1.10 Clinical Reasoning and Decision-Making Learning Activities
Within this unit, you have been introduced to many concepts related to pharmacokinetics and pharmacodynamics. These basic concepts are important to understand as we move our study into closer examination of various medication classes, principles of administration, and consideration of how medications can be safely incorporated into the client’s plan of care.
Interactive Activity
Lightbulb Moment
Test your knowledge and application. Use the information in the text, as well as evidence-informed online resources, such as OpenMD, Merck Manuals and Daily Med, to read more about the medications included in the client scenarios.
- You are working in a nursing home caring for an 86-year-old client with a history of stroke who reports left knee pain secondary to arthritis. The client has right-sided weakness and difficulty swallowing with no gag reflex. You review the client’s MAR, and note the provider has prescribed acetaminophen 325 mg either per oral or per rectal route. Which route would you choose and why?
- Mr. Johnson is a 92-year-old male admitted to the medical-surgical unit for severe pneumonia, and the provider prescribed gentamicin antibiotic therapy. Upon review of the order, you notice the initial dose is ordered at less than the standard recommended dose. What is the rationale behind the decreased starting dose for this client?
- Sara is a nurse working on the medical-surgical floor. She is reviewing her client’s chart and notes her client has a 0600 vancomycin infusion; however, the trough level is not available. The nurse phones the lab, and they state they will not be available to draw the trough level for an hour. What actions should the nurse take?
- Sam is a nurse working on the cardiology floor. He has an order to administer a dose of atenolol (a beta-blocker medication) to a client at 0800. What actions should the nurse take prior to administering the medication? What is the anticipated therapeutic effect of this medication?
- Julia is a 56-year-old client admitted to the cardiology unit with new-onset atrial fibrillation. She has been prescribed amiodarone for her irregular heartbeat and is set to receive her first dose with her morning breakfast tray. When you arrive in the room, you notice that she has grapefruit juice on her breakfast meal tray. Is this a concern? Why? What is the nurse’s next action?
- A nurse is caring for a 55-year-old male who recently was admitted to the medical-surgical unit for a total knee replacement. He is prescribed oxycodone/acetaminophen 5/325 mg (Percocet) every 4 hours for moderate pain. The client complains of pain in the knee, rating it at a “6.” Use your online resources to help you answer the following questions:
- When does the nurse anticipate the medication will peak in action?
- When does the nurse anticipate another dose will be needed due to the half-life of this drug?
Note: Answers to the light bulb moments can be found in the “Answer Key” sections at the end of the book.