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A 88 –year-old pt presents to the medical surgical floor as a direct admission from the...

A 88 –year-old pt presents to the medical surgical floor as a direct admission from the nursing home. Pt is lethargic. Has received the first cycle of antibiotic in the ED.

Vital Signs: RR: 26; BP: 90/62; HR: 118; Sat 90% RA; Temp 102.4

Medication: NSS 500 ml/hr; Zyvox (linezolid) 600 mg q 12 hours; Azithromycin (Zithromax) 750 mg IV; Vancomycin 1g IV; Tylenol 650mg via peg tube

Lab values: WBC 30

what are the nursing assessment priorties for this patient?

What order will the nurse administer the antibiotics?

What assessment finding is concerning when administering Vancomycin?

Is the NSS bolus rate correct?

What if the order is NSS 30 ml/kg? Weight is 80kg.

What are the steps in administering medication through a peg tube?

Expert Solution

ANSWERS:-

1) What are the nursing assessment priorities for this patient?

* Patient's BP is 90/62 mmHg(hypotension ) due to severe infection (septicemia )- administer IV fluids to improve BP.

* Heart rate is 118 beats/ min( tachycardia ) due to low blood pressure and fever.Administer IV fluids to improve BP and antipyretics, tylenol 650mg, to reduce fever.

*Respiratory rate is 26/min( tachypnoea )

*Temperature is 102.4°F ( hyperthermia )

2) What order will the nurse administer the antibiotics?

* First administer zyvox (linezolid) 600mg IV over 1 hour, protect it from light because it is photosensitive.After completing linezolid flush the IV line with saline.

* Second give Azithromycin 750 mg IV after dilution( concentration of 2mg/ml or 1mg/ml) as an infusion over 1hour.

* Last administer vancomycin 1gmIV after dilution (concentration of 5mg/ml) slowly over 1hour or more.It is nephrotoxic and ototoxic. Monitor renal functions and hearing.

3) What assessment finding is concerning when administering vancomycin?

* BP is 90/62 mmHg.

* Vancomycin can cause hypotension, especially when administered at high speed it can exaggerate hypotension. Here the patient is already with hypotension, BP is 90/62 mmHg.So administer slowly and cautiously and monitor BP frequently while administering vancomycin.

4) Is the NSS bolus rate correct?

* No, the NSS bolus rate is not correct.Recommended rate of fluid replacement in an elderly patient is maximum 30ml/kg/day.

* 500ml/hr is dangerous, patient can go to fluid overload, pulmonary edema and respiratory distress.

5) What if the order is NSS 30ml/kg? Weight is 80kg.

* 30ml/kg means the patient receives 100ml/hr.

* Total fluid /day is,

* 30ml/kg/day= 30x80= 2400ml/day.

* ml/hr = 2400/24 (total amount for 24hrs/no of hours, ie 24)= 100ml/hr.

6) What are the steps in administering medication through a peg tube?

* PEG tube (percutaneous endoscopic gastrotomy tube)

* Prepare the medication either by crushing into powder or diluting with water.

* stop feeding, if continuous feeding is going on and flush the tube with 15 ml of water.

* Use a 30ml or 50 ml syringe,.If feeding is not going on, the aspirate the gastric content 5 to 10 ml to verify the position of the tube and return it back through the tube.

* administer medication mixed with water by pouring through the syringe.

* make sure to pinch the proximal end of the feeding tube to prevent air entering into the stomach when ever the tube is opened oan release when ever the syringe is filled and hold the syringe high enough to allow it to empty gradually by gravity.

* After completing the medications clean the tubings with water and close the tubings with cork.secure the tubing safely.

Nightingale answered 2 years ago

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