Pharmacology Scenario 5 Guided Reflection Questions

Pharmacology Scenario 5 Guided Reflection Questions When writing up your GRQ's, please ensure in the Scenario Analysis or Opening Questions that you include a detailed description of the medications you administered (this includes IV therapy), the labs you monitored, the calculations you completed, and the teaching you completed or was required. Meds administered: According to the provider’s orders, I administered the following medications: 4 mg of ondansetron IV push (Ondansetron is a medication that is a serotonin (5-HT3) receptor antagonist. This drug reduces vomiting and nausea in a patient by blocking the action of serotonin. The provider in the vsim ordered this dose of medication every 6 hours prn for nausea/vomiting.) Infusion of potassium chloride 10mEq in 100mL dilution at 66mL/hr (Potassium chloride was given to restore adequate levels of serum potassium in Mary Richards. This drug requires a second check by another RN due to its potential to cause serious cardiac issues and death if the drug is given too quickly or in the wrong dose.) Labs monitored: According to the results of Mary Richards’ bloodwork, the abnormal values she had were as follows: K+ 2.8 mEq/L (normal 3.6-4.6 mEq/L ), HCT 46% (normal 40-45%), digoxin 2.1 ng/mL (normal 0.5-2 ng/mL). Her other labs were all within normal ranges. Calculations: After calling her provider to report on the results of her labs, the provider added additional orders. The provider’s orders stated that if Mary Richards’ serum K+ level was <3.0 mEq (it was 2.8), she was to be given 10 mEq KCL in 100 mL normal saline for IV infusion over 90 minutes. Her K+ levels were to be rechecked in 2 hours. To calculate the rate of the infusion: 1hr=60 mins 0.66*100= 66mL/hr 60 mins/90 mins= 0.66 To check my answer, I did the following: 90/60= 1.5 1.5*66.6= 100 I also needed to verify my calculations with another nurse in the vsim, and it was correct. Teachings: In this vsim, I educated Mary Richards about the adverse effects of medications, and informed her that digoxin has a therapeutic index that is narrow. I informed her that this drug should be closely monitored, and that digoxin toxicity signs and symptoms include nausea, confusion, and visual disturbances. I also educated her about the drug potassium, and that diuretics can cause hypokalemia which can lead to heart problems. I informed her that she may require supplemental potassium in the future. Lastly, I educated her about the drug ondansetron, and that although this drug will treat nausea, we still need to find the root cause. Scenario Analysis Questions PCC/EBP/PCC Richards? [1] What priority problem(s) did you identify for Mary Mary Richards came into the ER complaining of weakness, nausea, abdominal pain, and dizziness. She suffers from heart failure and hypertension and is taking the drug digoxin. Her symptoms indicate that she is experiencing a possible digoxin toxicity. PCC/EBP/PCC Are there any red flags noted when looking at the medications that Mary Richards is taking? Why or why not? Yes, there are some red flags of a drug-drug interaction. Mary Richards is taking furosemide, amlodipine, and digoxin. The use of diuretics is a known risk factor for digoxin toxicity. Furosemide is a diuretic, and carries the risk of causing hypokalemia and hypomagnesemia. Hypokalemia and hypomagnesemia increase the chances that a patient will develop digoxin toxicity. PCC/EBP/PCC What are the potential problems that could arise if Mary Richards does not receive treatment immediately? What type of treatment would she benefit from? If Mary Richards does not receive treatment immediately, she may experience cardiac problems such as arrhythmias, bradycardia, heart failure, and even death. Ms. Richards may also experience photophobia and visual disturbances, diarrhea, and confusion. She was already experiencing hypokalemia, which is another complication of digoxin toxicity. Digoxin affects the sodium/potassium pump and causes increased muscle contractions as a result of increased intracellular calcium. Mary Richards would benefit from treatment to rebalance her electrolytes, as is ordered by the provider with the infusion of potassium and fluids. Medication to control her nausea is being given, and she is on oxygen to keep her oxygen saturation levels at an appropriate level. The provider also ordered that she be on a continuous 3 lead ECG and pulse Ox, to monitor her heart closely. She would also benefit from the discontinuation of digoxin, furosemide, and amlodipine until her condition has improved, as the provider ordered as well. PCC/T &C/S Discuss what should be taught to Mary Richards regarding her care at home. Mary Richards should be educated on the signs and symptoms of drug toxicity to look for at home, including visual disturbances, nausea, vomiting, diarrhea, and anorexia, and at which point to seek medical help. She should be instructed to take the correct dose of the medications at the correct time, and to not take missed doses. She may benefit from education on how to monitor her blood pressure at home, due to her history of hypertension. Mary Richards should be taught how to take her pulse, and instructed to contact her provider if her pulse is under 60 bpm or over 110 bpm, or has an unusual rhythm. As long as she is on digoxin, she should be encouraged to eat foods that contain a good deal of potassium. Because she has heart failure, she should be educated on a diet appropriate for her medical needs. She should also be taught to avoid taking any herbal supplements without contacting her provider first, as there may be potential drug interactions. T&C What other interprofessional team members should be involved in Mary Richards’s care? Other interprofessional team members in addition to the provider and nurses in the hospital that should be involved in her care include her PCP, pharmacist, a dietician or nutritionist, a cardiologist, and CNA’s or patient care technicians. In the case of Mary Richards, it would also be of particular importance to educate and involve her son and other close family members with regards to her care. If her family is unable to help her manage her medications, home health care providers may be an option. [1] The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics