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Zorluk: ZorPharmacological Therapies

A practical nurse is caring for a client who underwent a bowel resection 1212 hours ago. The client appears increasingly restless, reports an abdominal pain level of 88 on a 00 to 1010 scale, and requests a prescribed PRN dose of oral hydrocodone-acetaminophen. A routine dose of oral carvedilol is also due at this time. Current vital signs are blood pressure 86/5286/52 mmHg, apical heart rate 118118 beats/min, and respiratory rate 2222 breaths/min. Which of the following actions should the practical nurse take first?

  1. Withhold both medications and immediately notify the registered nurse.Cevap
  2. B
    Administer the hydrocodone-acetaminophen to treat the pain but withhold the carvedilol.
  3. C
    Administer both medications and document the client's restlessness as a response to severe pain.
  4. D
    Increase the rate of the continuous intravenous fluids to stabilize the blood pressure.

Cevap

The practical nurse should withhold both the hydrocodone-acetaminophen and the carvedilol, and immediately notify the registered nurse.
The client's presentation of low blood pressure, high heart rate, and restlessness 1212 hours post-surgery indicates potential hemorrhage or hypovolemic shock. Carvedilol (a beta-blocker) lowers blood pressure and heart rate, which would blunt the body's compensatory mechanisms. Hydrocodone-acetaminophen (an opioid analgesic) causes vasodilation, which would further decrease blood pressure. The safest and most appropriate action within the practical nurse scope of practice is to withhold both medications and immediately alert the registered nurse so that rapid interventions (such as fluid resuscitation or blood products) can be initiated.

Adım Adım Çözüm

1
Analyze the client's vital signs and clinical presentation.
The client has hypotension (86/5286/52 mmHg), tachycardia (118118 beats/min), and restlessness, which are classic signs of hypovolemia or early shock following abdominal surgery.
Identifying physiological instability is the first essential step before administering any pharmacological therapies.
2
Evaluate the pharmacological effects of the prescribed medications on the client's current state.
Carvedilol decreases blood pressure and heart rate. Hydrocodone causes vasodilation and can further decrease blood pressure.
Medications must be held if their therapeutic or adverse effects will worsen the client's compromised circulatory status.
3
Determine the appropriate action within the practical nurse scope of practice.
The nurse must withhold the contraindicated medications and escalate the situation to the registered nurse.
Practical nurses must immediately report acute, life-threatening changes in a client's condition to the RN or provider for advanced assessment and orders.

Anahtar Kavram

Pre-administration Assessment and Safe Medication Administration in Unstable Clients
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Konular

Pharmacological Therapies

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