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VSim Nursing Assignment #1: Toua Xiong Jian 1

VSim Nursing Assignment #1: Toua Xiong 501 Pathophysiology and Pharmacology Gelsey Jian University of Maryland School of Nursing 9/14/18

VSim Nursing Assignment #1: Toua Xiong Jian 1

Toua Xiong is a 64 year old male admitted to the hospital for throat pain. He had been diagnosed with COPD previously and stated he had taken all his prescribed medication before arrival. These medications were as follows: Name

Mechanism of Action

Indication of use

Generic: Nystatin Brand: Nystop, Nyader m[1]

Antifungal. Binds to steroid alcohols in the fungus’s cell membrane to increase permeability and cause leakage of intracellular components. Administered orally or topically[1] Anticholinerg ic. Ach antagonist at muscarinic receptors. Dilates smooth bronchial muscles. Inhaled or administered intranasally[2]

Thrush/ oral candidiasis treatment[1]

Generic: Ipratropium bromide Brand: Atrovent[2]

Side effects/drug interactions Side effects: nausea, vomiting, diarrhea, rash, allergic reactions Drug interactions: Inhibits effect of progesterone[1

Nursing consideration s For local infections only. Avoid skin contact and monitor for skin rashes[1]

]

Reduce exacerbatio n of asthma[2]

Side effects: headache, nausea, dizziness, chest pain, hypertension, blurred vision, muscle pain, coughing, difficult breathing, bronchospasm s, allergic reaction Drug interaction: potentiates effects of other

Do not use intranasally for more than 4 days. Be wary of leakage during nebulizer treatment because of eye irritation. Monitor patients with glaucoma.[2]

Education points Tell patient to monitor skin for rashes, redness, swelling, or any irritation. Do not use too much mouthwash . Continue use after 2 days of symptom relief.[1] Tell patient how to properly use an inhaler and nebulizer. Remind them this drug will not treat bronchospa sms when it is an emergency that requires a rapid response. A minimum of 2 minute

VSim Nursing Assignment #1: Toua Xiong Jian 1

anticholinergi c drugs[2]

Generic: Fluticasone propionate Brand: Advair[3]

Antiinflammatory corticosteroid . Beta-2 agonist that dilates smooth bronchial muscles and inhibits mediator release. Inhaled[3]

Reduce exacerbatio n of COPD[3]

should pass between the 1st and 2nd inhalation. Avoid eye contact[2] Side effects: Monitor liver Tell patient headache, enzyme how to nausea, levels, RR, properly vomiting, and skin. Do use an diarrhea, URI, not use in inhaler. lower patients that They respiratory have should not infection, controlled exhale into coughing, asthma with the inhaler. bronchitis, inhaled Store in a muscle pain, corticosteroid dry, cool appendicitis, s. It is not an place and skin infection, emergency do not pneumonia, inhaler that wash any allergic can be used to part of the reaction stop an inhaler. Drug asthma attack, Throw interactions: and once away once Can cause asthma is used up or severe maintained, after one bronchospasm medication month. s if used with should be Rinse after beta blockers. discontinued. use to Potentiates prevent adverse fungal affects of infections. [3 ketoconazole Tell patient ] that effect may not be seen for up to a week or longer. Do not exceed prescribed dose. If exposed to chickenpox or measles,

VSim Nursing Assignment #1: Toua Xiong Jian 1

seek medical help immediatel y. Reflection of the virtual scenario reveals many points to address. Even though everything in the provider’s orders was done correctly, some things were done unnecessarily and others were done in a peculiar order. First of all, BP was measured twice, once manually and once with a NIBP. The NIBP would have been attached first, eliminating the need to measure BP manually. The NIBP also helps monitor BP continuously, which is not possible with the manual cuff. Medication reconciliation should have been performed earlier in the scenario, particularly in the beginning when Mr. Xiong was asked about his allergies. This would give the nurse a better picture of what they would need to inform the provider and it would make more sense to the patient, rather than being asked their medication regime randomly after all assessments have already been completed. In caring for Mr. Xiong, several things must be taken into consideration. He is 64, which is not yet old enough for most risk factors associated with old age, but the nurse might want to monitor him closely anyways. He is also on oxygen, which means his O2 levels and saturation must be monitored frequently to prevent hypoxemia[4]. In addition, one of his chief complaints is throat pain and difficulty swallowing. This can make providing him with adequate nutrition difficult. If it hurts to swallow hard food, a nurse might want to provide him with liquids and soft foods, like pudding-consistency foods or soups[6]. This would likely help reduce the pain in his throat. All patients should be closely and carefully monitored as often as possible, and their vital signs frequently checked. In this case, vital signs related to the heart and lungs are a strong priority due to Mr. Xiong’s previous COPD diagnosis and current observational wheezing.

VSim Nursing Assignment #1: Toua Xiong Jian 1

In a hospital setting, all patients present with one or more priority problems. In Mr. Xiong’s case, the most pertinent issues are associated with his lungs and throat. One problem was diagnosed as an ineffective breathing pattern related to O2 therapy in COPD, as evidenced by wheezing sounds in lungs heard during auscultation[5]. His respiration rate was 19, within normal range, and relatively regular. However, audible wheezing is still an indication that something is abnormal in the lungs. Therefore, the nurse should make it a priority to monitor his respiration rate and check his O2 saturation in case his breathing becomes more labored or his O2 saturation drops too low. A second problem that needed to be addressed was diagnosed as impaired swallowing related to upper airway anomaly, as evidenced by difficulty swallowing and esophageal pain. This is an issue for his nutritional status and means he may not be able to eat the foods he needs to be nutritionally adequate. While he is in the hospital, care must be taken to offer him food that he can eat with the least amount of difficulty while still providing him with the nutrition he needs. Should his nutritional status fall, he could be at risk for malnourishment or deficient for important bodily proteins.

Before release, it is imperative Mr. Xiong is well educated and confident about his future course of treatment. It is the job of the nurse to provide him with this education. They should teach him the proper use of all his medical equipment, including his portable oxygen tank and inhalers. The nurse should tell him to store the inhalers in dry, cool places and not to wash them if at all possible, to reduce risk of exposure to moisture[3]. Mr. Xiong should also be taught to rinse and clean his mouth after use to reduce the risk of another fungal infection[3]. In terms of treated the Thrush he already has, the nurse should tell Mr. Xiong to take all of his prescribed medication at the proper time intervals through the course of the infection, and two days after

VSim Nursing Assignment #1: Toua Xiong Jian 1

visible signs are relieved[1]. In addition, nurses should always tell patients to watch for signs of an allergic reaction. Mr. Xiong should be able to repeat back key points of education to ensure that he fully understands how he is to progress after his discharge to prevent another hospital visit in the near future. Although the scenario presented was simply a computer simulation, it has many real world applications. It provides an opportunity to see how patients and nurses operate in a hospital setting and emphasizes key points such as hand hygiene, vital sign assessments, and medication reconciliation that help to provide patients with the safest and highest quality of care. Nursing should always be patient-focused, as acknowledged by the case of Mr. Xiong. In a real hospital setting, medication reconciliation should always be performed and should always include OTC and herbal drugs or supplements to prevent unknowing drug interactions. These can be dangerous or even fatal. The introduction of the NIBP was also a helpful technique that can be used in a real hospital setting as it eliminates the need to monitor BP manually and allows continuous monitoring. This is more helpful for patients with an immediate concern for BP changes rather than Mr. Xiong, but in general all patients should have their vital signs checked frequently. At the end of the simulation, the provider was called. In a real hospital setting, this is highly important in order to proceed with the treatment care. Nurses cannot operate without orders, so it is imperative the provider come in to assess the patient as well, as soon as possible, to generate new orders. At the end of the hospital stay, the patient should be discharged with confidence and an increased health literacy in regards to their own treatment, knowing that they received the highest quality of care from their nurses.

VSim Nursing Assignment #1: Toua Xiong Jian 1

References [1] Nystatin. (n.d.). Retrieved September 14, 2018, from http://lnareference.wkhpe.com/ref/view.do? key=61410f7bc42ac377d2bb0c55e25129aacba94af1&nmn=openMonographFromGlobalId&mo nographId=mono_nystatin&cssUrl=http://download.lww.com/simulation/lns_branding/vsimforn ursing.css [2] Ipratropium bromide. (n.d.). Retrieved September 14, 2018, from http://lnareference.wkhpe.com/ref/view.do? key=61410f7bc42ac377d2bb0c55e25129aacba94af1&nmn=openMonographFromGlobalId&mo nographId=mono_ipratropium_bromide&cssUrl=http://download.lww.com/simulation/lns_brand ing/vsimfornursing.css [3] Fluticasone propionate–salmeterol inhalation powder. (n.d.). Retrieved September 14, 2018, from http://lnareference.wkhpe.com/ref/view.do? key=61410f7bc42ac377d2bb0c55e25129aacba94af1&nmn=openMonographFromGlobalId&mo nographId=mono_fluticasone_propionate_and_salmeterol_inhalation_powder&cssUrl=http://do wnload.lww.com/simulation/lns_branding/vsimfornursing.css [4] Stoller, J. K., Panos, R. J., Krachman, S., Doherty, D. E., Make, B., & the Long-term Oxygen Treatment Trial Research Group. (2010). Oxygen Therapy for Patients With COPD: Current Evidence and the Long-Term Oxygen Treatment Trial. Chest, 138(1), 179–187. http://doi.org/10.1378/chest.09-2555 [5] Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurses pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis Company. [6] Sura, L., Madhavan, A., Carnaby, G., & Crary, M. A. (2012). Dysphagia in the elderly: management and nutritional considerations. Clinical Interventions in Aging, 7, 287–298. http://doi.org/10.2147/CIA.S23404