NR 446 Lab prep 1 5/9/18
Janet Martin:
Janet Martin is a 75 year old female. Her daughter called stating that Janet was
complaining of coughing/not feeling well and is unable to get off the couch because
she is weak and fatigued. The daughter brought her into the Emergency Department
with c/o fever and chills for 2 days, decreased appetite, noted productive green
cough and fatigue. Janet was admitted to the telemetry unit with a diagnosis of
bilateral pneumonia. Janet also had an open wound on her left great toe that turned
out to have MRSA after a wound culture was done. The wound has closed.
Margaret Stanton:
Margaret Stanton is a 75 year old female admitted to the telemetry unit late last
night for MVP (Mitral valve prolapse) and is scheduled for surgery this morning at
0730.
1. The healthcare provider ordered 500mg Vancomycin Hydrochloride IVPB every
six hours. The maximum safe dose range is 40mg/kg/day. The client weighs 165
lb. What is the maximum therapeutic dose the nurse will administer per day?
mg/day (If needed, round to the nearest whole
number) 165lbs/ 2.2 kg= 75 kg
40mg X 75 kg= 3,000 mg/day maximum therapeutic dose for this patient
2. What is the purpose of Vancomycin Hydrochloride and what are the
side effects/administration protocols?
It is an anti-infective that treats life threatening infections such as MRSA.
Side affects may include tinnitus or hearing loss \, nephrotoxicity, or liver
damage. Do not infuse this medication with other drugs, give medication
over at least a 60 minute time period and the dose should be individually
adapted according to weight, age and renal function.. Pg 62
3. What are some of the risks that diabetics face as a result of uncontrolled
blood sugars?
Diabetic ketoacidosis (DKA) is an acute life threatening condition
characterized by uncontrolled hyperglycemia (greater than 300 mg/dL)
resulting in the breakdown of body fat for energy, dehydration, metabolic
acidosis, and an accumulation of ketones in the blood and urine. The onset is
rapid and mortality rate is up to 10%.
Hyperglycemic- hyperosmolar state (HHS) is an acute life threatening
condition characterized by profound hyperglycemia (greater than 600
, m/DL), hyperosmolarity that leads to dehydration, and an absence of ketosis.
Onset generally occurs gradually over several days and if left untreated can
lead to coma and death.
Poor wound healing
Neuropathy
High blood pressure
Stroke
Kidney disease
Explain the difference between Type I & Type II Diabetes.
Type 1 diabetes is an immune-mediated disease, caused by
autoimmune destruction of the pancreatic β cells, the site of insulin
production. This eventually results in a total absence of insulin
production.
In type 2 diabetes the pancreas usually continues to produce
some endogenous (self-made) insulin. However, the insulin that is produced
is either insufficient for the needs of the body or is poorly used by the tissues,
or both. Many factors contribute to the development of type 2 diabetes. The
most powerful risk factor is obesity, especially abdominal and visceral
adiposity.
Discuss a diet that is appropriate for a diabetic. How is it different from a
general diet?
Component Recommendations
Total • Minimum of 130 g/day.
carbohydrate • Include carbohydrate from fruits, vegetables, grains, legumes,
and low-fat milk.
• Monitor by carbohydrate counting, exchange lists, or use
of appropriate proportions (eFig. 49-1).
• Glycemic index may provide additional benefit.
• Sucrose-containing food can be substituted for other
carbohydrates in the meal plan.
• Fiber intake at 25-30 g/day.
• Nonnutritive sweeteners are safe when consumed within FDA
daily intake levels.
Protein • 15%-20% of total calories.
• High-protein diets are not recommended for weight loss.
Fat • Limit saturated fat to <7% of total calories.
• Trans fat should be minimized.
• Dietary cholesterol <200 mg/day.
Janet Martin:
Janet Martin is a 75 year old female. Her daughter called stating that Janet was
complaining of coughing/not feeling well and is unable to get off the couch because
she is weak and fatigued. The daughter brought her into the Emergency Department
with c/o fever and chills for 2 days, decreased appetite, noted productive green
cough and fatigue. Janet was admitted to the telemetry unit with a diagnosis of
bilateral pneumonia. Janet also had an open wound on her left great toe that turned
out to have MRSA after a wound culture was done. The wound has closed.
Margaret Stanton:
Margaret Stanton is a 75 year old female admitted to the telemetry unit late last
night for MVP (Mitral valve prolapse) and is scheduled for surgery this morning at
0730.
1. The healthcare provider ordered 500mg Vancomycin Hydrochloride IVPB every
six hours. The maximum safe dose range is 40mg/kg/day. The client weighs 165
lb. What is the maximum therapeutic dose the nurse will administer per day?
mg/day (If needed, round to the nearest whole
number) 165lbs/ 2.2 kg= 75 kg
40mg X 75 kg= 3,000 mg/day maximum therapeutic dose for this patient
2. What is the purpose of Vancomycin Hydrochloride and what are the
side effects/administration protocols?
It is an anti-infective that treats life threatening infections such as MRSA.
Side affects may include tinnitus or hearing loss \, nephrotoxicity, or liver
damage. Do not infuse this medication with other drugs, give medication
over at least a 60 minute time period and the dose should be individually
adapted according to weight, age and renal function.. Pg 62
3. What are some of the risks that diabetics face as a result of uncontrolled
blood sugars?
Diabetic ketoacidosis (DKA) is an acute life threatening condition
characterized by uncontrolled hyperglycemia (greater than 300 mg/dL)
resulting in the breakdown of body fat for energy, dehydration, metabolic
acidosis, and an accumulation of ketones in the blood and urine. The onset is
rapid and mortality rate is up to 10%.
Hyperglycemic- hyperosmolar state (HHS) is an acute life threatening
condition characterized by profound hyperglycemia (greater than 600
, m/DL), hyperosmolarity that leads to dehydration, and an absence of ketosis.
Onset generally occurs gradually over several days and if left untreated can
lead to coma and death.
Poor wound healing
Neuropathy
High blood pressure
Stroke
Kidney disease
Explain the difference between Type I & Type II Diabetes.
Type 1 diabetes is an immune-mediated disease, caused by
autoimmune destruction of the pancreatic β cells, the site of insulin
production. This eventually results in a total absence of insulin
production.
In type 2 diabetes the pancreas usually continues to produce
some endogenous (self-made) insulin. However, the insulin that is produced
is either insufficient for the needs of the body or is poorly used by the tissues,
or both. Many factors contribute to the development of type 2 diabetes. The
most powerful risk factor is obesity, especially abdominal and visceral
adiposity.
Discuss a diet that is appropriate for a diabetic. How is it different from a
general diet?
Component Recommendations
Total • Minimum of 130 g/day.
carbohydrate • Include carbohydrate from fruits, vegetables, grains, legumes,
and low-fat milk.
• Monitor by carbohydrate counting, exchange lists, or use
of appropriate proportions (eFig. 49-1).
• Glycemic index may provide additional benefit.
• Sucrose-containing food can be substituted for other
carbohydrates in the meal plan.
• Fiber intake at 25-30 g/day.
• Nonnutritive sweeteners are safe when consumed within FDA
daily intake levels.
Protein • 15%-20% of total calories.
• High-protein diets are not recommended for weight loss.
Fat • Limit saturated fat to <7% of total calories.
• Trans fat should be minimized.
• Dietary cholesterol <200 mg/day.
