PATIENT PROFILE INSTRUCTOR COPY ROBIN RITTER

7013 Orchard Lake Road, Suite 110, West Bloomfield, Michigan 48322Phone: (248) 855-3966 | (877) 593-6011 | Fax: (248) 671-1550

www.DiaMedicalUSA.com | www.SimLabSolutions.com | [email protected]

ROBIN RITTER

PATIENT SUMMARY Admitted with Total Hip Replacement (THA) - post-op day #3. Patient has a history of angina and requires

sublingual nitroglycerin. Colace is ordered but no BM since before surgery. Also requires administration of subQ heparin and clarification of pain medication.

LEARNING GOALS

• Identification of additional information required from report

• Correct dosage calculation• Correct administration of subQ, sublingual and

PO medications• Documentation of medication administration• Effective SBAR communication with prescriber

• Identification of priority nursing assessments for patient with angina and THA

• Interpretation of lab results for postoperative patient receiving heparin

• Creation of appropriate 5-minute nursing care plan for patient with angina and THA

• How to complete medication error report if needed

PATIENT PROFILEINSTRUCTOR COPY



PATIENT PROFILE - Robin RitterInstructor Copy

• Heparin 50,000 units/5 mL• Heparin 10,000 units/10 mL (Distractor)• Colace 100 mg tablets• Nitroglycerin sublingual spray• Nitroglycerin sublingual tablets (Distractor)• Oxycodone 5 mg/Acetaminophen 325 mg tablets

(controlled substance - count)

• SubQ syringes• Medication cups• Alcohol wipes• Injection training pad

Medications Required: Additional Supplies Needed:

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Medications Required:

Additional Supplies Needed:

SKU MEDICATION / ITEM QUANTITY PRICE

PM087803 Practi-Heparin™ 10,000 USP/10 mL (1,000 U/mL) 10 $59.95 / Box of 40

PM087804 Practi-Heparin™ 50,000 USP/5 mL (10,000 U/mL) 10 $62.95 / Box of 40

PM117805 Practi-Docusate™ Oral Medication 10 $14.95 / Box of 48

PM127805 Practi-Nitroglycerin Spray™ 1 $39.95 / Box of 5

PM117834 Practi-Nitroglycerin™ Oral Med 1 $24.95 / Box of 5

PM117814 Practi-Oxycodone & Acetaminophen™ Oral Medication 10 $14.95 / Box of 48

SKU MEDICATION / ITEM QUANTITY PRICEMED051026 3 mL Luer Lok Syringe with Safety Needle 10 $14.95 / Box of 50

MED051460 3 mL Luer Lok Syringe with Safety Needle 10 $19.29 / Box of 50

MED111001 3 mL Syringe with Blunt Vial Access Cannula 10 $37.49 / Roll of 100

MS081023 Plastic Medicine Cups 10 $1.76 / Box of 100

MED081072 Alcohol Prep Pads 30 $18.50 / Box of 2,000




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TODAY’S LAB RESULTSWBC 10.4

RBC 4.8

HGB 7.2

HCT 38.1

PLT 358,000

RBS 66

Na+ 135

Cl- 97

K+ 3.5

• Allergies: Plavix, Restoril• Admitted with THA (total hip replacement)• Post-op day #3• Medical history: stable angina• VS: T 99.8 - P 88 - RR 22 - BP 102/64 -

pulse ox 91%• Lung sounds diminished bilaterally• No BM since before

surgery• Patient just asked

for medication to relieve angina chest pain

Patient Health & History

Additional Optional Supplies:

SKU MEDICATION / ITEM QUANTITY PRICEMS153901 SLS Small Injection Trainer 1 $19.95 / Each

DATE TIME PATIENT NAME # ON HAND # USED # LEFT SIGNATURE

Controlled Substance Count Sheet:

MEDICATION:




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Medication Specifications:

HEPARIN 5,000 UNITS SUBQ BID | Dosage Time: 0900, 1700DRUG CLASS: AnticoagulantREASON WHY PRESCRIBED FOR THIS PATIENT: Prevent postoperative DVT

TWO MAIN PRECAUTIONS/CONSIDERATIONS FOR THIS PATIENT WITH THIS MEDICATION:1. Monitor platelet count for HIT - assess for signs of bleeding2. Do not administer other medications that affect clotting3. Do not rub the injection site after administration - bruising at injection sites common

SHOULD IT BE ADMINISTERED AS WRITTEN? YESRATIONALE: Prevent DVT

COLACE 100 MG PO BID | Dosage Time: 0900, 1700DRUG CLASS: Stool softenerREASON WHY PRESCRIBED FOR THIS PATIENT: Immobility and pain medications cause constipation

TWO MAIN PRECAUTIONS/CONSIDERATIONS FOR THIS PATIENT WITH THIS MEDICATION:1. Stool softener only, not a laxative - do not confuse with Dulcolax 2. Take with a full glass of water or juice3. Encourage dietary fiber -teach patient to avoid Valsalva maneuver

SHOULD IT BE ADMINISTERED AS WRITTEN? YESRATIONALE: No BM since before surgery, laxative needed as well

NITROGLYCERIN SUBLINGUAL SPRAY - 2 SPRAYS Q 5 MINUTES | Dosage Time: PRN UP TO 3 TIMES PRN CHEST PAIN **LAST DOSE: NOT PREVIOUSLY GIVEN

DRUG CLASS: Antianginal vasodilatorREASON WHY PRESCRIBED FOR THIS PATIENT: Relieve angina chest pain

TWO MAIN PRECAUTIONS/CONSIDERATIONS FOR THIS PATIENT WITH THIS MEDICATION:1. Have patient raise the tongue and spray underneath2. May be repeated Q 5 minutes x 2 —> if still not relief call Rapid Response3. Monitor heart rate & BP - can cause headache (relieve with acetaminophen)

SHOULD IT BE ADMINISTERED AS WRITTEN? YESRATIONALE: Patient requests medication to relieve angina pain




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ADDITIONAL INFORMATIONWhat additional information is needed from the shift report?• IV access?• Activity order? How tolerated? PT consulted?• Diet? • Trend of CBC? • Oxygen ordered? Spirometer? Any SOB? Lung sounds? Cough/deep breathe?• SOB with activity? (anemia)• Type & cross done? Blood on hold? • Incision appearance? Drain?

Interpretation of lab results? • Elevated WBC - possible infection, probable inflammation after surgery, need to look at diff• Low hgb/hct/rbc - blood loss after surgery• Pulse ox - probable atelectasis

What are the key nursing assessments?• Chest pain - quality, onset, etc. • Lung sounds (diminished —> atelectasis)• Incision appearance• Activity tolerance, especially with anemia• Abdomen (constipation)

SBAR communication with physician:• Angina (if not relieved with NTG)• Oxygen (titrate to keep pulse ox > 95-98%)• Order for spirometer (if facility requires order)• Laxative order in addition to Colace• Change subQ heparin order to Q 12 hours• Clarify pain level for Oxycodone PRN (consider Tylenol for mild pain

OXYCODONE 5 MG/ACETAMINOPHEN MG 1 TABLET PO Q | Dosage Time: PRN 4 HOURS PRN PAIN **LAST DOSE: 5 HOURS AGO

DRUG CLASS: Combination narcotic pain medication with prostaglandin inhibitorREASON WHY PRESCRIBED FOR THIS PATIENT: Postoperative pain relief

TWO MAIN PRECAUTIONS/CONSIDERATIONS FOR THIS PATIENT WITH THIS MEDICATION:1. Prescribed acetaminophen dosage is less than 4 gram/day - OK2. No anti-inflammatory effects - will not affect blood clotting times 3. Watch for respiratory suppression4. Causes constipation

SHOULD IT BE ADMINISTERED AS WRITTEN? NORATIONALE: Clarify dosage with prescriber




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5-MINUTE NURSING CARE PLAN

Problem #1: Impaired tissue perfusion R/T coronary blood vessel blockage AEB patient report of angina pain

Goals: Relief of chest pain within 15 minutes

Interventions:1. Assess quality and severity of chest pain2. Administer nitroglycerin sublingual spray as ordered3. Assess precipitating factors for pain

Evaluation of goal (met/not met):To be done at the end of the shift


Problem #2: Constipation R/T immobility, narcotic pain medications AEB no BM since before surgery

Goal: BM today

Interventions:1. Obtain order for and administer laxative2. Teach patient to avoid Valsalva maneuver3. Teach patient to increase dietary fiber and fluid intake

Evaluation of goal (met/not met):To be done at the end of the shift




MEDICATION ERROR REPORTPatient Name: Physician: Date of Error: / / Time of error: Date of report: / /

Physician Notified? □ Yes □ NoIf Yes: Name: Date: / / Time:If No: Explain:

Nursing Supervisor Notified: □ Yes □ NoIf Yes: Name: Date: / / Time:If No: Explain:

Family/Responsible party notified: □ Yes □ NoIf Yes: Name: Date: / / Time:If No: Explain:

Pharmacy Notified: □ Yes □ NoIf Yes: Name: Date: / / Time:If No: Explain:

Medications Involved:Description of Error (Include medication name, dose, route, and time(s) administered) Care provided and outcome of patient:

Type of Error:□ Wrong drug□ Wrong dose□ Wrong dosage form□ Wrong documentation□ Wrong time□ Wrong route□ Other:

Reason for Error:□ Transcription error□ Misread order□ Miscalculated dose□ Incorrectly measured dose□ Pharmacy error□ Failure to identify patient□ Other:

Actions to prevent recurrence:

Signature / Title: Date:

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ROBIN RITTER

PATIENT PROFILESTUDENT COPY

PATIENT SUMMARY Admitted with Total Hip Replacement (THA) - post-op day #3. Patient has a history of angina and requires sublingual

nitroglycerin. Colace is ordered but no BM since before surgery. Also requires administrationof subQ heparin and clarification of pain medication.



PATIENT PROFILE - Robin RitterStudent Copy

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• Allergies: Plavix, Restoril• 66 year-old admitted with THA

(total hip replacement)• Post-op day #3• Medical history: stable angina• VS: T 99.8 - P 88 - RR 22 - BP

102/64 - pulse ox 91%• Lung sounds diminished bilaterally• No BM since before surgery• Patient just asked for medication to

relieve angina chest pain

Patient Health & History

TODAY’S LAB RESULTSWBC 10.4

RBC 4.8

HGB 7.2

HCT 38.1

PLT 358,000

RBS 66

Na+ 135

Cl- 97

K+ 3.5



DAILY PATIENT WORKSHEETRoom

Name

Admitting Diagnosis Doctor

Allergies Admission Date Code Status

Diet Isolation Activity

Medical History Assessment Findings Diagnostic Test

Medications NaClK+CaMgPhosBUN CreatRBSCO2

WBCRBCHGBHCTPLTPTINRPTT

Vitals

TPRBPPOX

Intake Output Skin & Wounds

Pain Last BM Staff RN


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Medication Specifications:

HEPARIN 5,000 UNITS SUBQ BID | Dosage Time: 0900, 1700DRUG CLASS:

REASON WHY PRESCRIBED FOR THIS PATIENT:

TWO MAIN PRECAUTIONS/CONSIDERATIONS FOR THIS PATIENT WITH THIS MEDICATION:

1.

2.

SHOULD IT BE ADMINISTERED AS WRITTEN?

RATIONALE:

COLACE 100 MG PO BID | Dosage Time: 0900, 1700DRUG CLASS:



1.

2.


RATIONALE:


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NITROGLYCERIN SUBLINGUAL SPRAY - 2 SPRAYS Q 5 MINUTES | Dosage Time: PRN UP TO 3 TIMES PRN CHEST PAIN *LAST DOSE: NOT PREVIOUSLY GIVEN

DRUG CLASS:



1.

2.


RATIONALE:


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OXYCODONE 5 MG/ACETAMINOPHEN MG 1 TABLET PO Q | Dosage Time: PRN 4 HOURS PRN PAIN *LAST DOSE: 5 HOURS AGO

DRUG CLASS:



1.

2.


RATIONALE:



PATIENT PROFILE - Chris CrawleyInstructor Copy


Problem #1:

Goal:

Interventions:

1.

2.

3.

Evaluation of Goal (met/not met):


Problem #2:

Goal:

Interventions:

1.

2.

3.

Evaluation of Goal (met/not met):


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PATIENT PROFILE INSTRUCTOR COPY ROBIN RITTER