Assisting with Medications Case Study - Nursing Questions - PDF

1 Assisting with Medications Critical Thinking Activities Case Study #1 You have been coming to assist Ms. Periwinkle for over a year. The two of you have a special connection, so it is particularly distressing to you when you watch her slowly, over time, deteriorate because of her arthritis,...

1 Assisting with Medications Critical Thinking Activities Case Study #1 You have been coming to assist Ms. Periwinkle for over a year. The two of you have a special connection, so it is particularly distressing to you when you watch her slowly, over time, deteriorate because of her arthritis, angina, and CKD. Lately she has also developed a fungal rash under her left breast related to intertrigo. You regularly assist with bathing, meal preparation, and bed making, but she has always taken care of her own medications. You know she takes a few pills in the morning, and you have been careful during her bath not to dislodge the medication patch she wears for her heart condition. Lately Ms. Periwinkle has gotten much weaker, and she struggles to get her medication bottles open. She confides to you that she isn’t always sure anymore that she’s opening the right medication bottle because her vision is blurrier than it used to be. Additionally, she has a new diagnosis of asthma and now uses an inhaler and tells you it is too hard for her to hold and depress with her arthritis. You report your observations to your supervisor, and changes are made in the care plan that include a DOT for medication assistance. It is your first day assisting with Ms. P’s medications. You have read the DOT and see that you must assist her with: 650 mg of Acetaminophen (Tylenol), 40 mg of Furosemide (Lasix), Salbutamol (Ventolin) MDI and spacer Apply her Nitro patch each morning. After her bath apply a thin layer of Fucidin prescription cream to the crease in her left breast. Document on the MAR immediately following. Special Considerations: Her daughter will remove patch each evening as she only wears them for 12 hours. 1  2 Use a gloved finger to apply Fucidin Cream Provide oral care after MDI administration Complete the above DOT skills with a partner and then switch Then complete the questions together and submit: 1. What factors influence drug action that you need to be mindful of? Provide 6. 1. Age: Her metabolism may slower which increased the risks of side effects and toxicity. 2. Kidney Function issue (Chronic Kidney Disease - CKD) 3. Liver Function: Elderly people may have impaired liver function which could slow drug metabolism, increasing the risk of toxicity 4. Multiple medication issue. (Polypharmacy) 5. Weak vision and Arthritis make her hard to see clearly and with stiffy joints movement increased the risks mistakes of taking medication by herself. 6. Fungal rash under her breast will affect the absorption for the medication. 2. Why do the medications above have 2 names? Based on your answer. Which is which? One is the generic name, and another is the trade/brand name. Generic name: Acetaminophen, (Trade name: Tylenol) Generic name: Furosemide, (Trade name: Lasix) Generic name: Salbutamol, (Trade name: Ventolin) 3. What is the classification and action of each of these drugs? (Table 45-2 p.1064 in your text) Acetaminophen (Tylenol): Classification: Pain Reliever and fever reducer Action: Reducing pain and fever Furosemide (Lasix): Classification: Diuretic (water pill) Action: Increasing urine output (diuresis), reduces fluid retention (edema), decreases blood pressure by reducing blood volume. 2  3 Salbutamol (Ventolin): Classification: Bronchodilator (支氣管擴張藥) Action: Airway relaxation and widening. To relieve bronchospasms in conditions, such as asthma and COPD making breathing easier. 4. What is your responsibility with each medication? 1. Acetaminophen (Tylenol), 650 mg - Assist with correct dose - Observe any sign of nausea, jaundice, dark urine. These may indicate liver toxicity. - Document at MAR 2. Furosemide (Lasix) - Assist with correct dose in the morning so that there won’t be night urination. - Encourage fluid intake. Monitor signs of dehydration or low blood pressure, dizziness. - Monitor for electrolyte imbalances. (Confusion, fatigue, constipation, muscle cramps or weakness, nausea and vomiting, numbness in limbs, fingers and toes.) - Document in the MAR 3. Salbutamol (Ventolin) - Using the metered-dose inhaler (MDI) with the spacer. - Assist her to press the inhaler because she said she struggles to get her bottles open. - Offer her a cup of water to rinse her mouth after the use of Ventolin (preventing throat irritation) - Observe if she has any side effects such as, tremors, fast heart rate. - Document in the MAR. 4. Nitro Patch 5. Fucidin prescription cream 5. What observations do you need to make with each? - Observe any sign of nausea, jaundice, dark urine. These may indicate liver toxicity. - Observe if she has any side effects such as, tremors, fast heart rate. - Observe for electrolyte imbalances. (Confusion, fatigue, constipation, muscle cramps or weakness, nausea and vomiting, numbness in limbs, fingers and toes.) -. 3  4 6. You are about to push the medication out of the blister pack and notice that the Tylenol is 325 mg, but the dose required is 650 mg. How many tablets should you take from the blister pack? Should you report this to your nurse? Rationale? I need to take 2 tablets from the blister pack. Yes, I need to report it to my nurse. The reason is that there’s difference between what I was told and what was in the blister pack. To avoid further confusion and mistake, it’s better to clarify things here before next does. 7. The DOT says 2 puffs. How long do you tell Ms. P to wait before the next puff. At least 30 seconds between puffs. Usually, 30 seconds to 60 seconds will be considered a good practice. 8. You are now going to remove the nitro patch. How will you do this? What will you observe for? Where will you dispose of it? Rationale? - For sensitive skin, slowly peel off the patch from the skin and before that I need to put on gloves because I don’t want to have a contact with the medication on the patch. - I need to observe if there is any rash, redness, irritation area. - The patch needs to be disposed in a medication disposal container because the patch contains medication, and we don’t want anyone accidentally touch it. If anyone has contact with the medication, he/she may absorb certain amounts of it. 9. After her bath you need to apply her prescription cream. You notice that the area has cleared up and there is no redness. Ms. P refuses to have any cream applied. What are your next steps? - I can’t force her to apply the cream onto her skin. - Tell the nurse she refused the cream - Document the refusal in the MAR. 10. How would you record this on the MAR? Using the legend. o 650 mg of Acetaminophen (Tylenol), Administered, Time: 0700, PL o 40 mg of Furosemide (Lasix), Administered, Time: 0700, PL o Salbutamol (Ventolin) MDI and spacer, Administered (2 puffs), Time: 0700, PL o Apply her Nitro patch each morning, Applied, Time: 0700, PL o After her bath apply a thin layer of Fucidin prescription cream to the crease in her left breast, Refused, Time: 0700, PL 4