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Rashid Ahmed VSIM
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This document provides post scenario analysis of Rashid Ahmed's case scenario in VSIM Nursing.
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Case: Rashid AhmedVSIM Post Scenario Analysis and Reflection Activity (Adapted from VSim For Nursing & Wolters-Kluwer) VSIM Post
Review the medication list from the Electronic Health Record (HER) and please complete the medication research table below based on the medication listed in the assigned VSIM.
Medications – Classification and action Indication Side Effects Nursing Implications
Generic and Trade (reasons why this (pre and post assessments a nurse should be aware of prior to and
Names medication is prescribed after giving this medication)
for?)
1. Potassium Chloride Classifications: Electrolytic Uses: INTEG: Mild to moderate rashes Assessment
Replacement Solution − Pneumocystis jiroveci (including fixed drug eruptions), • MONITOR: for GI distress; lab tests
pneumonitis (formerly toxic epidermal necrolysis. GI: → GI symptoms that develop after a few days of therapy may
Action: PCP), shigellosis enteritis, Nausea, vomiting, diarrhea, indicate need for dosage adjustment. If symptoms persist,
− Both components of the and severe complicated anorexia, hepatitis, prescriber may withhold drug for 5–7 days and restart it at a lower
combination are synthetic folate UTIs. pseudomembranous dosage level.
antagonist anti-infectives. − Also, children with acute enterocolitis, stomatitis, → Periodic RBC folate in patients on high doses (more than 2 g/day);
− Principal action is by enzyme otitis media due to glossitis, abdominal pain; a daily supplement may be prescribed.
inhibition that prevents bacterial susceptible strains of UROGEN: Kidney failure, oliguria, • Be aware that adverse reactions generally occur within a few days
synthesis of essential nucleic acids Haemophilus influenzae, anuria, crystalluria; to 12 wk after start of therapy; most likely to occur in patients
and proteins. and acute episodes of HEMA: Agranulocytosis (rare), receiving high doses (4 g or more).
− Effective against Pneumocystis chronic bronchitis or aplastic anemia (rare), Patient & Family Education
jiroveci pneumonitis (formerly PCP), traveler’s diarrhea in megaloblastic anemia,
Shigellosis enteritis, and severely adults. hypoprothrombinemia, • Examine stools and report to prescriber if enteric-coated tablets
complicated UTIs due to most − UNLABELED: Isosporiasis; thrombocytopenia (rare); SYS: have passed intact in feces.
strains of the Enterobacteriaceae. cholera; genital ulcers Weakness, arthralgia, myalgia, → Some patients lack enzymes capable of dissolving coating;
caused by Haemophilus photosensitivity, allergic conventional tablet will be ordered.
ducreyi; prophylaxis for myocarditis • Be aware that drug may color alkaline urine and skin orange-
P. jiroveci pneumonia yellow.
(formerly PCP) in • Remain under close medical supervision.
neutropenic patients. → Relapses occur in about 40% of patients after initial satisfactory
response. Response to therapy and duration of treatment are
governed by endoscopic examinations.
2. Trimethoprim Classifications: Urinary Tract Anti- Uses: GI: Epigastric discomfort, Assessment
Infective − Initial episodes of acute nausea, vomiting, glossitis, • Assess: urinary pattern during treatment; Periodically check for
uncomplicated UTIs, abnormal taste sensation; bladder distention.
Action: acute otitis media in INTEG: Rash, pruritus, exfoliative → Altered pattern (frequency, urgency, nocturia, retention,
− Anti-infective and folic acid children. dermatitis, photosensitivity; polyuria) may reflect emerging drug resistance, necessitating
antagonist with slow bactericidal − UNLABELED: Treatment HEMA: Neutropenia, change of drug regimen;
action. and prophylaxis of megaloblastic • Reinforce necessity to adhere to established drug regimen.
− Binds and interferes with bacterial chronic and recurrent anemia,methemoglobinemia, Recurrent infection after terminating prophylactic treatment of
cell growth. UTI in both men and leukopenia, thrombocytopenia UTI may occur even after 6 mos. of therapy.
− Effective against most common UTI women; treatment in (rare).; SYS: Fever; METABOLIC: • Be alert: for toxic effects on bone marrow (particularly in older
pathogens (pathogens that are in conjunction with Increased serum transaminases adults, malnourished, alcoholic, pregnant, or debilitated
normal vaginal and fecal flora) dapsone of initial (ALT, AST), bilirubin, creatinine, patient). Recognize and report signs of infection or anemia.
− Effective in treatment of acute otitis episodes of BUN.
media. Pneumocystis carinii
1
, Case: Rashid Ahmed
VSIM Post Scenario Analysis and Reflection Activity (Adapted from VSim For Nursing & Wolters-Kluwer) VSIM Post
Medications – Classification and action Indication Side Effects Nursing Implications
Generic and Trade (reasons why this (pre and post assessments a nurse should be aware of prior to and
Names medication is prescribed after giving this medication)
for?)
pneumonia; travelers’ • Drug-induced rash, a common adverse effect, is usually
diarrhea. maculopapular, pruritic, or morbilliform and appears 7–14 days
after start of therapy with daily doses of 200 mg or less.
• Monitor lab tests: C&S tests before trimethoprim therapy is
initiated; Periodic urine cultures, BUN, creatinine clearance,
CBC, Hgb and Hct.
Patient & Family Education
• Drink fluids liberally (2000–3000 mL/day, if not contraindicated)
to help flush out urinary bacteria.
• DO NOT: postpone voiding even though increases in fluid intake
may cause more frequent urination; use douches or sprays
during treatment periods; practice careful perineal hygiene to
prevent reinfection. REPORT to prescriber: [promptly] any
symptoms of a blood disorder (fever, sore throat, pallor, purpura,
ecchymosis); [promptly] pain and hematuria; rash for evaluation.
• Consult prescriber if severe traveler’s diarrhea does not respond
to 3–5 days therapy (i.e., persistence of symptoms of severe
nausea, abdominal pain, diarrhea with mucus or blood, and
dehydration). Drug-induced rash, a common adverse effect, may
appear 7–14 days after start of therapy.
3. Sulfamethoxazole- Classifications: Urinary Tract Anti- Uses: INTEG: Mild to moderate rashes Assessment
Trimethoprim Infective; Sulfonamide − Pneumocystis jiroveci (including fixed drug eruptions), • MONITOR: for GI distress; lab tests
pneumonitis (formerly toxic epidermal necrolysis. GI: → GI symptoms that develop after a few days of therapy may
Action: PCP), shigellosis enteritis, Nausea, vomiting, diarrhea, indicate need for dosage adjustment. If symptoms persist,
− Both components of the and severe complicated anorexia, hepatitis, prescriber may withhold drug for 5–7 days and restart it at a lower
combination are synthetic folate UTIs. pseudomembranous dosage level.
antagonist anti-infectives. − Also, children with acute enterocolitis, stomatitis, → Periodic RBC folate in patients on high doses (more than 2 g/day);
− Principal action is by enzyme otitis media due to glossitis, abdominal pain; a daily supplement may be prescribed.
inhibition that prevents bacterial susceptible strains of UROGEN: Kidney failure, oliguria, • Be aware that adverse reactions generally occur within a few days
synthesis of essential nucleic acids Haemophilus influenzae, anuria, crystalluria; to 12 wk after start of therapy; most likely to occur in patients
and proteins. and acute episodes of HEMA: Agranulocytosis (rare), receiving high doses (4 g or more).
− Effective against Pneumocystis chronic bronchitis or aplastic anemia (rare),
jiroveci pneumonitis (formerly PCP), traveler’s diarrhea in megaloblastic anemia, Patient & Family Education
Shigellosis enteritis, and severely adults. hypoprothrombinemia, • Examine stools and report to prescriber if enteric-coated tablets
complicated UTIs due to most − UNLABELED: Isosporiasis; thrombocytopenia (rare); SYS: have passed intact in feces.
strains of the Enterobacteriaceae. cholera; genital ulcers Weakness, arthralgia, myalgia, → Some patients lack enzymes capable of dissolving coating;
caused by Haemophilus photosensitivity, allergic conventional tablet will be ordered.
ducreyi; prophylaxis for myocarditis • Be aware that drug may color alkaline urine and skin orange-
P. jiroveci pneumonia yellow.
2
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