Running Head: INTERDISCIPLINARY CARE
Patient Care
Elsie King
Chamberlain University
NR 341 Complex Adult Health
March 2018
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Background Information
Mrs. J.E. is a 62-year-old African American female. She has a significant other with two
children. She was admitted on 03/10/2018 at the emergency room. She is a full code. No allergy
to medications. She smokes a pack of cigarettes daily, she drinks about four to five glasses of
wine daily and she does combination of heroin and pain killers medications. The main reason
why the patient was admitted was due to shortness of breath and opiate overdose.
Past medical history for Mrs. J.E. are asthma, hypertension, urinary incontinence, UTI
and diabetes mellitus Type II. Patient had knee replacement on the right knee about five years
ago, had a cyst removal on the right breast, but the biopsy came back benign.
The patient present diagnosis is bilateral pulmonary infiltrate suspect opiate overdose.
According to Lilley L, (2017)., Act as agonists–drugs that stimulate receptors in the body. They
are central nervous system depressants, risk for respiratory depression and dependency
associated with opiate use. opiates and opioids do create a slowing of your respiration, your
breathing, and if it slows too much it creates severe respiratory depression.
Significant assessment findings during the day of care includes vital signs which include
blood pressure is 98/58mm hg on the right arm laying supine, oral temperature 98.9F, respiratory
8 breaths per minute, weight of 146 pounds, radial pulse recorded is 40 beats per minute pulse
and oximetry recording of 88% on room air. Focused assessments include odor of alcohol on
breath, odor of smoke on clothing. Intoxicated behavior during examination. Patient had Slurred
speech, inflamed nasal mucosa, Gingival ulceration notice, skin color warm to touch, laceration
and bruises all over the abdomen, legs and arms. Patient was alert and oriented to person.
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PERRLA was present, pupils were not equal, react to light and accommodative. Breathing was
labored, evidence of shortness of breath indicated, shallow reparations, dyspnea indicated.
Wheezing indicated with auscultations, Respiratory depression indicated.
Laboratory and Diagnostic Tests
The significant laboratory values performed are as follow.
Test
Result
Reference Range
pH
7.20/7.39
7.35 -7.45
Pco2
60/37
35-45
Po2
50/135
80-100
Bicarbonate
18/22
22-26
Sodium
145
Potassium
3.2
Urea Nitrogen
29
Creatinine
1.2
RBC Count
3.9
135-145
3.5-5.0
10-20
0.7-1.5
4.7-6.1
WBC count
9.5
5-11
Hemoglobin
12.0
12-16
Hematocrit
37
40-48
Running Head: INTERDISCIPLINARY CARE
Platelet Count
120
Urinalysis
Opiate positive
4
150,000-400,000
The diagnostic test or procedure performed EKG, Chest X-ray. EKG showed sinus
bradycardia, prolonged PR and QTc intervals. Chest X-ray showed a hazy infiltrate lower lobe.
The treatment that was done which was not successful because she did not respond naloxone,
due to that, intubation was done and between two to three hours after the arrival in the
emergency room, she was transferred to ICU.
Medication
According Vallerand, A. H., (2015). These are the lists and summary of relevant,
significant medication, and the information’s given.
Drug Name
Classification
Therapeutic Use
Adverse Effect
Nursing Implication
Metformin
Trade:
Fortamet, Glumetza,
Glucophage, Riomet
Antidiabetic
Maintenance of
blood glucose
Abdominal bloating,
diarrhea, nausea,
vomiting, unpleasant
metallic taste.
Hydrochlorothiazide
Trade:
Microzide, Oretic,
Urozide
Antihypertensives,
diuretics
Lowering of blood
pressure in
hypertensive
patients and
diuretic with
mobilization of
edema.
Hypokalemia,
dizziness, drowsiness,
lethargy, weakness,
When combined with
oral sulfonylureas,
observe for signs and
symptoms of
hypoglycemic reactions.
Monitor renal function
before initiating at least
annually during therapy.
Monitor BP, intake,
output, and daily weight
and assess feet for
edema daily.
Monitor BP before and
periodically during
therapy.
Assess patient for
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allergy to sulfonamides.
Enoxaparin
Trade: Levonox
Anticoagulant
Prevention of
venous
thrombosis, DVT.
Prophylaxis.
Dizziness, insomnia,
edema, alopecia,
anemia.
Oxybutynin
Trade:
Ditropan XL,
Oxytrol, Gelnique.
Urinary tract
antispasmodics
Increased bladder
capacity. Delayed
desire to void
Dizziness, drowsiness,
constipation, dry
mouth, nausea, urinary
retention
Albuterol
Trade:
Accuneb, airomir,
Proventil HFA,
Ventolin HFA
Bronchodilators
Bronchodilation
Nervousness,
restlessness, tremor,
chest pain, palpitation.
Salicylates
Trade:
Aspirin
Antipyretics
Analgesia.
Reduction of
inflammation.
Reduction of fever.
Dyspepsia, epigastric
distress, nausea,
abdominal pain,
anorexia, vomiting,
hepatotoxicity.
Morphine
Trade:
Astramorph PF,
Avinza, Duramorph
Opiod Analgesics
Decrease in
severity of pain
Confusion, sedation,
constipation,
hypotension
Assess for signs of
bleeding and
hemorrhage, assess for
evidence of additional
or increased thrombosis.
Monitor voiding pattern
and intake and output
ratios and assess
abdomen for bladder
distention prior to and
periodically during
therapy.
Assess lung sounds,
pulse, and blood
pressure before
administration and
during peak of
administration. Monitor
pulmonary function test
before initiating therapy
and periodically during
therapy.
Assess for rash
periodically during
therapy. May cause
Stevens-Johnson
syndrome or toxic
epidermal necrolysis.
Assess pain and
limitation of movement;
note type, location and
intensity before and the
peak after
administration.
Prolonged use may lead
to physical and
physiological
dependence and
tolerance. Assess bowl
function routinely.
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The dosage and route of administration are Metformin 500mg twice a day orally,
Hydrochlorothiazide 25mg daily orally, Enoxaparin 40mg subcutaneously, Oxybutynin 5mg
three times daily. Albuterol 2mg orally twice daily, Salicylates 81mg orally and Morphine 2mg,
IV push every 4 hours PRN.
Nursing Diagnosis
Ineffective airway clearance related to sedating or paralytic effects of drugs evidence by
non-responsiveness and using Narcan to revive the patient. The nursing outcome for the patient
will be, patient will improve a patent airway, and keeping the patient calm and comfortable.
Patient will maintain a patent airway at the end of the shift. A long-term care will be patient will
demonstrate an effective coughing and clear breath sounds by the end of the day. The nursing
interventions will be monitoring of blood gas values and pulse saturation levels. Normal ABGs
values of PO2 are 80-100mm Hg and a PCO2 of 35-45mm Hg. An oxygen saturation of less than
90% indicates problems with oxygenation. Hypoxemia can result from ventilation perfusion.
Ineffective health maintenance related to inability to make deliberate and thoughtful
judgement evidence by drug overdose. The nursing outcome for the patient will be improving
health promoting behavior and health seeking behavior. The nursing interventions will be
referring the patient to community agencies for appropriate follow up care. It is known that
social support has been related to decrease mortality rate. Making sure that a follow up
appointment is schedule before her discharge, by discussing with the patient to make sure that
the appointment is kept.
Risk for suicide related to substance abuse evidence by Statements of helplessness,
despair.Nursing outcome will be patient will remain safe while in the hospital, with the aid of
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nursing intervention and support. The nurse intervention will be encouraging the client to speak
freely about feeling and help plan alternative ways of handling disappointment, anger and
frustration. The rationale will be giving the client the power to learn ways of dealing with strong
emotions and gaining a sense of control.
Interventions- Routine Nursing Management
Due to the patient condition, the nursing management will be staying with an
unresponsive patient and not be distracted by anything other than performing resuscitation. Vital
signs were taken such as heart rate, blood pressure, oxygen saturation and temperature were
carefully monitored. Naloxone the antidote was used to reverse the opiate effects.12- lead ECG
test was done to initiate continuous ECG monitoring.
Maintaining a patent airway was the priority. The patient was position in high fowler
position. Mechanical ventilation was using to move air in and out of the lungs. Indwelling
catheter was placed instantly. Monitoring for any changes or improvement. IV access was
established immediately and initiated fluid placement. Obtaining information about the type of
substance abuse, the route it was used, when taken, the amount taken or any combination of
substance abuse.
Drug levels or comprehensive toxicity screen was obtained. Obtained health history and
any allergies from the patient. Monitor level of consciousness and oxygen saturation. The patient
was monitored closely because naloxone has a shorter duration of action and been aware that the
patient may have had mixed drug ingestion that does not respond to opioid antagonists.
Safety precaution was constantly use by the health providers, constantly asking the patient and
checking the name band for the name and date of birth before any treatment was done, hand
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hygiene was done. Patient was monitored continuously for neurologic status, including level of
consciousness, monitoring respiratory function and cardiovascular function was very critical to
make sure that the patient was stable.
Collaborative Management – Interdisciplinary Care
The interdisciplinary team members that came together to take care of Mrs. J. E. were
respiratory therapist, nurse, emergency medical doctor, ECG technician, Lab/diagnostic tests
personnel, assistive personnel.
The respiratory therapist administers respiratory care treatment involve managing life
support mechanical system. The respiratory therapist analyzed blood sample of Mrs. J.E. to
determine levels of oxygen and other gases. Assessed lungs capacity to determined impairment.
Managing artificial airways and ventilators. Consulted with the physicians and members of
medical team to recommend a change in therapy.
The next interdisciplinary care will be nurse, the nurse provides hand on care to the
patient, by monitoring and observing patient conditions, communicating with the doctors and
maintaining records. The nurse also administers medications, managing intravenous lines. The
nurses also relied on to give directions and supervisions to nurse aides. The nurse is always the
first person and the last health care provider a patient will see. They provide emotional support to
patient and patient’s family members.
The emergency medical doctors are responsible for several series by assessing the
condition of the patient and providing treatment. The emergency medical doctors order tests such
as CT Scan, MRI and chest X-ray and providing medication. They help to stabilize a critical
patient.
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The ECG technician attaches electrodes to the patient and constantly monitoring the
patient cardiac activities. Records the activities of the heart and print out the data recorded for
further treatment of the patient.
The Lab/diagnostic tests personnel roles collect specimens from patient and properly
labels them for testing. Basically, the technicians perform tests and procedures that physician
orders. Assistive personnel assist the nurse in taking vital signs, they are supervised, and
delegations are given to them by the nurse.
Therapeutic Modalities
Therapeutic modalities provide a non-surgical medication free treatment for a wide range
of condition. Therapeutic Modalities helps to provide pain relief physically and emotionally.
Helps to provide better quality of life and functioning. One of the therapeutic modalities care
that was used for Mrs. J.E. was psychosocial assessment, which involve sitting by the patient
bedside, taking to the patient, which in turns relaxes and calm the patient. As you gain the trust
of your patient.
The nurse provides a lot of therapeutic modalities care by just taking time to
communicate, engaging the patient with treatment, explaining treatment for the patient
understanding. Demonstrating respect and non-judgmental. Promote equality and attempt to
promote independence where it is possible. Just by actively listening and been attentive to patient
provides a therapeutic modality care.
The nurse does a continuous assessment on the patient, which is a form of therapeutic modality
care, by touching the patient, getting the attention of the patient and just been there for the
patient or answer some question.
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Nursing Role Reflection
My clinical day was quiet at first at the emergency room until Mrs. J.E came to the ER by
the ambulance. I was assigned to follow the Patient nurse by the charge nurse. I remembered
going to the patient room assisting with ECG placement, taking vital signs like blood pressure,
respiration, heart rate. Respiratory therapist came, lab technician and emergency doctor arrived.
One nurse was getting the patient history, while another nurse was establishing IV line. All hands
were on deck, helping the patient to maintain patency. I was told to step out for a few minutes
because the room was crowded. I waited by the door for about 15-20 minutes just in case they
will need me to get something for them. I remembered having an anxiety and at the same time
excited to experience an overdose case.
The doctor told me to come in after a while, the doctor ordered for mechanical ventilation
which was done on the patient, labs were taken, indwelling catheter was placed. The patient kept
trying to pull out the indwelling Foley catheter, she was not aware of what she was doing. The
emergency doctor ordered for a restraint. It was beautiful to see how everyone came together to
save a life. The patient was finally stable and was transferred to ICU.
In conclusion watching the nurses taking care of the patient, makes me know that I made
the right choice. I learned a lot from my instructor and the nurse I was place that I was placed
with. She was calm and moving quickly and making sure things were done appropriately.
Running Head: INTERDISCIPLINARY CARE
References
Carpenito, L. J. (2017). Nursing diagnosis: Application to clinical practice. Philadelphia, PA:
Wolters Kluwer.
For All Your Nursing Needs. (n.d.). Retrieved March 30, 2018, from https://nurseslabs.com/
Lewis, S. L., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Medical-surgical nursing:
Assessment and management of clinical problems (9th ed.). Elsevier Mosby.
Lilley, L. L., Collins, S. R., & Snyder, J. S. (2017). Pharmacology and the nursing process. St.
ALouis, MO: Elsevier.
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Vallerand, A. H., (2015). Davis's Drug Guide for Nurses (14th ed.). Philadelphia, PA: F.A Davis
Company.
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