Oral and Parenteral
Medication Administration
Skills & Reasoning.
Jerry Williams, 62 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
Gas Exchange
Clinical Judgment
Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory 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%
1
, History of Present Problem:
Jerry Williams is a 62-year old obese (BMI 35.2) Caucasian male with a history of diastolic heart failure and type II
diabetes. Last evening, he began having difficulty breathing with activity. He thought he might be getting a cold because
he had a runny nose. He reports more swelling in his lower legs the past couple days. He woke up this morning with
increased difficulty breathing when he woke up and his wife called 911.
Paramedics report that his initial VS: HR:92 RR: 28 BP: 172/88 O2 sat: 80% on room air with scattered expiratory
wheezing bilat. He was placed on oxygen by facemask and albuterol nebulizer administered with some improvement in
his breathing. His RR is now 24 upon arrival to the emergency department ED). His initial labs have resulted; creatinine
of 2.5 (last adm. 1.8), K+ 3.5 (last adm. 3.7) and BNP 944 (last adm. 322). Jerry is given furosemide 40 mg IV in the ED
and had 800 mL urine output in the last hour. He is admitted to cardiac telemetry, and you are the nurse responsible for his
care.
What data from the present problem do you NOTICE as RELEVANT and why is it clinically significant?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT Data: Clinical Significance:
1. obese, type II diabetes, Diastolic 1. shows that patient was not in the best health before these
heart failure problems began
2.shortness of breath with activity/ 2.shows that there is something going on with his gas
increased difficulty breathing when exchange
he woke up 3. could be a problem with purfusion, possible DVT
3.more swelling in his lower legs 4. proves that hes is having difficulty breathing and his heart
4. High RR and BP and low O2 sat is trying to pick up the slack
5. high creatine and BNP labs 5. increase risk for kidney and heart failure
What is the RELATIONSHIP of his past medical history and current medications? Why is your patient receiving these
medications? (Which medication treats which condition? Draw lines to connect)
Past Medical History (PMH): Home Medications:
Hyperlipidemia Furosemide 20 mg PO every morning
Hypothyroidism Atorvastatin 40 mg PO at bedtime
Type II diabetes Metoprolol 50 mg PO BID
Diastolic heart failure Levothyroxine 112 mcg PO daily
Chronic kidney disease stage III Exenatide microspheres 2 mg subq. weekly
Nursing Assessment Begins:
Current VS: Most Recent in ED: P-Q-R-S-T Pain Assessment:
T: 98.2 F/36.8 C (oral) T: 98.8 F/37.1 C (oral) Provoking/Palliative:
P: 88 (reg) P: 92 (reg) Quality: Denies
R: 24 (reg) R: 24 (reg) Region/Radiation:
BP: 142/76 BP: 148/80 Severity:
O2 sat: 93% 4 liters n/c O2 sat: 94% 4 liters n/c Timing:
2
Medication Administration
Skills & Reasoning.
Jerry Williams, 62 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
Gas Exchange
Clinical Judgment
Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory 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%
1
, History of Present Problem:
Jerry Williams is a 62-year old obese (BMI 35.2) Caucasian male with a history of diastolic heart failure and type II
diabetes. Last evening, he began having difficulty breathing with activity. He thought he might be getting a cold because
he had a runny nose. He reports more swelling in his lower legs the past couple days. He woke up this morning with
increased difficulty breathing when he woke up and his wife called 911.
Paramedics report that his initial VS: HR:92 RR: 28 BP: 172/88 O2 sat: 80% on room air with scattered expiratory
wheezing bilat. He was placed on oxygen by facemask and albuterol nebulizer administered with some improvement in
his breathing. His RR is now 24 upon arrival to the emergency department ED). His initial labs have resulted; creatinine
of 2.5 (last adm. 1.8), K+ 3.5 (last adm. 3.7) and BNP 944 (last adm. 322). Jerry is given furosemide 40 mg IV in the ED
and had 800 mL urine output in the last hour. He is admitted to cardiac telemetry, and you are the nurse responsible for his
care.
What data from the present problem do you NOTICE as RELEVANT and why is it clinically significant?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT Data: Clinical Significance:
1. obese, type II diabetes, Diastolic 1. shows that patient was not in the best health before these
heart failure problems began
2.shortness of breath with activity/ 2.shows that there is something going on with his gas
increased difficulty breathing when exchange
he woke up 3. could be a problem with purfusion, possible DVT
3.more swelling in his lower legs 4. proves that hes is having difficulty breathing and his heart
4. High RR and BP and low O2 sat is trying to pick up the slack
5. high creatine and BNP labs 5. increase risk for kidney and heart failure
What is the RELATIONSHIP of his past medical history and current medications? Why is your patient receiving these
medications? (Which medication treats which condition? Draw lines to connect)
Past Medical History (PMH): Home Medications:
Hyperlipidemia Furosemide 20 mg PO every morning
Hypothyroidism Atorvastatin 40 mg PO at bedtime
Type II diabetes Metoprolol 50 mg PO BID
Diastolic heart failure Levothyroxine 112 mcg PO daily
Chronic kidney disease stage III Exenatide microspheres 2 mg subq. weekly
Nursing Assessment Begins:
Current VS: Most Recent in ED: P-Q-R-S-T Pain Assessment:
T: 98.2 F/36.8 C (oral) T: 98.8 F/37.1 C (oral) Provoking/Palliative:
P: 88 (reg) P: 92 (reg) Quality: Denies
R: 24 (reg) R: 24 (reg) Region/Radiation:
BP: 142/76 BP: 148/80 Severity:
O2 sat: 93% 4 liters n/c O2 sat: 94% 4 liters n/c Timing:
2
