each day.
Activity= Try to stay active but don't exaggerate. Engage in physical
activity as much as you are able to without pushing yourself.
Weight: Weight yourself regularly and determine if you gain or lose
any weight as this can be an indicator that the medication is too
strong or not efficient.
Diet: Follow the low salt diet which reduces blood pressure and the
effort the heart has to undergo and also try to limit fluid intake to < 2
quarter/day due to the diuretic education.
Symptoms: Check for symptoms and report early in case of changes.
ARDS stands for Acute respiratory distress syndrome which represents an
acute inflammation at the level of the lungs which can lead to hypoxemia and
edema.
Risk factors which are associated to ARDS are direct lung injury (pulmonary contusion,pneumonia, aspiration of gastric
content, inhalation injury) or indirect injuries (multiple trauma, cardiopulmonary bypass, drug overdose, blood product
transfusion,sepsis).The patient presents the following risk factors: multiple trauma due to accident ( right hemothorax
which prevents the expansion of lung; pneumothorax - the lung is no ability to perform normally, fractured spleen - can
lead to internal bleeding, multiple liver lacerations - can cause shock + sepsis, fracture of legs can lead to fat
embolism).Another cause can be represented by the amount of trasfusion she received.
Additional information should include:
1.Assessment of lungs (such as the presence of any sounds and their pattern)
2. Assessment of patient feed method ( what type of food, amount and how frequently)
3.Assessment of the Foley output ( the frequency of it, the amount and its look)
4. Determining the current pain level of the patient
5. Determine the list of medications for the patient and how frequently she should take them.
6. Determine if there are any tests which need to be conducted periodically.
Crackles are defined as being the rattling sounds which can be heard either in one
of the pulmonary lobes or both. They are heard with the stethoscope during
inhalation. The sound is produced by the small airways or the alveoli which are
collapsed due to the presence of exudation- fluid. In our case, this can be a first
indicator of ARDS as inflammation can lead to the presence of exudation which can
cause the crackles.
The statement is possible to be valid because since crackles can be caused
by fluid accumulation, it is thought that coughing can remove the excess fluid.
Even so, in case of edema or ARDS the crackles won't clear after a simple
cough.
Furosemide acts as a diuretic drug which means its role is to remove excess fluid from the body. A
way through which this medication can relieve the patient's crackled is by removing the fluids from the
lungs and ensuring that the secretions which are in her airways get dried. It is expected that under the
administration of furosemide, the crackles to eventually subside.
Check Blood pressure (drug can reduce blood pressure), check potassium level and administer extra
dose if required as drug can remove potassium from the body,
The following electrolytes are decreased: Na, K, Cl, CaEven so, the most important parameters
are represented by creatinine (normal 0.6-1.1 mg/dl) and BUN (normal 10-20 mg/dl). As can be
seen in the case of the patient, but these values are increased. The problem is that furosemide
acts at the level of the loop of the kidney. In case the kidney is damaged, this medication can
increase the damage and because of that, it should be avoided.
I would administer some potassium to tbe patient and closley monitor the kidney function.
The potassium chloride is efficient in increasing the value of potassium before furosemide
administration. It is important that the nurse take into consideration that these medications need
to be administered at a controlled rate. When administering KCL and calcium gluconate, the
nurse should do it slowly and constantly monitoring the heart rhythm and rate of the patient for
any modifications. Hyperkalemia can lead to muscle cramps and decreased cardiac contractility
which can have severe consequences.
Medication borrow is indeed an illegal action because it can lead to medication errors. In case the
vial was already opened, it is important to administer it to the patient as it is no use in storing it again.
In all circumstances, all the steps need to be documented and it is essential to inform the physician
about this situation. By keeping quiet and not declaring the incident, there is a very high risk of
medication error which can lead to the harm of another patient.
The first action would be to put the patient of an ECG monitor and determine the heart
rhythm,rate and w...