Shadow Health Pharm John Larsen Patient Case 1 Verified Assignment, Assignments of Health sciences

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• Shadow Health Pharm John Larsen Patient Case

Started: Nov 18, 2018

hello

Oh, hey.

im going to be administering your medications today, they are for

your blood pressure. they might make you feel dizzy, but they should

be effective in about 30 minutes

Oh, okay, thanks.

are you in any pain today?

Nah, I'm not in any pain right now. My knee was really hurting a few

hours ago, probably because of the surgery. You don't get through a

total knee replacement without some pain, huh? The last nurse gave

me some pretty heavy stuff for it though, so, no, I'm not in pain.

this medication will also effect your cholesterol levels, to help

prevent stroke heart disease

Oh, okay, thanks.

do you have a history of liver disease?

No, nothin' like that.

are you having muscle tenderness?

Question

10:00 PM

CST

Statement

10:03 PM

CST

Question

10:04 PM

CST

Statement

10:10 PM

CST

Question

10:10 PM

CST

Question

10:11 PM

CST

Some others to let me know about could be joint pain, feeling very

tired or weak, confusion, or issues with remembering things.

Oh, okay, thanks.

Statement

12:46 PM

CST

Checked vitals before giving medication

Exam Action

12:46 PM

CST

Can you rate your level of pain right now on a scale from 0-10?

I guess a 1 or 2. I don't feel much on this heavy pain med they have

me on.

Question

12:52 PM

CST

Checked intake and output before giving medication

Exam Action

12:56 PM

CST

How much have you drank today?

I had some water when I woke up, but that's about it.

Do you feel thirsty now?

Nah, they've been keeping me watered. I'll let you know if I'm thirsty.

Question

1:43 PM

CST

Question

1:43 PM

CST

When was your last bowel movement?

Oh, I probably went some time before bed last night. I didn't write it

down in my diary or anything.

Was it loose or solid? (No matching questions found.)

Was it a normal bowel movement? (Clarified to Was your bowel

movement normal?.)

Yeah, it was normal. (Clarified to if my last bowel movement was

normal.)

Im your nurse Kara and I will be taking care of you today.

Oh, hey.

Can you confirm your name?

It's John Larsen. Can't you see that on the forms?

are you allergic to any medications?

I have an allergy to codeine.

So what's this?

Question

1:45 PM

CST

Question

1:46 PM

CST

Question

1:46 PM

CST

Question

7:52 AM

CST

Question

7:59 AM

CST

Question

7:59 AM

CST

The nurse returns to monitor the patient after one hour.

Question

I am your nurse Kara again. I need to reevaluate you since it has been 11/21/

an hour since you took your medications.

Hey.

How are you feeling?

Same as before. Stuck in this bed, but otherwise pretty peachy for a

guy in the hospital.

Are you experiencing any adverse side effects after taking your

medications?

Nope.

8:18 AM

CST

Question

8:18 AM

CST

Question

8:18 AM

CST

Checked vitals after giving medication

Exam Action

8:19 AM

CST

Checked intake and output after giving medication

Are you in any pain?

Exam Action

8:19 AM

CST

Question

8:20 AM

CST

Nah, I'm not in any pain right now. My knee was really hurting a few

hours ago, probably because of the surgery. You don't get through a

total knee replacement without some pain, huh? The last nurse gave

me some pretty heavy stuff for it though, so, no, I'm not in pain.

Can you rate your pain level on a scale from 0-10? (Clarified to Can

you rate your current pain level on a scale of 0 to 10?.)

The last nurse gave me some pretty heavy-duty stuff for my pain. It's

all the way down to a zero at this point--I'm not feeling it at all.

(Clarified to how I would rate my pain on a scale.)

Question

8:20 AM

CST

Lisinopril: Indications

What is this?

Let the patient know which medication you are giving, and what it is intended to treat.

Student Response Model Response

This medication I am giving you is called Lisinopril. It

helps lower your blood pressure. You only take this once a

day with or without food.

This is lisinopril, which you are

getting to help control your high

blood pressure.

Lisinopril: Drug-Food Interactions

So, this is the Lipitor then?

Let your patient know about the generic medication he is receiving.

Student Response Model Response

Yes. It is the generic brand for Atorvastatin. It will

help lower your bad cholesterol levels and raise the

good ones. It works by reducing the amount of

cholesterol made by the liver.

Yes, this is atorvastatin, which is the

generic name for Lipitor. I’m giving it to

you to help keep your cholesterol levels

under control.

Atorvastatin: Lifestyle

So, I just keep taking this stuff and it'll do its magic for

my cholesterol, huh?

This is an opportunity to educate your patient on the lifestyle adjustments he can make to

improve the desired outcomes of this medication.

Student Response Model Response

If you want to improve the outcomes of this

medication, try to eat a heart healthy diet,

exercise daily, Keep your weight within a

normal healthy range as instructed by your

To manage your cholesterol levels effectively, it is

important to work on this in your lifestyle too.

Having a regular exercise regimen, eating a diet

that is low in fats, carbohydrates, and alcohols, and

doctor, avoid smoking and drinking alcohol. not smoking can help this medication do its job.

Patient Assessment

• Finding:

Asked for patient identification

(Found)

Pro Tip: Proper identification is critical for the protection of your patient. It is

recommended to check two identifiers before interacting with the patient.

Example Question:

Can you confirm your name?

• Finding:

Checked vitals before giving medication

(Found)

Pro Tip: Assessing the patient's vitals may impact your care plan and the safe

administration of ordered medications.

Example Question:

• Finding:

Asked current breathing status

(Available)

Pro Tip: Difficulty breathing is one of the adverse effects of enoxaparin, a medication the

patient received prior to this assessment.

Example Question:

How is your breathing?

• Finding:

Asked about medication allergies

(Found)

Pro Tip: Patients may have allergies that are not included in their documentation, so

asking for verbal confirmation can prevent serious adverse events.

Example Question:

Do you have any allergies to medications?

• Finding:

Asked about current pain

(Found)

Pro Tip: This patient has been ordered pain medication. Assessing for pain is vital to

determining the efficacy of prior treatment and the need for further analgesic

intervention.

(Available)

Pro Tip: Managing multiple home medications can a difficult routine adjustment for some

patients. It is important to assess the patient's likelihood to miss doses of new

prescriptions to better shape your care plan.

Example Question:

How do you manage your medication?

• Finding:

Asked current nausea status

(Available)

Pro Tip: Nausea is a symptom that may be an indicator of rhabdomyolysis, which is a

potentially life-threatening adverse effect associated with atorvastatin.

Example Question:

Are you feeling nauseated?

Patient Monitoring

• Finding:

Checked vitals after giving medication

(Found)

Pro Tip: Assessing the patient's vitals may impact your care plan and the safe

administration of ordered medications.

Example Question:

• Finding:

Asked about muscle pain and soreness

(Found)

Pro Tip: Muscle pain is a symptom that may be an indicator of rhabdomyolysis, which is

a potentially life-threatening adverse effect associated with atorvastatin.

Example Question:

Do you have muscle pain?

• Finding:

Ask about pain worsening

(Found)

Pro Tip: This patient has been ordered pain medication. Assessing for pain is vital to

determining the efficacy of prior treatment and the need for further analgesic

intervention.

Example Question:

Have you had an increase in pain?

• Finding:

Asked about rash

(Available)

Pro Tip: Rashes are one of the most common adverse effects associated with atorvastatin.

Example Question:

Have you noticed a rash?

• Finding:

Checked intake and output after giving medication

(Found)

Pro Tip: Assessing the patient's intake and output may impact your care plan and the safe

administration of ordered medications.

Example Question:

• Finding:

Asked about heart palpitations

(Available)

Pro Tip: An increased heart rate, resulting in heart palpitations, is a symptom of

agranulocytosis and rhabdomyolysis, which is a potentially life-threatening adverse effect

associated with lisinopril.

Example Question:

Have you felt your heart beating abnormally?

• Finding:

Asked about weakness

(Available)

Pro Tip: Weakness is an adverse effect associated with atorvastatin.

Example Question:

Do you feel weak?

• Finding:

Asked about vomiting

(Available)

Pro Tip: Vomiting is a symptom that may be an indicator of rhabdomyolysis, which is a

potentially life-threatening adverse effect associated with atorvastatin.

Example Question:

Have you been vomiting?

• Finding:

(Available)

Pro Tip: Diarrhea is one of the most common adverse effects associated with atorvastatin.

Example Question:

Do you have diarrhea?

• Finding:

Asked about general swelling

(Available)

Pro Tip: Swelling, especially facial swelling, can be an indicator of angioedema, a

potentially life-threatening condition and adverse effect associated with lisinopril.

Example Question:

Do you have swelling?

• Finding:

Asked about abdominal cramps

(Available)

Pro Tip: Abdominal cramping is one of the most common adverse effects associated with

atorvastatin.

Example Question:

Do you have any abdominal cramps?

Summary

Total Findings 12 / 27 (44.4%)

Tier 1 Total 9 / 11 (81.8%)

Subjective 8 / 23 (34.8%)

Tier 2 Total 3 / 16 (18.8%)

Objective 4 / 4 (100.0%)

Notes Student Documentation Model Documentation

Patient has an allergy to Codeine. Causes upset stomach and vomitting.

Acetiaminophen with Codeine has been discontinued. Patient has

(No Model

Documentation

Student Documentation Model Documentation

Hyperlipidemia & HTN. Provided)

Notes

Student Documentation Model Documentation

Patient needs to be monitored for any type of allergic reaction such as upset

stomach, vomitting, rash, hives, confusion, coughing, wheezing, extreme joint

pain, not able to sleep, sudden memory loss, swelling of the face, lips, tongue,

throat. Watch for hepototoxicity, lowered BP. Patient not complaining of thirst,

need to watch for dehydration and I/O levels have dropped in the past 24 hrs.

Possible need for IV fluids to improve intake and output.

Review Questions

1. A patient has been given a new prescription for warfarin. Which statement indicates the need for additional teaching?

Correct: Aspirin increases the effect of warfarin and may cause a higher risk of bleeding; the patient should not take aspirin while on warfarin therapy. All other statements are consistent with safe use of warfarin.

• I will use a soft toothbrush while taking this medication
• I can eat moderate amounts of foods with vitamin K on a regular basis
• I should report unusual bleeding to my doctor
• I can keep taking a daily aspirin to protect against heart disease (Correct Response) 2. What is the nurse’s priority assessment for a patient receiving heparin treatment?

Correct: While all options are relevant assessments, bruising or unusual bleeding can be a life threatening adverse effect of heparin treatment, and therefore needs to be the nurse’s priority.

• Assess for elevated liver enzymes
• Assess for inflammation at the injection site
• Assess for bruising or unusual bleeding (Correct Response)
• Assess aPTT levels

Student Response: I have a lot to learn on medications themselves, but this experience did show me the correct steps to take to administer the medications and what to look for throughout the entire process during patient care.