NR 446 Lab prep NOTES Latest 2023 / 2024
Janet Martin:
Janet Martin is a 75 year old female. Her daughter called stating that Janet was complaining of coughing/not feeling well and is unable to get off the couch because she is weak and fatigued. The daughter brought her into the Emergency Department with c/o fever and chills for 2 days, decreased appetite, noted productive green cough and fatigue. Janet was admitted to the telemetry unit with a diagnosis of bilateral pneumonia. Janet also had an open wound on her left great toe that turned out to have MRSA after a wound culture was done. The wound has closed.
Margaret Stanton:
Margaret Stanton is a 75 year old female admitted to the telemetry unit late last night for MVP (Mitral valve prolapse) and is scheduled for surgery this morning at 0730.
- The healthcare provider ordered 500mg Vancomycin Hydrochloride IVPB every
six hours. The maximum safe dose range is 40mg/kg/day. The client weighs 165 lb. What is the maximum therapeutic dose the nurse will administer per day? mg/day (If needed, round to the nearest whole number)
165lbs/ 2.2 kg= 75 kg
40mg X 75 kg= 3,000 mg/day maximum therapeutic dose for this patient
- What is the purpose of Vancomycin Hydrochloride and what are the side
effects/administration protocols?
It is an anti-infective that treats life threatening infections such as MRSA. Side affects may include tinnitus or hearing loss \, nephrotoxicity, or liver damage. Do not infuse this medication with other drugs, give medication over at least a 60 minute time period and the dose should be individually adapted according to weight, age and renal function.. Pg 62
- What are some of the risks that diabetics face as a result of uncontrolled blood
sugars?
Diabetic ketoacidosis (DKA) is an acute life threatening condition characterized by uncontrolled hyperglycemia (greater than 300 mg/dL) resulting in the breakdown of body fat for energy, dehydration, metabolic acidosis, and an accumulation of ketones in the blood and urine. The onset is rapid and mortality rate is up to 10%.
Hyperglycemic- hyperosmolar state (HHS) is an acute life threatening condition characterized by profound hyperglycemia (greater than 600 m/DL), hyperosmolarity that leads to dehydration, and an absence of ketosis. 1 / 2
Onset generally occurs gradually over several days and if left untreated can lead to coma and death.
• Poor wound healing • Neuropathy • High blood pressure • Stroke • Kidney disease Explain the difference between Type I & Type II Diabetes.
• Type 1 diabetes is an immune-mediated disease, caused by autoimmune destruction of the pancreatic β cells, the site of insulin production. This eventually results in a total absence of insulin production.• In type 2 diabetes the pancreas usually continues to produce some endogenous (self-made) insulin. However, the insulin that is produced is either insufficient for the needs of the body or is poorly used by the tissues, or both. Many factors contribute to the development of type 2 diabetes. The most powerful risk factor is obesity, especially abdominal and visceral adiposity.
Discuss a diet that is appropriate for a diabetic. How is it different from a general diet?
Component Recommendations Total carbohydrate • • • Minimum of 130 g/day.• Include carbohydrate from fruits, vegetables, grains, legumes, and low-fat milk.• • Monitor by carbohydrate counting, exchange lists, or use of appropriate proportions (eFig. 49-1).• • • Glycemic index may provide additional benefit.• Sucrose-containing food can be substituted for other carbohydrates in the meal plan.• • • Fiber intake at 25-30 g/day.• Nonnutritive sweeteners are safe when consumed within FDA daily intake levels.Protein • • 15%-20% of total calories.• • High-protein diets are not recommended for weight loss.Fat • • • • Limit saturated fat to <7% of total calories.• Trans fat should be minimized.• Dietary cholesterol <200 mg/day.• • ≥2 servings of fish per week to provide polyunsaturated fatty acids.
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