Narcotics or Sepsis? Pharmacology Clinical Reasoning Case Study

Narcotics or Sepsis? Pharmacology Clinical Reasoning Case Study Brian Sanders, 34 years old NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment • Management of Care 17-23% • Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity • Basic Care and Comfort 6-12% • Pharmacological and Parenteral Therapies 12-18% • Reduction of Risk Potential 9-15% • Physiological Adaptation 11-17% © 2018 Keith Rischer/www.KeithRN.com History of Present Problem: Brian Sanders is a 34-year-old male who was evaluated in the emergency department (ED) earlier this morning for an abscess that was drained from his left thigh. He was given two tablets of hydrocodone-acetaminophen 5-325 mg and sent home with a prescription for #10 hydrocodone-acetaminophen 5-325 mg tablets to be taken PRN for pain every 4 hours. Eight hours after being discharged from the ED, his mother became concerned and called 911 because he was more lethargic and she had difficulty arousing him. The paramedics who brought him to the ED report that he took his scheduled alprazolam 0.5 mg PO after returning home from the ED. He arouses and opens his eyes to loud verbal commands, but falls back to sleep several seconds later. His last set of vital signs per paramedics were: • P: 50 regular • R:16 regular • BP: 92/50-MAP 64 • O2 sat: 98% on room air Personal/Social History: Brian is currently unemployed and lives with his parents. He has struggled with bipolar depression, anxiety, schizoaffective disorder and ETOH abuse in the past but denies current ETOH use. Allergies: NKDA What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance:  Abscess of left thigh, drained  Given Hydrocodone-Acetaminophen 5- 325 mg  Sent home after medication administration  New order:#10HydrocodoneAcetaminophen 5-325 mg to be taken PRN q4 hrs  8 hours after discharge, new symptoms  Lethargic and difficulty arousing  Blood pressure and pulse are low  Took Alprazolam after returning home  Abscess could result at risk for infection.  Opioid pain medicine  No nursing monitoring  Patient is to control medication administration  Time frame when new symptoms developed  Impaired cognitive function  CV system/ cardiac function is affected  Use of benzodiazepines and opioids together is not recommended. Could result in profound sedation, respiratory depression, coma and even death. RELEVANT Data from Social History: Clinical Significance:  Bipolar disorder, anxiety and schizophrenia diagnosis.  ETOH abuse  Unemployed, lives with parents  Some people with mental health disorders misuse drugs to get high or to self-medicate; Can have severe mood swings  The use of ETOH with opioids, antipsychotics can cause extreme side effects.  May affect mood, mental health What is the RELATIONSHIP of the past medical history and current medications? Why is your patient receiving these medications? (Which medication treats which condition? Draw lines to connect)