Question

In: Nursing

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?

Solutions

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.


Related Solutions

6. A nurse on a Medical-Surgical floor is receiving the orders for the new admission. What...
6. A nurse on a Medical-Surgical floor is receiving the orders for the new admission. What order would need to be clarified by the physician for this patient? A. Aspirin 325 mg PO daily   B. Lopressor 2.5 mg IVP q. 6 hrs. as need for >125 bpm C. Digoxin 0.125 mg PO daily D. Morphine 1 mg IVP q. 4 hrs. as needed for pain > 5 (1-10) (Explain why the chosen answer is correct)
T.M, a 72 year old female was admitted to the medical-surgical floor for abdominal pain. The...
T.M, a 72 year old female was admitted to the medical-surgical floor for abdominal pain. The nurse is reviewing the orders and sees that the patient is scheduled for surgery (a laparotomy) in the morning. The nurse discusses post-op orders with the patient. The provider prescribes morphine. Why was morphine ordered? What are the nursing considerations for patients who are prescribed morphine? What are your concerns? Explain your answer. Would a PCA pump be appropriate for this patient? Explain your...
Mr. Henderson is a 49-year-old patient who is admitted to the medical-surgical floor in a hypertensive...
Mr. Henderson is a 49-year-old patient who is admitted to the medical-surgical floor in a hypertensive crisis. The patient's vital signs are B/P: 200/98, HR: 62; RR: 12; T: 98.4 F, and oxygen saturation: 96% on room air. The patient is complaining of a headache and blurred vision. The patient's past medical history: hyperlipidemia, borderline diabetes, and gout. The patient takes atorvastatin and allopurinol. The patient states, "l control my diabetes with my diet." He is ordered Cardene, 5 mg/hr.,...
Ricky Waltz, a 50-year-old American-Asian patient, is admitted to the medical-surgical floor from the emergency department...
Ricky Waltz, a 50-year-old American-Asian patient, is admitted to the medical-surgical floor from the emergency department with severe abdominal pain thought to be from acute pancreatitis. He has a history of drinking at least a case of beer a day. He also smokes and appears cachectic. His old chart indicates a history of COPD, but he does not take drugs for this. He does have a new productive cough. At change of shift, the nurse finds the patient dyspneic and...
A nurse on a Medical-Surgical floor is receiving the orders for the new admission. What order would need to be clarified by the physician for this patient?
6. A nurse on a Medical-Surgical floor is receiving the orders for the new admission. What order would need to be clarified by the physician for this patient?A. Aspirin 325 mg PO daily  B. Lopressor 2.5 mg IVP q. 6 hrs. as need for >125 bpmC. Digoxin 0.125 mg PO dailyD. Morphine 1 mg IVP q. 4 hrs. as needed for pain > 5 (1-10)Please explain your rationale for the answer7. The nurse is caring for an 84-year-old male with a...
Ms. K, who is 32 years old, is admitted to the medical/surgical floor with abdominal pain,...
Ms. K, who is 32 years old, is admitted to the medical/surgical floor with abdominal pain, diarrhea and rectal bleeding. Her initial diagnosis is inflammatory bowel disease. Test results indicate inflammation of the mucosa and submucosa of her rectum and colon. Which form of IBD does Ms. K most likely have? You review the medication record and note that Ms. K is to receive sulfasalazine. What will your teaching for this medication include? Ms. K wants to know more about...
You work on a medical/surgical floor at a county medical center. There is a patient on...
You work on a medical/surgical floor at a county medical center. There is a patient on your floor who had a stroke, and his wife is his power of attorney. The patient’s stroke was mild and his cognitive functions were not affected by the stroke (he is oriented times 3). He has been on the unit for 3 weeks. Early in his hospitalization his hemoglobin was found to be 6.0g. The patient’s wife is a Jehovah’s Witness; however, the patient...
D.V., a 32-year-old man, is being admitted to the medical floor from the neurology clinic for...
D.V., a 32-year-old man, is being admitted to the medical floor from the neurology clinic for evaluation of his symptoms. D.V. has experienced increasing urinary frequency and urgency over the past 2 months. Because his female partner was treated for a sexually transmitted infection, D.V. underwent treatment, but the symptoms did not resolve. D.V. has also recently had two brief episodes of eye “fuzziness” associated with diplopia and flashes of brightness. He has noticed ascending numbness and weakness of the...
You are working on a medical/surgical floor with a client with adrenal dysfunction. The client is...
You are working on a medical/surgical floor with a client with adrenal dysfunction. The client is a 61-year-old male who presented to the ED in a markedly unwell state. He complains of progressive development of symptoms that include feeling generally not well, weakness, and fatigue. He is dizzy most of the time, and it gets worse upon standing. During your admission assessment he comments on unintentional weight loss and a darkening of his skin, "like a suntan.” His vital signs...
Jordan is a 9 year old boy who is a direct admission for observation. He has...
Jordan is a 9 year old boy who is a direct admission for observation. He has a hx of vomiting and diarrhea for 48hrs. Subjective Data: N/V/D x 48hrs reports haven’t voided today unable to tolerate oral fluids Obj Data: VS: T 37.8 C (100 F) HR 120 RR 24bpm BP 110/60 wt: 34.2 kg BS hyperactive x 4 quads lethargic, poor skin turgor What assessment data is most concerning to the RN? What other assessment data would be useful?...
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT