Suggested Answer Guidelines Marilyn Fitch, 78 years old Medication Categories: Concepts/Content: Antidysrhythmics Assessment ACE Inhibitors Drug-drug interactions Beta Blockers Evaluation of desired outcomes Statins Monitoring for adverse effects Oral Anticoagulants Emergency treatment of dysrhythmias Diuretics Client education Electrolytes Psychosocial support 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% X • Safety and Infection Control 9-15% X Health Promotion and Maintenance 6-12% X Psychosocial Integrity 6-12% X Physiological Integrity • Basic Care and Comfort 6-12% • Pharmacological and Parenteral Therapies 12-18% X • Reduction of Risk Potential 9-15% X • Physiological Adaptation 11-17% X © 2020 KeithRN LLC. All rights reserved. No part of this case study may be reproduced, stored in retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of KeithRN I. Initial Presentation: Marilyn Fitch is a 78-year-old Caucasian woman with a history of hypercholesteremia, hypertension, and heart failure and has NKDA. She was brought in by her daughter after Marilyn complained of feeling dizzy several times this morning and then almost passed out at home. Marilyn has a six-month history of paroxysmal atrial fibrillation. Her heart rate has been regular and she has had no episodic dizziness since she had a synchronized cardioversion one week prior to this visit. Her initial VS in triage were: T: 98.9 F/37.2 C (oral) P: 52 R: 16 BP: 94/52 and O2 sat: 98% room air. Personal/Social History: Marilyn is a widow and lives alone in her own home. She denies smoking and admits to drinking one glass of wine with her dinner. 1. What data from the histories are RELEVANT and must be NOTICED as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance: • Hypercholesterolemia Hypertension Heart failure • Dizziness/ almost passing out • 6-month paroxysmal A fib • Synchronized cardioversion • Pulse of 52, BP 94/52 • All of these are risk factors (especially when combined) for heart attack and stroke • Concerning signs of heart rhythm changes • Vitals of low HR and Low BP, usually if one of these two vitals changes, the other will increase to compensate. RELEVANT Data from Social History: Clinical Significance: • Widow and lives alone • Drinking wine with dinner • Shows the pt doesn’t have much of a support system, and there could be psychosocial aspects to include in her care • Drinking 1 glass of wine with dinner is usually ok, in a healthy individual. Since she has heart problems, cholesterol issues and hypertension, she should restrict alcohol use. 2. 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) Medical History (PMH): Home Medications: Hypercholesteremia Apixaban 2.5 mg po bid Hypertension Captopril 100 mg po BID daily Heart failure Amiodarone 100 mg po bid Atrial fibrillation Hydrochlorothiazide 50 mg po daily Atorvastatin 10 mg po daily Carvedilol 6.25 mg po bid As the nurse responsible for this patient, you promptly review the medical history and current home medications in the medical record: Applying your knowledge of pharmacology, to provide safe patient care, answer the following essential information: