solved

Question
Answered step-by-step
Asked by ChefElephantPerson71

You are managing an 81-year-old male who presents to your Emergency Department by ambulance after his wife witnessed her husband take a ground-level fall while he was taking out the trash. He was immediately unconscious after falling backward and hitting his head and has not responded to commands in the ambulance or in the ED as he arrives. It was felt that he needed rapid sequence intubation given his history and Glasgow coma scale so that he could have an urgent head CT completed.

 

HX: Type 2 Diabetes Mellitus

Hyperlipidemia

Social HX: Lifetime nonsmoker

No ETOH or recreational drug use
Lives with wife. Retired. Typically walks 5 miles a day. Independent in his activities of daily living.

Medications: Tylenol 500mg po every 6 hours as needed

Metformin (Glucophage) 500mg po daily
Atorvastatin (Lipitor) 20mg po daily

Allergies: Penicillin (rash)

Exam

Vitals:
Pulse 97
Resp 18
BP 179/88
SpO2 97%
Temp 37.0 °C (98.6 °F)
Wt. 85kg
Ht. 6’0″
Constitutional: Awake, moving all extremities but nonverbal other than moaning. Not responding to any commands.
HEENT: Head is normocephalic. Large open wound over occiput with surrounding boggy hematoma. Pupils are 4mm and equal, round and reactive to light and accommodation. Does not follow commands for extraocular exam but has roving eye movements. Eyes are without icterus or injection. Posterior oropharynx atraumatic. Mucous membranes pink and moist. Neck is in cervical collar placed by EMS. No obvious deformity.
Resp: Lungs clear to auscultation bilaterally without wheezes, rales, or rhonchi. No chest tenderness or increased work of breathing on room air.
Cardiovasc: S1S2 without murmur, rub, or gallop. Normal rate and regular rhythm. Periphery well perfused. No edema.
Abd/GI: Soft, non-tender, atraumatic and nondistended +bowel sounds.
Skin: Pink, warm, dry. Early stage of bruising noted to left hip region.
Ext: Atraumatic.
Back: Normal inspection. No tenderness.
Psych: Agitated
Neuro: No gross motor deficit. Not following commands. Moans without other verbal response. DTRs 1+ and equal throughout. Babinski and clonus negative.

1.      You would like to order something for pain. What medication would you order? Write out the order including the pharmaceutical agent, dose, route, and duration. Why have you selected this medication in this situation? Justify your selection over alternatives. What class/schedule of medication are you choosing and why? Explain why this medication and route was chosen over other options. Include the pharmacodynamic action of the medication you have chosen in comparison to the other options you mentioned. Include either a research article or evidence-based guideline that supports your decision-making and selection process. Give rationale and reference your information.

2.   You would like to order something for procedural sedation. What medication(s) would you order? Write out the order including the pharmaceutical agent, dose, route, and duration. Why have you selected this medication in this situation? Justify your selection over alternatives. What class of medication are you choosing and why? Explain why this medication and route was chosen over other options. Include the pharmacodynamic action of the medication you have chosen in comparison to the other options you mentioned. Include either a research article or evidence-based guideline that supports your decision-making and selection process. Give rationale and reference your information.

3.   What are the potential side effects and/or adverse drug reactions and how should they be managed? Are there any reasons/indications that you would not give this medication? What would you expect that your patient might experience, and what are your worst-case scenarios? If these occur, what would you do?

4.      What are potential drug interactions for this patient and what would your management be if you were concerned about a drug interaction? (Note: This answer may be none.) Don’t just copy and paste drug interactions into this area. What is applicable for this patient?

5.      What is the cost of each of the medications? What reference was used to obtain this cost information? How does it compare to other options available for this patient? Is it your best option based on cost and effectiveness and indication for this patient?

6.      How would you monitor the efficacy of theses medications? Specifically, when would you expect these medications to work? Are there lab tests or other information that you would need to gather to see if these medications are efficacious? How do you know the medications are efficacious?

7.   What are alternative treatment plans should this option fail? Specifically, address what medication, how, and when you would use it.

8.      How would this treatment change if the patient was a pregnant female? Specifically, what category in pregnancy is this medication? How would you approach these medications or alternative medications in this case scenario with a pregnant patient?

9.   How would this treatment change if the patient was an adolescent 13-year-old boy?

10.  Include an APA , including one evidence-based Internet resource (a URL), and at least one evidence-based research article.

 

SCIENCE
HEALTH SCIENCE
NURSING
NURSING NP 655