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Pharmacology Reasoning

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Neurologic Changes Introduction In this unfolding case study that simulates the complexities of clinical practice, you will assume the role of a

nurse in the emergency department. You will use a holistic approach to provide safe care by making correct

clinical judgments for a patient with neurologic changes resulting from medications or new problems. You will

need to apply essential knowledge of pharmacology to notice and interpret the most crucial assessment findings

and lab values to properly establish care priorities and recognize a declining neurologic status before it

needlessly progresses.

Preparation for Care Activity Review the home medications of this patient. Prepare for patient care by completing the table below.

Medication Indications Mechanism of action

Expected Side

Effects

Assessments/

Responsibilities

Aripiprazole 10

mg PO daily

Safe dose range:

Therapeutic

Class:

Pharmacologic

Class:

Medication Indications Mechanism of action

Expected Side

Effects

Assessments/

Responsibilities

Alprazolam 0.5

mg PO BID

Safe dose range:

Therapeutic

Class:

Pharmacologic

class:

Pharmacology Reasoning

Medication Indications Mechanism of action

Expected Side

Effects

Assessments/

Responsibilities

Hydrocodone-

acetaminophen

5-325 mg tablet

one tab every 4

hours PO PRN-

pain

Safe dose range:

Therapeutic

Class:

Pharm Class

Medication Indications Mechanism of action

Expected Side

Effects

Assessments/

Responsibilities

Divalproex 500

mg XR 2 tabs

PO BID

Safe dose range:

Therapeutic

Class:

Pharmacology Reasoning

1. Which findings are most important and must be recognized as clinically significant by the nurse?

Most Important Findings Clinical Significance

2. Review the medical history and home medications of this patient. Which medication treats what condition? Draw a

line to identify each clinical relationship.

Medical History Home Meds Pharm. Classification

• Anxiety

• Bipolar Depression

• Schizoaffective disorder

• Aripiprazole 10 mg PO daily

• Divalproex 500 mg XR 2 tabs PO

BID

• Alprazolam 0.5 mg PO BID

3. Based on this patient's current medications, does the nurse need to address the clinical concern of polypharmacy with

the provider?

Polypharmacy Rationale

4. Based on this patient's home medication list, are there any concerning medication interactions that the nurse needs to

communicate to the provider?

Medication Interactions Rationale

Patient Care Begins

Interpretation:

Clinical Significance:

Recognizing a potential problem, you collect a full set of

vital signs and complete a nursing assessment:

Pharmacology Reasoning

5. Which vital sign findings are most important and noticed by the nurse as clinically significant?

Most Important Data Clinical Significance

As you complete the head-to-toe assessment,

you notice these findings:

6. What assessment data needs to be noticed as most important? Interpret its clinical significance and determine how the

nurse should immediately respond.

Most Important Data Clinical Significance Nurse Response

7. What assessment data needs to be noticed as most important? Interpret its clinical significance and determine how the

nurse should immediately respond.

Most Important Data Clinical Significance Nurse Response

8. What assessment data needs to be noticed as most important? Interpret its clinical significance.

Most Important Data Clinical Significance

The following diagnostic test results just posted in the

electronic health record:

Metabolic Panel

Na K Cl CO2 AG Gluc Ca BUN Creat GFR

Pharmacology Reasoning

Hematology: Complete Blood Count (CBC)

WBC HGB PLTS % Neuts % Lymphs % Monos % Eosin Bands

Misc.

Salicylates Acetaminophen Urine Drug Screen

Lipase Lactate (Ven) Hgb A1C

9. Identify which diagnostic findings relate to the home medications or meds that have been recently administered. Place

an "x" for each finding to determine if the results are expected, improved, or worsened.

Diagnostic Result Expected Improved Worsened

WBC

Neutrophils

Hemoglobin

Creatinine

+ for benzo/hydrocodone

Acetaminophen

10. After interpreting diagnostic data, what is the priority problem and pathophysiology?

Priority Problem Pathophysiology in Own Words

11. Identify the rationale for each provider order and its expected outcome.

Provider Orders Rationale Expected Outcome

Establish peripheral IV

0.9% NS 1000 mL IV bolus

Naloxone 0.04 mg IV. May

repeat every 2-3 minutes

until consistently awake (Use 0.4 mg ampule of 1 mL

and add 9 mL of 0.9% NS in

10 mL syringe for dose of

0.04 mg/1 mL)

Pharmacology Reasoning

12. What findings will be present if the pharmacologic therapy is effective? When would those findings be evident?

Medication Expected Assessment Findings How Long Before

Evident?

Rationale

0.9% NS 1000 mL

IV bolus

Naloxone 0.4 mg

IV. May repeat

every 2-3 minutes

until consistently

awake

13. For the new order of naloxone, apply your knowledge to complete the table below.

Medication Indications Mechanism of action Expected Side

Effects

Assessments/

Responsibilities

Naloxone

Safe dose

range:

Therapeutic

Class:

Pharm class:

Pharmacology Reasoning

Dosage Calculation: Naloxone 0.04 mg IV push Medication

Time

frame to

Administer

Show Work Volume to

Administer

14. After interpreting clinical data collected, identify the current nursing priority and which action(s) the nurse

should take. List appropriate interventions, rationale, and expected outcome

Nursing Priority

Priority Intervention(s) Rationale Expected Outcome

Pharmacology Reasoning

Evaluation

15. The nurse collects the following assessment data below. For each finding, place an "x" to determine if the patient's

condition has improved, has not changed, or has declined.

Assessment Data Improved No Change Declined

T: 98.4 F/36.9 C (oral)

P: 72 (regular)

R: 18 (regular)

BP: 110/65 MAP: 80

O2 sat: 96% room air

5/10 sharp ache in the left thigh

Pupils 3 mm/brisk reactive to light

Awake and follows verbal commands

16. Has the patient's overall status improved, declined, or remained unchanged? If the patient has not improved, what

pharmacologic changes could be recommended by the nurse?

Current Status Pharmacologic Recommendations (if applicable) Rationale

Documentation Write a concise nurse's note using your program's preferred format to document what was most important in the

medical record.

Five minutes after receiving a total of 0.16 mg naloxone IV, the

patient is consistently awake and able to follow verbal commands. The

nurse collects the following clinical data:

Pharmacology Reasoning

Nurse Reflection To strengthen your clinical judgment skills, reflect on your knowledge and the decisions made caring for this patient by

answering the reflection questions below.

Reflection Question Nurse Reflection

As you worked through this

simulation, how did it make you

feel?

What did you already know and do

well on this simulation?

What areas do you need to

develop/improve?

What did you learn? How will you

apply what was learned to improve

patient care?

Medication:
Aripiprazole 10 mg PO daily:
Safe dose range:
IndicationsRow1:
Mechanism of actionRow1:
Expected Side EffectsRow1:
Assessments ResponsibilitiesRow1:
Medication_2:
Alprazolam 05 mg PO BID:
Safe dose range_2:
IndicationsRow1_2:
Mechanism of actionRow1_2:
Expected Side EffectsRow1_2:
Assessments ResponsibilitiesRow1_2:
Medication_3:
Safe dose range_3:
Therapeutic Class Pharm Class:
IndicationsRow1_3:
Mechanism of actionRow1_3:
Expected Side EffectsRow1_3:
Assessments ResponsibilitiesRow1_3:
Medication_4:
Safe dose range_4:
Therapeutic Class:
IndicationsRow1_4:
Mechanism of actionRow1_4:
Expected Side EffectsRow1_4:
Assessments ResponsibilitiesRow1_4:
Most Important FindingsRow1:
Clinical SignificanceRow1:
Medical History:
Home Meds:
Anxiety Bipolar Depression Schizoaffective disorder:
Pharm ClassificationAripiprazole 10 mg PO daily Divalproex 500 mg XR 2 tabs PO BID Alprazolam 05 mg PO BID:
PolypharmacyRow1:
RationaleRow1:
Medication InteractionsRow1:
RationaleRow1_2:
InterpretationRow1:
Clinical Significance:
Pharmacology Reasoning:
Most Important DataRow1:
Clinical SignificanceRow1_2:
As you complete the headtotoe assessment you notice these findings:
Most Important DataRow1_2:
Clinical SignificanceRow1_3:
Nurse ResponseRow1:
Most Important DataRow1_3:
Clinical SignificanceRow1_4:
Nurse ResponseRow1_2:
Most Important DataRow1_4:
Clinical SignificanceRow1_5:
Metabolic Panel:
Metabolic PanelRow1:
Ca:
Hematology Complete Blood Count CBCRow1:
Misc:
MiscRow1:
Salicylates:
Acetaminophen:
Lipase:
Lactate Ven:
Hgb A1C:
Diagnostic Result:
ExpectedWBC:
ImprovedWBC:
WorsenedWBC:
ExpectedNeutrophils:
ImprovedNeutrophils:
WorsenedNeutrophils:
ExpectedHemoglobin:
ImprovedHemoglobin:
WorsenedHemoglobin:
ExpectedCreatinine:
ImprovedCreatinine:
WorsenedCreatinine:
Expected for benzohydrocodone:
Improved for benzohydrocodone:
Worsened for benzohydrocodone:
ExpectedAcetaminophen:
ImprovedAcetaminophen:
WorsenedAcetaminophen:
Priority ProblemRow1:
Pathophysiology in Own WordsRow1:
Provider Orders:
RationaleEstablish peripheral IV 09 NS 1000 mL IV bolus Naloxone 004 mg IV May repeat every 23 minutes until consistently awake Use 04 mg ampule of 1 mL and add 9 mL of 09 NS in 10 mL syringe for dose of 004 mg1 mL:
Expected OutcomeEstablish peripheral IV 09 NS 1000 mL IV bolus Naloxone 004 mg IV May repeat every 23 minutes until consistently awake Use 04 mg ampule of 1 mL and add 9 mL of 09 NS in 10 mL syringe for dose of 004 mg1 mL:
Medication_5:
Expected Assessment Findings09 NS 1000 mL IV bolus:
How Long Before Evident09 NS 1000 mL IV bolus:
Rationale09 NS 1000 mL IV bolus:
Expected Assessment FindingsNaloxone 04 mg IV May repeat every 23 minutes until consistently awake:
How Long Before EvidentNaloxone 04 mg IV May repeat every 23 minutes until consistently awake:
RationaleNaloxone 04 mg IV May repeat every 23 minutes until consistently awake:
Medication_6:
Naloxone:
Safe dose range_5:
Therapeutic Class Pharm class:
IndicationsRow1_5:
Mechanism of actionRow1_5:
Expected Side EffectsRow1_5:
Assessments ResponsibilitiesRow1_5:
MedicationRow1:
Time frame to AdministerRow1:
Show WorkRow1:
Volume to AdministerRow1:
Nursing Priority:
Priority InterventionsRow1:
RationaleRow1_3:
Expected OutcomeRow1:
Assessment Data:
ImprovedT 984 F369 C oral:
No ChangeT 984 F369 C oral:
DeclinedT 984 F369 C oral:
ImprovedP 72 regular:
No ChangeP 72 regular:
DeclinedP 72 regular:
ImprovedR 18 regular:
No ChangeR 18 regular:
DeclinedR 18 regular:
ImprovedBP 11065 MAP 80:
No ChangeBP 11065 MAP 80:
DeclinedBP 11065 MAP 80:
ImprovedO2 sat 96 room air:
No ChangeO2 sat 96 room air:
DeclinedO2 sat 96 room air:
Improved510 sharp ache in the left thigh:
No Change510 sharp ache in the left thigh:
Declined510 sharp ache in the left thigh:
ImprovedPupils 3 mmbrisk reactive to light:
No ChangePupils 3 mmbrisk reactive to light:
DeclinedPupils 3 mmbrisk reactive to light:
ImprovedAwake and follows verbal commands:
No ChangeAwake and follows verbal commands:
DeclinedAwake and follows verbal commands:
Current Status:
Pharmacologic Recommendations if applicable:
Rationale:
medical record:
Reflection Question:
Nurse ReflectionAs you worked through this simulation how did it make you feel:
Nurse ReflectionWhat did you already know and do well on this simulation:
Nurse ReflectionWhat areas do you need to developimprove:
Nurse ReflectionWhat did you learn How will you apply what was learned to improve patient care:
Text1:
Text2: