DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS)
The patient Kenneth Bronson was diagnosed with Pneumonia and
... [Show More] Anaphylactic Shock. Pneumonia is inflammation of the lungs caused by bacteria or viral agents. The normal flora found in the lungs is usually altered or resistant which causes a loss of host defenses in the body. Inflammation impairs oxygen ventilation and diffusion from mucosal edema that infiltrates the alveoli. Symptoms include difficulty breathing, cough with sputum, chills, tachypnea, and fever. Anaphylactic shock is a severe allergic reaction that is usually caused by an foreign substance. In this scenario the patient developed an anaphylactic shock due to the antibiotic Ceftriaxone. This is due to activation of antigen-antibody reactions that causes activation of many cytokines and histamine. Signs and symptoms usually occur within 2-30 minutes of ingestion and include: headache, nausea, vomiting, abdominal pain or discomfort, difficulty breathing, laryngeal edema, cardiac dysrhythmias, and hypotension.
DIAGNOSTIC TESTS (REASON FOR TEST AND RESULTS)
PATIENT INFORMATION ANTICIPATED PHYSICAL FINDINGS
- Sputum culture (shows which bacteria caused pneumonia)
- CBC
- Chest X-ray (reveals where pneumonia is located)
- Arterial blood gas (shows oxygen and carbon dioxide levels)
Name: Kenneth Bronson Age: 27 years old Allergies: NKDA Diagnosis: Pneumonia Past History: none
- Shortness of breath
- Fever (over 102F)
- Productive cough
- Chest tightness
ANTICIPATED NURSING INTERVENTIONS
- Take vital signs every 4 hours
- Maintain oxygen saturation rate above 92%
- Administer antibiotics as prescribed by provider
- Observe for any signs of anaphylaxis
- Educate patient about pneumonia and the treatment
- Contact provider for any alerting changes, especially during an anaphylactic reaction
- Assess pain levels and provide therapeutic communication
vSim ISBAR ACTIVITY STUDENT WORKSHEET
INTRODUCTION
Your name, position (RN), unit you are working on
SITUATION
Patient’s name, age, specific reason for visit
BACKGROUND
Patient’s primary diagnosis, date of admission, current orders for patient
ASSESSMENT
Current pertinent assessment data using head to toe approach, pertinent diagnostics, vital signs
RECOMMENDATION
Any orders or recommendations you mayhave for this patient
“Hello my name is Karen and I am the student nurse working on the Medical Unit from the Emergency department.”
“My patient’s name is Kenneth Bronson, he is 27 years old, and was admitted to the emergency department two hours ago due chest tightness, difficulty breathing, and a productive cough for a week accompanied by fever.”
“Chest X-rays revealed right lower lobe pneumonia and he was admitted today. The current orders consist of maintaining oxygen saturation above 92% with nasal cannula, continue IV normal saline at 75 mL per hour, give acetaminophen PRN for fever above 102F, and take vital signs every 4 hours. The provider also prescribed Ceftriaxone antibiotics.”
“Skin is warm, slightly sweating, and intact. Vital signs consist of the following: heart rate 97/min, blood pressure 136/82 mm hg, respiration 19/min, oxygen saturation 95%, temperature 103F, and radial and carotid pulse are 95/min. Heart sounds are normal while breath sounds are reduced at the right lung base. During the anaphylactic shock vital signs consisted of the following: heart rate 136/min, blood pressure 137/71 mm Hg, respiration 32/min, oxygen saturation 91%, temperature 102F, and radial and carotid pulses are strong and 155/min.”
“Recommendations would be to continue monitoring vital signs. If patient reports signs of an anaphylactic reaction stop infusion and obtain new orders from provider. Administer new medications as instructed by provider. Place 3 lead EKG leads to monitor for any cardiac dysrhythmias. Once stabilized, educate patient about the anaphylactic reaction and explain that he is allergic to medication and what to do to avoid an event such as this. Continue monitoring oxygen saturation rate by administering oxygen via nasal cannula with warm humidified oxygen. Ask patient how he is feeling and if he reports any new symptoms.”
PHARM-4-FUN PATIENT EDUCATION WORKSHEET
NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE
MEDICATION:
1. Acetaminophen
2. Ceftriaxone
3. Diphenhydramine
4. Epinephrine
5. Methylprednisolone
6. Ranitidine
CLASSIFICATION:
1. Acetaminophen - analgesics and antipyretics
2. Ceftriaxone – cephalosporin antibiotics
3. Diphenhydramine - antihistamines
4. Epinephrine – alpha and beta adrenergic agonists (sympathomimetic agents)
5. Methylprednisolone- glucocorticoids
6. Ranitidine – histamine-2 blockers
PROTOTYPE:
1. Acetaminophen – Tylenol, Actamin, Elixsure, Mapap, Medi-tabs, Tactinal, Tycolene, Vitapap
2. Ceftriaxone – Cefotaxime sodium
3. Diphenhydramine – Benadyl, Allergy relief, Allermax, Banophen, Sil[hen cough, etc
4. Epinephrine – Adrenalin, Auvi-Q, Epipen-2 Park, Epinephrinesnap-EMS
5. Methylprednisolone – Medrol, Medrol Dosepak
6. Ranitidine - Zantac
SAFE DOSE OR DOSE RANGE, SAFE ROUTE
1. Acetaminophen – oral: 325mg to 1g orally every 4 to 6 hours
2. Ceftriaxone – 1 to 2 g IV or IM once a day
3. Diphenhydramine – 10 to 50 mg deep IM or IV as needed
4. Epinephrine – 30 kg or greater take 0.3 – 0.5mg IM or subcutaneously
5. Methylprednisolone – high dose therapy 30mg/kg IV over at least 30 minutes every 4-6 hours until condition has stabilized
6. Ranitidine – 150mg orally twice a day for 300mg orally once a day (parenteral is 50mg IM or IV every 6 to 8 hours)
PURPOSE FOR TAKING THIS MEDICATION
1. Acetaminophen – This medication is used to reduce fever and treat mild to moderate pain
2. Ceftriaxone – it is used to treat bacterial infections such as pneumonia.
3. Diphenhydramine – it is an antihistamine that reduces symptoms of allergy such as sneezing, itching, watery eyes, hives, skin rash, and runny nose.
4. Epinephrine – is used to treat severe allergic reactions such as anaphylaxis
5. Methylprednisolone – used to treat inflammatory conditions such as arthritis, lupus, psoriasis, ulcerative colitis and other conditions that affect skin, eyes, lungs, stomach, nervous system, or blood cells
6. Ranitidine – reduces the amount of acid your stomach produces
PATIENT EDUCATION WHILE TAKING THIS MEDICATION [Show Less]