Question

An elderly client presents to the Emergency Room with fatigue, shortness of breath, and jaw pain. The client states, "I just haven't been feeling well the last few days. My jaw is aching. I thought maybe I had a cavity, so I went to the dentist and they said nothing was wrong." During the admission assessment, the client reports substernal chest pain of 8/10 and is pale and diaphoretic. Vital signs: T: 97.6; P: 145; B/P: 89/45 mm/Hg; RR: 22; O2 Sat: 96% on 2 l via cannula.  

• Discuss two medications that the nurse would anticipate administering to this client for pain management. For each medication describe it’s mechanism of action and nursing considerations.
• The provider orders Lasix 80mg IVP x1. The pharmacy sends a vial of Lasix, 100 mg per 10 ml, to the client's bedside. How many ml will the nurse administer and at what rate will this dose be administered? Describe the medication’s adverse effects on which the nurse to educate the client.

Answer 1

The symptoms like substernal chest pain ,jaw pain, fatigue ,shortness of breath, hypotension, tachycardia is suggestive of problem related to cardiovascular system so in order to manage pain and related symptoms .

• Digoxin a cardiac glycoside  can be prescribed .It is a strong sodium potassium ATPase inhibitor .The sodium calcium exchange is targeted leading to retention or pulling of calcium into cells and decreasing the heart rate at the same time the contractile property of it can increase the blood pressure .As a result the patient hypotension and tachycardia will be recovered and decreasing the cardiac symptoms .
• The nursing consideration are
  • Monitor apical pulse
  • Monitor for digoxin toxicity
• Diuretics to relieve any fluid retention which can be cause for substernal chest pain .Lasix is loop diuretic leading to excretion of sodium, potassium, chloride .This can remove the fluid and maintain cardiac functions .
• The nursing consideration are
  • Monitor vital signs (pulse, blood pressure, oxygen saturation)
  • Maintain intake and output chart
  • Assess the neurological status as patient may have hyponatremia.

Given

Order :Lasix

Dose:80mg

Route : intravenous

Frequently :once

Available:100mg/10ml

When 100mg=10ml

Then 80mg =??ml

Cross multiply and divide

80*10/100

=800/100

=8

The nurse will administer 8ml

This has to be administered slowly

Flow rate:Volume(ml)*drop factor /Time (hr ) *60

Here volume =8ml can be diluted with 10ml NS for getting 10mg/ml(8*10=80ml)

Time:1min

Drop factor :15gtt/ml (standard)

=80*15/1*60

=80/4(60 is divisible four times by 15)

=20gtt/min

The will administer 8ml diluted medication at a rate of 20gtt/min

The adverse effects which the nurse has to educate are

• Increase in urine output (maintain adequate fluid intake)
• Risk of hypotension is possible so report any dizziness
• Decreased sodium level can occur so electrolytes as to be replaced
• Report any diarrhoea as this can lead to loss of electrolytes due to dehydration
• Report in case of tinnitus ,dyspnea,etc.,