Gary Rawlings is admitted to the emergency room for falls at the Methodist Hospital. Gary Rawlings is 71 years old. He lives at home with his wife, Karen, and son, Doug. He recently was hospitalized for a stage 4 pressure ulcer to his heel. Gary suffers from diabetes and high blood pressure. Gary is unable to walk far distances due to his heel. Karen recently bought Gary a motorized wheelchair for Gary to get around easier. Gary has been admitted to the hospital three times in the last six months for falls without any major injuries. Mr. Gary is presently on Metformin 1000mg Orally twice a day, Norvasc 10mg Orally daily and Zocor 40mg Orally daily. Mr, Rawlings left calf is swollen, red and tender to touch.

QUESTION

Analyze the presented case studies, and then complete the following four activities:

o       Clinical Worksheet

o        Plan of Care Concept Map

o        Pharm4Fun Worksheet (one per medication)

o        ISBAR Worksheet

DUE DATE

Case Study # 1

Gary Rawlings is admitted to the emergency room for falls at the Methodist Hospital. Gary Rawlings is 71 years old. He lives at home with his wife, Karen, and son, Doug. He recently was hospitalized for a stage 4 pressure ulcer to his heel. Gary suffers from diabetes and high blood pressure. Gary is unable to walk far distances due to his heel. Karen recently bought Gary a motorized wheelchair for Gary to get around easier. Gary has been admitted to the hospital three times in the last six months for falls without any major injuries. Mr. Gary is presently on Metformin 1000mg Orally twice a day, Norvasc 10mg Orally daily and Zocor 40mg Orally daily. Mr, Rawlings left calf is swollen, red and tender to touch.

Case Study # 2

Mike Hughes is a 21-year-old male who was just admitted to the Medical Unit from the ER. He presented to the ER 3 hours ago with chest pain, shortness of breath, a productive cough for 2 weeks, and elevated temperature. Chest x-ray revealed bil. lower lobe pneumonia. Patient has a history of Asthma. IV was started of normal saline at 100 mL per hour. He is receiving oxygen at 3 L/min per nasal cannula. SpO2 on room air was 88%, which increased to 93% with supplemental oxygen. He had a temp of 103.5°F and was given acetaminophen 1,000 mg in the Emergency Department. The following medications were ordered: Ceftriaxone 1000mg IV every 12 hours. Solumedrol 40 mg IV daily. Ranitidine 50mg IV daily.

Case Studies # 3

Mr. Daniel is a 58-year-old male who presented to the Emergency Department 3 days ago with complaints of nausea, vomiting, and severe abdominal pain and was admitted for emergent surgery for bowel perforation. He has history of ulcerative colitis. He underwent a hemicolectomy. He has a midline abdominal incision without redness, swelling, or drainage. He is tolerating a soft diet without nausea or vomiting. Bowel sounds are present in all four abdominal quadrants. He had a bowel movement yesterday. Last urinary output was 400 ml at 6 a.m. He is reluctant to use the incentive spirometer, but his wife encourages him to do his deep breathing. Abdominal pain has been controlled with fentanyl. He has refused to ambulate this morning because of fatigue and a sore leg. He is on TPN 2 Liters/day with Lipids. 10 units of regular insulin and 1 vial (10ml) of multivitamins is to be added to each bag before infusing the TPN.

CASE STUDIES #4

Julia, age 62 years, became severely depressed 6 years ago when her son experienced a traumatic brain injury sustained in an automobile accident. She has been nonadherent with pharmacologic antidepressant therapy, which has led to her admission to an acute care psychiatric setting. During the assessment interview, she reports becoming increasingly forgetful and now has difficulty sleeping and concentrating. A physical assessment shows that she has lost 30 pounds during the last year as a result of “not being interested in eating.” Her home needs repairs, and she feels overwhelmed with completing the maintenance required. Julia reports “feeling helpless and alone,” adding that she “is alone and no one cares.” She was started on Sertraline 25mg PO daily

CASE STUDIES #5

Carla Hernandez is a 32-year-old Hispanic female, G2P1 (L1), at 39 5/7 weeks of gestation. She was admitted to labor and delivery in active labor at 0600 hours today, accompanied by her husband Earl.

To progress the delivery, artificial rupture of membranes was performed by the provider a few minutes ago. The provider has just left the room to make rounds.

Suddenly, the fetal heart rate drops dramatically, and you discover that the umbilical cord is prolapsed. You are ready to handle this situation with another nurse who is also present in the room. The doctor ordered terbutaline sulfate 1mg Subcutanous stat.

CASE STUDIES #6

Brittany Long is a 5-year-old African American female with a history of sickle cell disease, diagnosed at 6 months old, and has been prescribed regular folic acid supplement.

She was brought into the emergency department during the night by her mother, who stated that the patient has been complaining of right lower leg pain over the last 2 days. Brittany rated her pain as a 5 on the FACES Scale and did not want anyone to touch her leg during assessment. She has not had an appetite in the last 24 hours but has taken small amounts of oral fluids.

She has had pain crises before, mostly managed at home with acetaminophen and ibuprofen. She has been hospitalized twice, once at age 4 years for a vaso-occlusive crisis episode and once at age 3 years for a fever.

Brittany was given oral pain medication in the emergency department at 6:00 AM. She is asleep but is responsive when awakened. She has been taking small amounts of oral fluids and continues to receive intravenous maintenance fluids Normal Saline at 52 mL/hr. When examined this morning, her blood pressure was 101/70 and her temperature was 37.4°C (99°F). She now rates her pain as a 3. New orders have been given for the following medications: Acetaminophene elixir 240mg orally every 6 hrs, Codiene elixir 8mg orally every 4 hrs, Ibuprofen elixir 160mg orally every 6 hrs, Colace syrup 100mg orally every day, and folic acid 1mg orally daily.

ANSWER

Clinical Worksheet

Case Study #1:
Patient: Gary Rawlings
Age: 71
Medical History: Diabetes, high blood pressure, stage 4 pressure ulcer
Medications: Metformin 1000mg orally twice a day, Norvasc 10mg orally daily, Zocor 40mg orally daily
Presenting Complaint: Left calf swollen, red, and tender to touch
Other Relevant Information: Recently hospitalized for falls, uses a motorized wheelchair, unable to walk long distances

Case Study #2:
Patient: Mike Hughes
Age: 21
Medical History: Asthma
Medications: Ceftriaxone 1000mg IV every 12 hours, Solumedrol 40mg IV daily, Ranitidine 50mg IV daily
Presenting Complaint: Chest pain, shortness of breath, productive cough, elevated temperature
Other Relevant Information: Diagnosed with bil. lower lobe pneumonia, receiving oxygen at 3 L/min, started on IV normal saline

Case Study #3:
Patient: Mr. Daniel
Age: 58
Medical History: Ulcerative colitis
Procedure: Hemicolectomy
Medications: Fentanyl for pain control, TPN 2 Liters/day with lipids, 10 units of regular insulin and 1 vial (10ml) of multivitamins to be added to each TPN bag
Presenting Complaint: Nausea, vomiting, severe abdominal pain (post-surgery)
Other Relevant Information: Midline abdominal incision, tolerating a soft diet, bowel sounds present, reluctance to use incentive spirometer, refusal to ambulate

Case Study #4:
Patient: Julia
Age: 62
Medical History: Severe depression, nonadherence to antidepressant therapy
Medication: Sertraline 25mg PO daily
Presenting Complaint: Forgetfulness, difficulty sleeping, weight loss, feeling helpless and alone
Other Relevant Information: Son’s traumatic brain injury, home needs repairs, overwhelmed with maintenance

Case Study #5:
Patient: Carla Hernandez
Age: 32
Medical History: G2P1 (L1), 39 5/7 weeks of gestation
Medication: Terbutaline sulfate 1mg subcutaneous (ordered)
Presenting Complaint: Umbilical cord prolapse during active labor
Other Relevant Information: Fetal heart rate drop, artificial rupture of membranes performed

Case Study #6:
Patient: Brittany Long
Age: 5
Medical History: Sickle cell disease, prescribed regular folic acid supplement
Medications: Acetaminophene elixir 240mg orally every 6 hrs, Codiene elixir 8mg orally every 4 hrs, Ibuprofen elixir 160mg orally every 6 hrs, Colace syrup 100mg orally every day, folic acid 1mg orally daily
Presenting Complaint: Right lower leg pain, decreased appetite, previous pain crises
Other Relevant Information: Hospitalized twice for sickle cell-related issues, currently receiving intravenous maintenance fluids

Plan of Care Concept Map:

(Note: The concept map cannot be provided in text form as it requires visual representation. Please create the concept map based on the information provided in the case studies.)

Pharm4Fun Worksheet:

Case Study #1:
Medication: Metformin
– Indication: Diabetes management
– Dosage: 1000mg orally twice a day
– Side Effects: Gastrointestinal upset, lactic acidosis (rare)
– Nursing Considerations: Monitor blood glucose levels, assess for signs of hypoglycemia or hyperglycemia

Case Study #2:
Medication: Ceftriaxone
– Indication: Treatment of bacterial infection (pneumonia)
– Dosage: 1000mg IV every 12 hours
– Side Effects: Allergic reactions, gastrointestinal disturbances
– Nursing Considerations: Monitor for signs of allergic reactions, assess renal function

Case Study #3:
Medication: Fentanyl
– Indication: Pain control
– Dosage: Administered as needed (dosage not specified)
– Side Effects: Respiratory depression, sedation
– Nursing Considerations: Monitor respiratory rate, assess pain level, observe for adverse effects

Case Study #4:
Medication: Sertraline
– Indication: Treatment of depression
– Dosage: 25mg PO daily
– Side Effects: Nausea, insomnia, sexual dysfunction
– Nursing Considerations: Monitor mood changes, assess for suicidal ideation, encourage adherence to medication

Case Study #5:
Medication: Terbutaline sulfate
– Indication: Relaxation of uterine smooth muscle, tocolytic
– Dosage: 1mg subcutaneous (stat order)
– Side Effects: Tachycardia, tremors, palpitations
– Nursing Considerations: Monitor maternal heart rate, assess for chest pain or shortness of breath

Case Study #6:
Medication: Acetaminophene, Codiene, Ibuprofen, Colace, Folic acid
– Indication: Pain relief, stool softener, supplementation
– Dosage: Varied dosages as specified in the case study
– Side Effects: Nausea, constipation (Colace), gastrointestinal upset
– Nursing Considerations: Assess pain level, monitor bowel movements, provide education on medication administration

ISBAR Worksheet:

Case Study #1:
Identification: Gary Rawlings, 71-year-old male with diabetes, high blood pressure, and a stage 4 pressure ulcer.
Situation: Admitted to the emergency room for falls with a swollen, red, and tender left calf.
Background: Recently hospitalized for falls, uses a motorized wheelchair, on Metformin, Norvasc, and Zocor.
Assessment: Left calf swelling, redness, and tenderness; unable to walk far distances due to the heel ulcer.
Recommendation: Perform further assessment, consult wound care specialist, consider imaging studies, monitor blood glucose levels.

(Note: ISBAR worksheets need to be completed for each case study using the given information. They are communication tools used by healthcare professionals for structured handoff and reporting. Each worksheet will include Identification, Situation, Background, Assessment, and Recommendation for the respective case.)