14 Jan 2. List a short-term

NUR2407 Pharmacology

Module 4 Assignment

Case Study – Pain

P. W. is a 65-year-old male that slipped and fell on an ice patch. He was an active person before the accident with a past medical history of osteoarthritis of both knees. X-rays of the R hip shows a complete fracture across the neck of the femur and a second fracture of the Greater Trochanter. He is scheduled for a total hip replacement the following day. He is rating his pain as an 8 out of 10. VS 98.7°F – 73 – 18, BP 142/88, O2 Saturation is 98% on room air. The following medications were prescribed during the night:

· Hydromorphone 1 mg IV every 2 hours PRN for severe pain

· Temazepam 15mg PO at bedtime

Thirty minutes before the surgery, P.W. is given 2 mg of atropine IM and 1 mg of midazolam IV push. Following the surgery, the following prescriptions are entered:

· Hydromorphone PCA 0.1mg/hr continuous rate, with a 0.3mg on-demand dose (lockout 10 minutes, 1.5 mg/hour limit)

· End-tilde CO2 while on PCA therapy

· Naloxone per hospital PCA protocol

Assignment:

1. In addition to treating pain, name three nursing priorities?

2. List a short-term (during shift) and a long-term (within one Module) SMART goal for the patient?

3. What are the classification, action, and therapeutic effects (reason) for hydromorphone, temazepam, and naloxone?

4. List drug interactions or contraindications to be concerned about for hydromorphone, temazepam, and naloxone?

5. What adverse effects/side effects does the nurse need to monitor for hydromorphone, temazepam, and naloxone?

6. Why was the patient prescribed atropine and midazolam before the surgery? What adverse/side effects should the nurse monitor for post-anesthesia?

7. What is the purpose of end-tilde CO2 monitoring while the patient is receiving PCA therapy? What other safety precautions are necessary for PCA therapy?