PHARM REASONING CASE STUDY EXAMINATION STUDY GUIDE LATEST UPDATED 2023, Exams of Nursing

Download PHARM REASONING CASE STUDY EXAMINATION STUDY GUIDE LATEST UPDATED 2023 and more Exams Nursing in PDF only on Docsity! PHARM REASONING CASE STUDY EXAMINATION STUDY GUIDE LATEST UPDATED 2023 Pharmacology Reasoning Case Study Susan Jones, 42-year-old female Medication Categories Concepts Antihypertensives Perfusion NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment • Management of Care 17-23% ✓ • Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% ✓ Psychosocial Integrity 6-12% Physiological Integrity • Basic Care and Comfort 6-12% • Pharmacological and Parenteral Therapies 12-18% ✓ • Reduction of Risk Potential 9-15% ✓ • Physiological Adaptation 11-17% ✓ PHARM REASONING CASE STUDY EXAMINATION STUDY GUIDE LATEST UPDATED 2023 I. Initial Presentation: PHARM REASONING CASE STUDY EXAMINATION STUDY GUIDE LATEST UPDATED 2023 Stress Test Taking multiple diuretics Negative – CV not a big worry at this point Would want to monitor kidney fxn regularly as well as electrolyte levels for imbalances Recognizing a potential problem, you collect a full set of vital signs and complete a nursing assessment: Current VS: P-Q-R-S-T Pain Assessment: T: 98.4 F/36.9 C (o) Provoking/Palliative: Reports no pain at this time P: 90 (reg) Quality: R: 15 (reg) Region/Radiation: BP: 100/70 Severity: O2 sat: 99% room air Timing: Blood Glucose finger stick: 101 2. What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential) RELEVANT VS Data: Clinical Significance: Pulse – 90 BP – 100/70 Blood Glucose - 101 WNL but on the higher side – would want to watch Low BP could indicate the need for medication change – too low BP put pt at risk for falls Normal blood glucose shows pts symptoms are likely not due to hypoglycemia Current Assessment: GENERAL SURVEY: Pleasant, in no acute distress, calm, body relaxed, no grimacing, sitting in chair NEUROLOGICAL: Alert & oriented to person, place, time, and situation (x4); muscle strength 5/5 in both upper and lower extremities bilaterally. HEENT: Head normocephalic with symmetry of all facial features. PERRLA, sclera white bilaterally, conjunctival sac pink bilaterally. Lips, tongue, and oral mucosa pink and moist. RESPIRATORY: Breath sounds clear with equal aeration on inspiration and expiration in all lobes anteriorly, posteriorly, and laterally, nonlabored respiratory effort on room air. CARDIAC: Pink, warm, no edema, heart sounds regular, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks, brisk cap refill. Heart tones audible and regular, S1 and S2 noted over A-P-T-M cardiac landmarks with no abnormal beats or murmurs. No JVD noted at 30-45 degrees. ABDOMEN: Abdomen round, soft, and nontender. BS active in all 4 quadrants GU: Reports no changes in urinary habits. Urine reported as clear, non-odorous, not painful, no burning, frequency of urination INTEGUMENTARY: Skin warm, but diaphoretic, normal color for ethnicity. No clubbing of nails, cap refill <3 seconds. Hair soft-distribution normal for age and gender. Skin integrity intact, skin turgor elastic, no tenting present. 3. What assessment data is RELEVANT and must be interpreted as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX Reduction of Risk Potential) Clinical Significance: RELEVANT Assessment Data: PHARM REASONING CASE STUDY EXAMINATION STUDY GUIDE LATEST UPDATED 2023 4. Interpreting relevant clinical data, identify potential problems. What additional data is needed to identify the priority problem and nursing priorities? (NCSBN: Step 2 Analyze cues/NCLEX Management of Care/Physiologic Adaptation) Likely Problems: Additional Clinical Data Needed: Syncope r/t hypotensive status Medications likely need adjusting Patient needs labs, BUN, Creatinine, Electrolytes, GFR, and preganancy test. Recognizing that a problem is present, use SBAR to concisely communicate your concern to the primary care provider: Situation: Name/age: Susan Jones, 42 year old female BRIEF summary of primary problem: Pt presented with feelings of faintness and dizziness. Background: RELEVANT past medical history: Hx of diabetes melitus type 2, HTN, family hx of CAD RELEVANT background data: Recently stopped smoking, lost 20 lbs, blood glucose stable Assessment: Most recent vital signs: Pulse:90, BP:100/70 ,T: 98.4 F/36.9 C (o), R: 15 (reg), O2 sat: 99% room air and Blood Glucose finger stick: 101 RELEVANT body system nursing assessment data: Patient no longer feels faint after sitting, diaphoresis RELEVANT lab values: Blood glucose: 101 Patient response: Patient is feeling better. INTERPRETATION of current clinical status (stable/unstable/worsening): Appears stable Recommendation: Likely due to the combo of medications Could be body/heart working harded to pump low blood volume Cause is unknown perhaps pt is uncomfortable or anxious – warrants further investigation Low BP Elevated Pulse Diaphoretic PHARM REASONING CASE STUDY EXAMINATION STUDY GUIDE LATEST UPDATED 2023 Suggestions to advance the plan of care: Contact health care provider for the pregnancy test and other recommended labs. There has been no change in Susan’s status. She currently denies feeling lightheaded. Her husband arrives, and transports her to her primary care provider’s clinic. The Primary Care Provider Orders the Following: 5. State the rationale and expected outcomes for the medical plan of care. (Pharm. and Parenteral Therapies) Orders: Rationale: Expected Outcome: Complete blood count (CBC) Basic metabolic profile (BMP) Hgb A1c Urine analysis (UA) -Assesses RBC count, as well as WBC for signs of infection. -Fluid balance, electrolyte balance, kidney functioning. -assess the blood glucose over a period of 3months - assess the kidney function. Pt. will not have an infection. -Pt. will have values withing normal limits -<6.5% -No infection -negative Urine hCG -Pregancy indicator 12 lead EKG -Assessing pt. for dyshythmia 12 Lead EKG is normal sinus rhythm-rate 72. The following diagnostic test results just posted in the electronic health record: Complete Blood Count (CBC) WBC HGB PLTs % Neuts Bands Current: 7.0 13.1 250 55 0 Most Recent: 8.5 12.8 225 65 0 Basic Metabolic Panel (BMP ) Na K Gluc. Creat. Current: 135 3.4 105 0.9 Most Recent: 137 3.7 117 0.85 Urinalysis + UA Micro Color: Clarity: Sp. Gr. Protein Nitrite LET RBCs WBCs Bacteria Epithelial Current: dark yellow clear 1.025 neg neg neg neg neg neg neg