clinical

Evet Ogam, 34 y/o, has been admitted to the hospital since last night for a heroin overdose. She received naloxone 2 mg twice by EMS.

Night shift nurse is giving Sharon, the dayshift nurse, report. He gives the background of her admission.

He reports the following information:

* Alert & oriented x3

* Lungs clear

* IV- 22 g in RFA, she is a hard stick

* Skin is intact, multiple areas of track marks, watch the area on her left forearm

* Ibuprofen 400 mg is given Q 6hrs- next dose is 0800

* COWS score- 14

* She really didn’t sleep at all

PMH: back surgery 5 yrs ago, depression, drug abuse, heroin overdose x2, rehab attempts x3

Allergies: ASA

Social: going through a divorce, poor relationship with her children

* She is super anxious, on the call light frequently, he makes statements:

“so best to just avoid her”

“she’s a drug seeker”

Sharon makes a statement to her peer. “I’m feeling very concerned about the direction we’re going here”.

What do you think she means about this? Do you agree or disagree? Could she have done anything different to get a better response from the nurse? How can this affect patient care? Do you see any bias here?

1)

Sharon goes into the room to assess Evet. What is your initial impression of Evet? Do you see anything that concerns you at this time?

Using the information provided, score this patient using the COWS scale.

T 98.6

HR 122

RR 22

BP 150/85

SpO2 100% room air

2)

Explain the difference between an acute vs. chronic pain assessment.

3)

Explain the pathophysiology of a patient experiencing a heroin overdose & withdrawal.

Explain the use of naloxone- mechanism of action, how it works to correct a heroin overdose, indications, contraindications, dose, how to administer

4)

Sharon called Dr. Lopez to ask for new orders related to her assessment. She effectively uses SBAR to make her point.

Write out Sharon’s SBAR.

SBAR-

Refer to the lab results that have now been resulted in the computer.

ETOH

Urine toxicology

CBC

CMP, Mg, Phos

Everyone needs to review these labs. Identify which are abnormal and what their significance are to this patient.