Lillian has been on her medication for pneumonia for 24 hours. The physician says the pneumonia is improving, but she also is having an acute exacerbation of her COPD and a chronic irregular heart rate. Her vital signs are T 37C, B/P 140/87, P 82 and irregular, R 12, and pulse oximetry 92% on 2L O2 per nasal cannula. The physician is concerned about her blood pressure and wants to continue to watch it. She feels that Lillian will benefit from regular medication for her COPD while in the hospital and when she goes home. Lillian also is complaining of cigarette cravings and constipation. The physician is urging her to quit smoking.
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The physician leaves the following orders.
- Albuterol MDI two puffs every 6 hours
- Ipratropium MDI two puffs every 6 hours
- Nicoderm 7 mg/24 hr transdermal patch daily
- Bisacodyl 10 mg suppository now x1 then 10 mg po daily
- Bathroom privileges
- Respiratory therapist to determine need for O2 at home
- Cardiologist, Dr. B, to consult for irregular heart rate
1. How does albuterol MDI work? Make sure to include drug category, mechanism of action, onset and duration of action, and safety considerations.
2. How does ipratropium MDI work? Make sure to include drug category, mechanism of action, onset and duration of action, and safety considerations.
3. How would the nurse properly administer the two MDIs when both have been scheduled at the same time of day?
4. Lillian asks the nurse why she is on two inhalers for her COPD when she used to use just one. What points would the nurse want to cover to answer her question, considering her history of noncompliance?
The following morning, the cardiologist came to consult on Lillian’s case and left orders for anticoagulation because of Lillian’s chronic irregular heartbeat from atrial fibrillation. Dr. B left the following orders for anticoagulation.
Heparin 5,000 units SQ every 12 hours
Warfarin 2.5 mg po daily for a target INR of 2.5
aPTT, PT, and INR now and then every morning
Digoxin 0.25 mg po daily
1. What is the rationale for the cardiologist ordering heparin and warfarin at the same time?
2. What are some nursing implications when administrating digoxin?
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