University:
West Coast University
Course:
NURS 122 | Introduction to Medical Surgical Nursing
Academic year:

2020
Views:

38

Pages:

3
Author:

Kristopher Elliott

PHYSICIAN ORDER’S Patient Name: Carl Shapiro Diagnosis: Angina I Coronary Artery Disease No Known Allergies/Sensitivities Age: 54 Gender: Male WeIght: 242 pounds (110 kg) Access 12 lead ECG now Normal Saline at 75 ml/hour Oxygen per nasal cannula to keep saturation greater than 92% Place patient on cardiac monitor/apply defib paddles Administer 325 mg Aspirin po stat/patient to chew tablet NTG sublingual 1 0.4 mg tablet x 3 tablets q 5 minutes apart for chest pain/pressure Morphine 2 mg IVP for relief of chest pain/pressure Labs: CPK-MB, Troponin, Cardiac Enzymes Wash hands, Glove use Introduce self with name and title, addresses patient respectfully utilizing Mr.Ms. Identify the patient (name, ID band, DOB. MR#)before medications/high risk interventions Obtain BP, pulse, respiratory rate, temperature, Sp02/Pain and reassesses vitals after interventions. Attach ECG monitor leads/turn monitor on/general rhythm assessment verbalized Administer oxygen per physician order after SpO2 assessment/Reassessment after oxygen application. Assess pain utilizing pain scale appropriate for patient/reassessment after interventions Auscultate lung sounds Access 12-lead ECG Obtain medical history including allergies or medication use Administer emergency medications per order for the correct problem. Maintain cardiovascular and respiratory stability Side effects and special notes on Nitroglycerin a. Peripheral vasodilatation can cause profound hypotension and reflex tachycardia. b. Common side effects: throbbing headaches, flushing, dizziness c. Less common: orthostatic hypotension, sometimes marked. Nitroglycerin does not provide controlled hypotension. d. Because nitroglycerin causes generalized smooth muscle relaxation, it may be effective in relieving chest pain caused by esophageal spasm. Morphine IV push – Davis Drug book I rapid 20 min 4–5 hr V Contraindicated in: Hypersensitivity; Some products contain tartrazine, bisulfites, or alcohol and should be avoided in patients with known hypersensitivity; Acute, mild, intermittent, or postoperative pain (extended/sustained-release); Significant respiratory depression (extended-release); Acute or severe bronchial asthma (extended-release); Paralytic ileus (extended-release). Adverse Reactions/Side Effects CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams EENT: blurred vision, diplopia, miosis Resp: RESPIRATORY DEPRESSION CV: hypotension, bradycardia Endo: adrenal insufficiency GI: constipation, nausea, vomiting GU: urinary retention Derm: flushing, itching, sweating Misc: physical dependence, psychological dependence, tolerance * CAPITALS indicate life-threatening. Underline indicate most frequent High Alert: Assess level of consciousness, BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Subsequent doses may need to be decreased by 25–50%. Initial drowsiness will diminish with continued use IV Push: Diluent: Dilute with at least 5 mL of sterile water or 0.9% NaCl for injection.Concentration: 0.5–5 mg/mL.