2.7 Learning Activities

Case Study #1

Gary, a 68-year-old male client, arrives in the ED with his wife. During the triage assessment, the client states, “It feels as if there is someone standing on my chest. I can’t breathe, and I have a headache.” His vital signs show hypertension and tachycardia. Gary was walking with his wife in their neighborhood when he began experiencing these symptoms.  His wife adds, “I ran into our neighbor’s house, and he drove us here immediately. Our dog is still at the neighbor’s house.”

The client has a history of hypertension, diabetes, and colon cancer. He recently retired from hospital administration, following a long medical leave for treatment of his cancer, including chemotherapy and steroid medications. Gary says to you, “I can’t believe that I am feeling this way. Please help!”

The MD gives you the following orders:

• • Start a peripheral IV STAT
  • Administer metoprolol 5 mg rapid IV q2min, up to 3 doses for chest pain and MI symptoms

1. What will you consider when initiating an IV for Gary?

2. Based on the provided supply of metoprolol of 10 mg/10 mL, what will be the amount you will administer for each dose? What will be the rate of administration?

3. What are the following for the ordered medication?

• Indication and action of medication
• Onset, peak, and duration of the medication
• Nursing considerations or special instructions for use
• Assessments pre-, post-, and during administration
• Patient education

Case Study #2

Karen is a 55-year-old female client in the medical-surgical unit. She arrived this afternoon with uncontrolled vomiting. She received oral antiemetics in the ED, with no effect. During your admission assessment, Karen states, “I feel so terrible. My stomach is turning constantly; I haven’t eaten anything since yesterday morning, and I have only sipped a little water here and there. I’m worried about becoming dehydrated. Whatever they gave me in the Emergency Department didn’t help at all. Can’t you give me something that will work more quickly?”

You note that Karen is pale, and her lips are dry. She closes her eyes frequently and is holding her stomach. After arriving on the unit an hour ago, she has vomited a small amount of clear liquid.

Karen has a history of chronic kidney disease and biweekly dialysis, as well as depression. You immediately call the doctor on call for further orders.

The MD gives you the following orders:

• • Start a peripheral IV STAT
  • Administer ondansetron 8 mg IV now
  • Start NaCl 0.9% IV at 500 mL/hr

1. What will you consider when initiating an IV for Karen?

2. Based on the provided supply of 16 mg/8 mL, what will be the amount you will administer? What will be the rate of administration?

3. What are the following for the ordered medication?

• Indication and action of medication
• Onset, peak, and duration of the medication
• Nursing considerations or special instructions for use
• Assessments pre-, post-, and during administration
• Patient education