[Answered]: It is 0700 and the nurse is caring for a 75 y/o…

It is 0700 and the nurse is caring for a 75 y/o patient admitted with infected diabetic ulcers on the left heel and left great toe. The patient has a history of HTN and Type 2 DM. He is scheduled for surgery to debride his foot ulcer and amputate his left great toe today at 1100. He has been NPO except for medications since midnight for surgery. Today’s labs drawn at 0600. WBC = 20,000 mm3 Platelets = 10,000 mm3 Hgb = 6.8 g/dl Hct = 21% Potassium = 2.6 mEq/L Glucose = 90 mg/dl Vital Signs at 0730 today: b/p 148/75, HR 59, respirations 16, temp 100.5 po The following is the patient’s MAR for 72 hours. Today’s date/time is November 20 at 0800 Name: John Doe MR# 0003487229 DOB: January 1, 1940 Allergies: Hydrocodone Start Stop Medication Scheduled Times 11/18 11/19 11/20 11/17 Metoprolol 50 mg PO BID (hold for HR < 55 and Systolic b/p < 100) 0800 2000 Given b/p 122/65 HR 80 Given b/p 138/70 HR 70 Given 130/72 60 Given 122/55 68 11/17 Lisinopril 20 mg PO daily 1200 Given Given 11/17 Lantus 25 units SQ daily 0900 Given Given Accucheck 110 11/17 Metformin 1000 mg BID 0800 1700 Given Given Given Given 11/17 Vancomycin 1500 mg / 275 mL D5W IV Q12 hours Infuse over 90 minutes 0800 2000 Given Given Given Given 11/19 Sliding Scale before meals and at bedtime. Insulin Lispro SQ For each 20 mg/dl > 120 give 1 units. Max dose 16 units. Call for glucose > 400. 0800 1100 1700 2100 0 units given Accucheck 108 4 units given Accucheck 168 2 units given Accucheck 136 11/17 Morphine 2-4 mg IV Q4 hours as needed (PRN) for pain PRN 11/17 Hydrocodone / Acetaminophen 7.5/325 1-2 tabs Q6 hours as needed (PRN) for pain PRN Given 0830 2 tabs Given 2100 2 tabs Given 0600 2 tabs Given 2200 2 tabs 11/17 Tylenol 500 mg Po 1-2 tabs Q4 hours as needed (PRN) for pain PRN 1. What additional assessment data and information would the nurse want to obtain for this patient? 2. Which routinely scheduled medications would the nurse administer? Why? 3. Which medications would the nurse hold? Why? 4. Would the nurse need to contact the primary care provider for any reason? Explain. 5. What type of medication is Vancomycin? What will the nurse monitor for while administering IV Vancomycin? The patient returns from surgery at 1300. He is awake, alert and cooperative. He is complaining of nausea and incisional pain of his left foot. 6. What assessment data would the nurse want to obtain at this time? 7. What pain medication would be best for the nurse to administer as per the MAR above? 8. Considering the patient complaints and the MAR above, what is the priority action for the nurse to take at this time? It is now 1700 and the patient is feeling is comfortable and requesting to eat dinner. He has orders to resume his diet. His accucheck is 204. 9. What insulin and how much will the nurse administer? The patient is now 3 days post-operative and the nurse is preparing to discharge this patient home. The patient will be discharged home on the following medications: Metoprolol 50 mg PO BID Lisinopril 10 mg PO daily Nateglinide 120 mg PO BID Insulin glargine 20 units SQ daily hydrocodone / acetaminophen 5mg/325 mg 1-2 tabs q6 hours as needed for pain. 10. List 4 priority patient education instructions the nurse will discuss with the patient regarding his medications before discharge. 1. 2. 3. 4. Earn 2 extra credit points below. 1. Which discharge medication is new for this patient? 2. Would the nurse contact the prescriber about any of the discharge medications and request a different medication? Which one? Explain.