Discussion post: Simulation

1 Running head: Multi-client

Simulation Multi Client

Bernadette Mendoza

Chamberlain College of Nursing

NR 446: Collaborative Nursing

September, 2018

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2 MULTI CLIENT

1. 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)

2. What is the purpose of Vancomycin Hydrochloride and what are the side effects/administration protocols?

 Treatment of potentially life-threatening infections when less toxic anti-infectives are contraindicated. Particularly useful in methicillin-resistant staphylococcal infections. PO: Treatment of staphylococcal enterocolitis or pseudomembranous colitis due to Clostridium difficile.

 Adverse Reactions/Side Effects

 EENT: ototoxicity.

 CV: hypotension, massive histamine release called “red-man syndrome” with rapid IV infusion.

 GI: nausea, vomiting.

 GU: nephrotoxicity.

 Derma: rashes.

 Hematology: eosinophilia, leukopenia.

 Local: phlebitis.

 MS: back and neck pain.

 Miscellaneous: anaphylaxis, superinfection.

 Need to Know:

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3 MULTI CLIENT

 Culture and sensitivity tests are per- formed prior to initiating therapy.

 Monitor IV site closely to avoid extravasation.

 Monitor blood pressure and presence of skin flushing throughout IV infusion.

 Monitor intake and output and daily weight.

 Cloudy or pink urine may be a sign of nephrotoxicity.

 Assess bowel status.

 Monitor CBC with differential, and liver and renal function.

 Monitor peak and trough drug levels.

 Report subtherapeutic or toxic levels immediately.

 IV: Administer over at least 60–90 min to prevent “red-man syndrome” (massive histamine release).

 Look for Candida infections.

 Teach client:

 Oral forms are to be taken exactly as directed.

 Report tinnitus, rash, vertigo, or hearing loss.

 Report flushing of the skin, or dizziness.

3. What are some of the risks that diabetics face as a result of uncontrolled blood sugars? Explain the difference between Type I & Type II Diabetes. Discuss a diet that is appropriate for a diabetic. How is it different from a general diet?

 Risks as a result of uncontrolled blood sugars:

 Chronic health problems and early death

 Macrovascular complications include coronary artery disease, cardiomyopathy, hypertension, CVD and PVD

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4 MULTI CLIENT

 Microvascular complications such as retinopathy, nephropathy and neuropathy

 Infection is also a concern

 Male erectile dysfunction

 Type 1 Diabetes is nearly absolute deficiency of insulin; if insulin is not given fats are metabolized for energy resulting in ketonemia (acidosis)

 Type II Diabetes is relative lack of insulin or resistance to action of insulin; insulin is sufficient to stabilize fat and protein metabolism but not carbohydrate metabolism.

 Diet for Diabetic Patients:

 The diabetic client’s diet should take into account weight, medication, activity level, and other health problems.

 Carbohydrate counting may be a simpler approach for some clients; it focuses on the total grams of carbohydrates eaten per meal. The client may be more compliant with carbohydrate counting, resulting in better glycemic control; it is usually necessary for clients undergoing intense insulin therapy.

 Limiting foods that are high in sugar

 Eating smaller portions, spread out over the day

 Being careful about when and how many carbohydrates you eat

 Eating a variety of whole-grain foods, fruits and vegetables every day

 Eating less fat

 Limiting your use of alcohol

 Using less salt

4. What PPE is necessary for a patient who has MRSA?

 Contact Precautions

 Gown and Gloves

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5 MULTI CLIENT

5. What is the nurse’s role in providing client and family support for the recent loss of a family member?

 Acknowledge that you can’t imagine how they are feeling

 Ask about their loved one

 Ask them what they need.

 Help them connect with those who will best support them

 Ask if they want to speak with a doctor about any questions that have come up

 Ask if they would like you to page the Social Worker or Pastoral Care.

 Discuss with them if and how they want to spend time with the deceased to say their goodbyes.

 Make the goodbye comfortable and meaningful by explaining what they are going to see.

 Offer ‘memory making’ options, if that is a practice in your hospital.

 Answer their questions about what happens next

 Acknowledge that you don’t know what to say

 Give them space if they need it

 Let them know who they can contact once they have left the hospital

 Don’t judge.

6. Review the causes and treatment options used for Mitral Valve Prolapse with regurgitation and how they can prevent further heart failure.

 Mitral Valve Prolapse – valve leaflets protrude into the left atrium during systole.

 Prevention by:

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6 MULTI CLIENT

 Avoid competitive sports

 Eat well. Make smart, heart-healthy food choices. That means eating a diet rich in fruits, vegetables and whole grains and cutting down on saturated, trans and other types of fats.

 Don’t smoke or drink alcohol to excess. Women should have no more than one-half drink per day; men should have no more than one drink per day.

 Maintain a healthy weight

7. List 5 nursing interventions a nurse is responsible for performing to ensure safety of the client when they are assigned a client who is disoriented.

 Assist patient to safe area or back to bed.

 Re orient client to reality

 If LOC is diminished, position to maintain patent airway.

 Provide supplemental O2 if saturation in room air is 93%.

 Check MAR for recently given medications.

 Stay with patient, and notify physician or NP.

 Document patient status, phone call to physician or NP, and physician or NP response.

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