NR-293 Week 5 Discussion: Unfolding Case Study Lillian has been on her medication for pneumonia for 24 hours. The physician says the pneumonia is improving, but she also is having an acute exacerba tion of her COPD and a chronic irregular heart rate. Her vital signs are T 37C, B/P 140/87, P 82 and ...
Unit 5: Unfolding Case Study
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Lillian has been on her medication for pneumonia for 24 hours. The physician says the
pneumonia is improving, but she also is having an acute exacerbation of her COPD and a
chronic irregular heart rate. Her vital signs are T 37C, B/P 140/87, P 82 and irregular, R 12,
and pulse oximetry 92% on 2L O2 per nasal cannula. The physician is concerned about her
blood pressure and wants to continue to watch it. She feels that Lillian will benefit from
regular medication for her COPD while in the hospital and when she goes home. Lillian also
is complaining of cigarette cravings and constipation. The physician is urging her to quit
smoking.
The physician leaves the following orders.
Albuterol MDI two puffs every 6 hours
Ipratropium MDI two puffs every 6 hours
Nicoderm 7 mg/24 hr transdermal patch daily
Bisacodyl 10 mg suppository now x1 then 10 mg po daily
Bathroom privileges
Respiratory therapist to determine need for O2 at home
Cardiologist, Dr. B, to consult for irregular heart rate
For your first post, answer all of the following questions about the unfolding case
study. Remember that you must also respond to at least one peer in this thread.
1. How does albuterol MDI work? Make sure to include drug category, mechanism of
action, onset and duration of action, and safety considerations.
2. How does ipratropium MDI work? Make sure to include drug category, mechanism of
action, onset and duration of action, and safety considerations.
3. How would the nurse properly administer the two MDIs when both have been
scheduled at the same time of day?
4. Lillian asks the nurse why she is on two inhalers for her COPD when she used to use
just one. What points would the nurse want to cover to answer her question, considering
her history of noncompliance?
For your second post, answer all of the following questions about the unfolding
case study. Remember that you must also respond to at least one peer in this
thread.
The following morning, the cardiologist came to consult on Lillian’s case and left orders
for anticoagulation because of Lillian’s chronic irregular heartbeat from atrial fibrillation.
Dr. B left the following orders for anticoagulation.
Heparin 5,000 units SQ every 12 hours
Warfarin 2.5 mg po daily for a target INR of 2.5
aPTT, PT, and INR now and then every morning
Digoxin 0.25 mg po daily
1. What is the rationale for the cardiologist ordering heparin and warfarin at the same
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