Scenario 4 Lab 3

Scenario 4: Jason Brown Jason Brown is a 21 year old college football player. It is the first post-op day following surgery of a fracture of his right tibia and fibula. He has sutures over the anterior knee and the lateral malleolus and a posterior splint on the right leg. He reports considerable pain. He has an IV of N/S infusing TKVO. O2 is @ 2L./min via nasal prongs. DR’s Orders: VS q4h IV N/S TKVO C&S swab knee site Change drsgs. on sutures daily Morphine 5-10mg IM/IV q4h – prn for pain Senekot S i-ii tabs OD

Nursing diagnosis: 1) Acute pain related to fractured right tibia and fibula as evidenced by patient’s complain of considerable pain. 2) Risk for infection related to surgical incision on right anterior knee as evidenced by doctor’s order of culture and sensitivity swab on the knee site. 3) Risk for constipation related to Morphine as evidenced by Doctor’s order of Senekot.

Nursing Intervention: 1) Administer pain medication as ordered. 2) Monitor Vital signs. Change dressings as ordered. 3) Encourage patient to drink plenty of fluids and increase fiber on diet. Administer senekot as ordered. Morphine Sulfate Brand name: Duramorph, Statex, epimorph Generic name: Morphine sulfate Indications and dosages: Adult PO 10-30 mg q4h prn/ subcu:5- 15 mg prn, IV: 4-10 mg q4h prn. Classification: Narcotic Uses: decreases severe pain Adverse/Side effects: Anorexia, nausea and vomiting, constipation, drowsiness, dizziness, sedation, confusion, urinary retention, rash, flushing, bradycardia. Pruritis. Drug Interaction: Increase effect with alcohol, sedatives-hypnotics, antipsychotic drugs and muscle relaxant.

Contraindications: Asthma with respiratory depression, increased intra cranial pressure and shock. Nursing Consideration/Teaching: 1) Encourage patient not to use alcohol or CNS depressants, respiratory depression can result. 2) Suggest non-pharmacologic measures to relieve pain as patient recuperates from surgery.

Senekot Generic name: Docusate sodium Pregnancy category: C Classification: Laxative, Emolient Action: Acts by lowering the surface tension of the feces and promoting penetration by water and fat, thus increasing the softness of the fecal mass Uses: To lessen strain of defecation in persons with hernia or CV disease or other diseases in which straining at stool should be avoided. Contraindications: Nausea, vomiting, abdominal pain, and intestinal obstruction. Drug Interaction: Docusate may increase absorption of mineral oil from the GI tract. Side effects: Excess activity of the colon resulting in nausea, diarrhea, or vomiting. Obstruction in the esophagus, stomach, small intestine or rectum. Client/Family Teaching: 1) May administer PO solutions of docusate with milk or fruit juices to help mask bitter taste. 2) Drink a glass of water with each PO dose. 3) When used in enemas, add 50- 100 mg to a retention or flushing enema. 4) Because docusate salts are minimally absorbed, it may require 1- 3 days to soften fecal matter.