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An 80-year-old man “Gus” was 3 days postoperative. He was alert and oriented. A nursing student...

An 80-year-old man “Gus” was 3 days postoperative. He was alert and oriented. A nursing student administered his morning medications in one cup that included clopidogrel (Plavix), carbidopa-levodopa (Sinemet), prednisone, rivastigmine tartrate (Exelon), and risperidone (Risperdal). Unfortunately, this cup of medications belonged to another patient on the unit. The nursing student realized her error when she went to medicate her second patient and the patient noted that the medications in the cup did not look like her medications.

  1. What potential side effects might Gus experience from the medications in this cup? Which of these side effects is most concerning to you?
  2. What assessments are critical to monitor on this patient for the remainder of your shift due to potential side effects of the administered medications?

Gus became drowsy with mild nausea and hypotension after taking the medication.

  1. What interventions could be provided to relieve the patient of these side effects? (name at least one for each)
  2. What needs to be monitored with each intervention to prevent further complications? (name at least one for each)
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Answer #1

The potential side effects which Gus might experience are

  • GIT:nausea,vomiting,diarrhea,abdominalmpsin and discomfort ,headache, bloating
  • CNS:drowsiness ,fatigue, altered thermoregulation
  • CVS: hypotension, palpitations, bleeding,bruising
  • Respiratory:decreased breath rate
  • Other:infection

The most concerning side effect is bleeding because the chance of bleeding in post OP patient is very high so a blood thinner should not be administered. Here the oral anticoagulant like placid can stay in the blood for 5 days.The drug prednisone can suppress immune system which can further suppress patients immunity after surgery and risk him at infection prone diseases, slow wound healing. Alteration in the motor function and mental function due to Sinemet. Respiratory depression due to risperidone

The critical assessment which has to be done in the reminder of the shift are

  • Monitoring vital signs (Temperature, pulse, respiration, BP ,SPo2
  • Administration of IV fluids as per order or good adequate oral intake to prevent dehydration due to diarrhea
  • Measure GCS to know cognitive stability
  • Any signs of bleeding from the surgical site
  • Assessment of pain

The intervention needed to relieve his symptoms are

  • Hypotension:intravenous fluids,oral fluids (monitor for fluid overload and its consequences)
  • Nausea:administration of anti emetic drugs,avoid foods which cause nausea (monitor for bowel movements and sounds as it may cause constipation, dry mouth)
  • Drowsy:encourage communications, provide mild task on bed to stay active (monitor alertness ,consciousness, orientation)+
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