Harold Case Study

Question 1

What are Harold’s presenting symptoms at the ER?

Answer 1

right-sided weakness, slurred speech, and difficulty forming words

Question 2

What is Harold’s past medical history?

Answer 2

CAD, HTN, CHF, A Fib, DM2

Question 3

Med card for bisoprolol:
- therapeutic/pharm class
- mechanism of action
- side effects
- what to assess for at the bedside

Answer 3

• antihypertensive/beta blocker
• Decrease sympathetic nervous system activation by blocking beta 1 receptors so epi/norepi can’t activate
  Decreases contractility/conduction through the AV node → decrease HR ( helps with fill time), and decreases CO (bad side effect if you have HF)
  Decreases RAAS activation
• Drowsiness, fatigue, weakness, bronchospasm, hypotension, pulmonary edema, ED, behaviour changes, nightmares, depression
• assess for decreased ssx of HF and CHEST PAIN r/t decreased cardiac output

Question 4

Med card for spironolactone:
- therapeutic/pharm class
- mechanism of action
- side effects
- what to assess for at the bedside

Answer 4

• K+ sparing diuretic
• Blocks action of aldosterone
  Causes loss of Na and H20 but potassium is retained
  Lowers the amount of fluid in the body
• Hyperkalemia, hypotension, kidney dysfunction
• assess for decreased ssx of HF such as decreased edema, monitor K+ levels and BP, signs of nephrotoxicity

Question 5

Med card for metformin:
- therapeutic/pharm class
- mechanism of action
- side effects
- what to assess for at the bedside

Answer 5

• antidiabetic/diguanides
• decreases liver glucose production, decreases glucose absorption in intestines, increases insulin sensitivity
• lactic acidosis, abdominal bloating, diarrhea, vomiting, nausea
• monitor for evidence of controlled glucose levels, observe for ssx of hypoglycemia, ketoacidosis,

Question 6

Med card for statins (general)
- therapeutic/pharm class
- mechanism of action
- side effects
- what to assess for at the bedside

Answer 6

• lipid-lowering agents/ HMG-CoA reductase inhibitors (to manage cholesterol/dislipidemia)
• limits total and LDL cholesterol production and increases HDL by inhibiting HMG-CoA enzyme
• rash, cramps, constipation, diarrhea, flatus, heartburn
• decrease in LDL, increase in HDL, slowed progression of CAD

Question 7

Med card for pantoprazole
- therapeutic/pharm class
- mechanism of action
- side effects
- what to assess for at the bedside

Answer 7

• anti-ulcer agent/proton pump inhibitor
• for healing erosive esophagitis associated with GERD, prevents transport of H+ into gastric lumen
• assess for epigastric pain

Question 8

Why are Harold’s creatinine levels high?

Answer 8

renal hypoperfusion r/t CHF, they aren’t filtering out creatinine as well

Question 9

What is the priority problem for Harold? what is the priority nursing intervention?

Answer 9

problem: impaired perfusion r/t possible CVA AEB right sided weakness, double vision, slurred speech and dysphasia.
intervention: get a CT to determine type/location of stroke, perform focused neuro assessment to monitor changes

Question 10

What else is Harold at risk for?

Answer 10

• At risk for poor perfusion/GE because decreased RBC/HGB/HCT → not delivering blood to tissues
• At risk for pneumonia r/t high WBC and HF (fluid in lungs)

Question 11

What is the desired goal/outcome for Harold?

Answer 11

minimize cell death by treating within 4.5 hours, and re-perfuse penumbra

Question 12

Med card for Warfarin
- therapeutic/pharm class
- mechanism of action
- side effects
- what to assess for at the bedside

Answer 12

• anticoagulant/coumarins
• prevents thromboembolic events by blocking Vitamin K dependent clotting pathways
• bleeding
• assess for signs of bleeding/hemorrhage, monitor PT/INR