Alfred Angeles

Final Case scenario # 4

2006 December 19

PRNR 198 Final case Scenario # 4

Mr. Xu, age 66 has had surgery for a fractured right hip two days ago. He also has a
diagnosis of COPD. He is complaining if pain, which he rates as 10/10 on the pain scale.
His oxygen is running at 8L /min per nasal cannula, and he is experiencing shortness of
breath.

Doctors orders: Demerol 75 mg IM q 3-4 h prn for pain

02@2.5L continuous change dressing 4th day postoperatively ventolin 2 puffs bid via
aerochamber.

Nursing Diagnosis
1. Ineffective breathing pattern related to COPD as evidenced by requirement of
having an oxygen at 2.5 L continuously and SOB
2. Acute pain related to right hip fracture as evidenced by pain 10/10
3. Impaired mobility related to fracture as evidenced by increased pain and
discomfort.

Nursing Interventions
1. Put patient in a high Fowlers position or in Orthopneic position to facilitate the
expansion of the lungs lower down the oxygen from 8 L to 2.5 L
2. Assess COLDSPA administer medication as prescribed
3. Put the bed on the lowest position put call bell on reach

Brand name: Demerol

Generic name: Meperidine Hydrochloride
Pregnancy category: C
Classification: narcotic analgesic, synthetic
Action: Only one-tenth as potent an analgesic as morphine. Has no antitussive effects and
does not produce miosis
Uses: Analgesic for severe pain, hepatic and renal colic useful for minor surgery
Side effects: transient hallucinations, transient hypotension visual disturbances.
Contraindications: Asthma, emphysema severe obesity.

Nursing considerations
1. Review list of drugs with which narcotics interact and their associated effects
2. Request that orders be rewritten at timed interval as required for continued
administration.

Brand name: Ventolin

Generic name: Albuterol, salbutamol
Pregnancy category: C
Classification: direct acting adrenergic agent
Actions: Albuterol stimulates beta 2 receptors of the bronchi, leading to bronchodilation.
Causes less tachycardia and is longer acting than Isoproterenol
Uses: bronchial asthma, bronchospasm due to bronchitis or emphysema
Prophylaxis of bronchial asthma or bronchospasm
Contraindication: Aerosol for prevention of exercise induced bronchospasm is not
recommended for children less than 12 years of age. Use during lactation
Side effects: Diarrhea, dry mouth, increased apatite, epigastric pain, fatigue nightmares,
disturbs sleep, bronchitis and urticaria
Dosage: metered dose inhaler adults and children over 12 years of age 180 mcg every 4-
6hrs
Nursing Considerations
1. obtain history prior to starting the drug therapy
2. note any previous experiences with this class of drugs
3. Monitor vital signs