Scenario 4

Alfred Angeles Final Case scenario # 4 2006 December 19 PRNR 198 Final case Scenario # 4 Mr. Xu, age 66 has had surgery for a fractured right hip two days ago. He also has a diagnosis of COPD. He is complaining if pain, which he rates as 10/10 on the pain scale. His oxygen is running at 8L /min per nasal cannula, and he is experiencing shortness of breath. Doctors orders: Demerol 75 mg IM q 3-4 h prn for pain [email protected] continuous change dressing 4th day postoperatively ventolin 2 puffs bid via aerochamber. Nursing Diagnosis 1. Ineffective breathing pattern related to COPD as evidenced by requirement of having an oxygen at 2.5 L continuously and SOB 2. Acute pain related to right hip fracture as evidenced by pain 10/10 3. Impaired mobility related to fracture as evidenced by increased pain and discomfort. Nursing Interventions 1. Put patient in a high Fowlers position or in Orthopneic position to facilitate the expansion of the lungs lower down the oxygen from 8 L to 2.5 L 2. Assess COLDSPA administer medication as prescribed 3. Put the bed on the lowest position put call bell on reach Brand name: Demerol Generic name: Meperidine Hydrochloride Pregnancy category: C Classification: narcotic analgesic, synthetic Action: Only one-tenth as potent an analgesic as morphine. Has no antitussive effects and does not produce miosis Uses: Analgesic for severe pain, hepatic and renal colic useful for minor surgery Side effects: transient hallucinations, transient hypotension visual disturbances. Contraindications: Asthma, emphysema severe obesity. Nursing considerations 1. Review list of drugs with which narcotics interact and their associated effects 2. Request that orders be rewritten at timed interval as required for continued administration. Brand name: Ventolin Generic name: Albuterol, salbutamol Pregnancy category: C

Classification: direct acting adrenergic agent Actions: Albuterol stimulates beta 2 receptors of the bronchi, leading to bronchodilation. Causes less tachycardia and is longer acting than Isoproterenol Uses: bronchial asthma, bronchospasm due to bronchitis or emphysema Prophylaxis of bronchial asthma or bronchospasm Contraindication: Aerosol for prevention of exercise induced bronchospasm is not recommended for children less than 12 years of age. Use during lactation Side effects: Diarrhea, dry mouth, increased apatite, epigastric pain, fatigue nightmares, disturbs sleep, bronchitis and urticaria Dosage: metered dose inhaler adults and children over 12 years of age 180 mcg every 46hrs Nursing Considerations 1. obtain history prior to starting the drug therapy 2. note any previous experiences with this class of drugs 3. Monitor vital signs