14 Nursing Case Studies to discuss - CustomNursingPapers.Com

14 Nursing Case Studies to discuss
Instructions: Answer all questions in complete sentences and provide a rationale for each
answer. Reference all answers and rationales in APA format. Case Study 2
63-year-old K.S. has just arrived to the PACU, where the nurse makes the initial assessment. K.S. is
turned, the OR sheets are removed, his skin is observed for redness and pooling of blood, and his head is elevated 45 degrees.

14 Nursing Case Studies to discuss
He is on 40% humidified oxygen via a Ventimask mask. K.S’s initial set of vital signs are 140/80, HR 92, RR 14, T 99° and pulse ox 98%. Fifteen minutes later, the nurse charts his vital signs as 144/76, HR 100; RR 10, T 99.1° and pulse ox 88%.

14 Nursing Case Studies to discuss
1. What action would be appropriate by the nurse based on the vital signs assessment 15 minutes
after arrival to PACU?
2. What age-related factors would the nurse want to consider regarding K.S.’s nursing care?
Case Study 3
M.H. is a 37-year-old man who initially sought medical care for complaints of weakness in his left leg.
He felt that he “lost control” of his left foot each time he took a step and that his foot just “flopped to the
floor.” He now complains of muscle spasms and jerking of his legs at night, which he feels keeps him
awake. His provider prescribed baclofen (Lioresal). M.H. tells the nurse that he does not understand how
this medication will help because the provider told him that the drug works on his brain, not on his
muscles. He also does not understand why he cannot have his usual few beers in the evening.
1. What patient teaching regarding baclofen’s mechanism of action should the nurse provide to
M.H.?
2. Why should M.H. avoid drinking beer?
3. If M.H.’s spasticity worsens, the provider will add dantrolene (Dantrium) to the patient’s
medication regimen. How does this drug differ from baclofen?
Case Study 4
D.F., 23 years old, is scheduled have her wisdom teeth removed under conscious sedation with a
benzodiazepine. Her friends describe her as the “life of the party” with nearly daily consumption of
alcohol. She lives alone in the country, just down the road from her elderly parents.
1. What are the safety concerns for D.F.?
2. What adverse effects might you expect to see in D. F.’s situation?
3. When she doesn’t come to work the next morning, what is the priority action?
4. What patient teaching is essential to prevent a harmful outcome?
5. What measures would be taken if D.F. comes into the emergency department unconscious from a
mixture of alcohol and benzodiazepines?
Case Study 5
Stacy weighs 300 lb, and she has been trying to lose weight for the past 5 years. She has attempted
numerous short-lived diets, as well as vigorous exercise. Over these years, she has been able to lose
between 50 and 125 lb and has, within the next 6 months, gained the weight back. She comes to the
weight loss clinic today to attempt weight loss again. In addition to a diet of 1200 calories per day, she
will begin to take the drug phentermine (Ionamin). She has many questions.
1. Stacy asks the nurse, “How effective will this medication be in helping me lose weight?” How will
the nurse respond?
2. Stacy is worried about experiencing side effects. What information will the nurse provide Stacy about
potential side effects?
3. Finally, Stacy asks if phentermine has any interactions with other drugs. How will the nurse respond?
Case Study 6
Nancy has been unsuccessful in preventing migraine headaches and has been prescribed a selective
serotonin receptor agonist (SSRA), sumatriptan (Imitrex).
1. What patient teaching would be included for Nancy regarding the action and route of administration
of sumatriptan?
2. What patient teaching should be included for Nancy regarding adverse effects or contraindications?
3. What medications would Nancy have been prescribed for first- and second-line preventive therapy?
4. Nancy asks the nurse about the effects of caffeine on migraines. What should the nurse’s response be?
5. Nancy also asks the nurse if there are effective nonpharmacologic treatments for migraines. What
evidence-based answer can the nurse provide?
Case Study 7
The camp nurse has been called to the field outside the recreation center. As the nurse arrives, there is a
large crowd that begins to separate. The nurse notes that one of the campers is lying on the ground, and
the camper’s arms and legs are thrashing back and forth. The nurse also notes a small cut above the
camper’s right eye. The nurse recognizes the camper as one who comes to see her every day for
medication administration, and the nurse remembers that the medication the camper takes is
carbamazepine (Tegretol). As the nurse moves closer, she also sees two of the counselors preparing to
attempt to restrain the camper.
1. What should be the nurse’s initial response?
2. The camper is transferred to a local emergency department, where she is stabilized. A blood level of
carbamazepine is drawn, and the result is 1.2 mcg/mL. How will the nurse interpret this finding?
Case Study 8
Stacy weighs 300 lb, and she has been trying to lose weight for the past 5 years. She has attempted
numerous short-lived diets, as well as vigorous exercise. Over these years, she has been able to lose
between 50 and 125 lb and has, within the next 6 months, gained the weight back. She comes to the
weight loss clinic today to attempt weight loss again. In addition to a diet of 1200 calories per day, she
will begin to take the drug phentermine (Ionamin). She has many questions.
4.Stacy asks the nurse, “How effective will this medication be in helping me lose weight?” How will the
nurse respond?
5.Stacy is worried about experiencing side effects. What information will the nurse provide Stacy about
potential side effects?
6.Finally, Stacy asks if phentermine has any interactions with other drugs. How will the nurse respond?

14 Nursing Case Studies to discuss
Case Study 9
Nancy has been unsuccessful in preventing migraine headaches and has been prescribed a selective
serotonin receptor agonist (SSRA), sumatriptan (Imitrex).
1.What patient teaching would be included for Nancy regarding the action and route of administration of
sumatriptan?
2.What patient teaching should be included for Nancy regarding adverse effects or contraindications?
3.What medications would Nancy have been prescribed for first- and second-line preventive therapy?
.
4.Nancy asks the nurse about the effects of caffeine on migraines. What should the nurse’s response be?
5.Nancy also asks the nurse if there are effective nonpharmacologic treatments for migraines. What
evidence-based answer can the nurse provide?
Case Study 10
A 65-year-old patient with a 2-year history of PD has been experiencing an increase in symptoms,
especially muscle tremors and rigidity. The patient has been taking carbidopa–levodopa (Sinemet CR)
and selegiline (Eldepryl) since diagnosis. The physician has chosen to add benztropine (Cogentin) to the
patient’s medication regimen. The nurse is administering the first dose of benztropine and intends to
provide patient teaching about the drug and its side effects.
1. What side effects are associated with benztropine?
2. Given the effect the medication has on the pupils, what condition if present in the patient would cause
concern?
3. An indication that the addition of benztropine is effective in this patient would be relief of which PD
symptom?
Case Study 11
The patient is a 54-year-old man with a history of schizophrenia. The patient was started on haloperidol
(Haldol) 6 months ago. Today the patient’s family calls the clinic to discuss symptoms that have occurred
more frequently over the past 2 weeks. The family describes that the patient has had stiffness, a shuffling
gait, hand tremors, and a delay in response to questions.
1. What advice will the nurse offer to the family?
2. The nurse anticipates that the physician will order which medication to treat these symptoms?
3. The family asks the nurse if there are any other adverse effects of haloperidol that the family should
anticipate. How will the nurse respond?

14 Nursing Case Studies to discuss
Case Study 12
I.S. is a 59-year-old woman who lives next door to a nurse. She goes to see the nurse to discuss her recent
health problems. I.S. tells the nurse that upon seeing her ophthalmologist, she was diagnosed with early-
onset glaucoma. The ophthalmologist prescribed several medications, and I.S. has started taking them. As
the nurse talks with I.S., it becomes clear that she is in need of patient teaching about her eye medications,
pilocarpine (Pilocar) and latanoprost (Xalatan).
1. What is the expected outcome of treatment of glaucoma with pilocarpine and latanoprost?
2. I.S. is wondering if she may be allergic to one of the drugs because she feels a burning sensation in
her eye after administering them. How will the nurse respond?
3. The neighbor asks, “Will I have to take these medications for the rest of my life?” How will the nurse
respond?

14 Nursing Case Studies to discuss
Case Study 13
S., age 8 years, is brought to the emergency department by her mother. S.’s mother states that S. has a 3-
year history of allergy-induced asthma. S. is in acute distress; her respiratory rate is 38 breaths/min, and
the nurse notes sternal and intercostal contractions. S.’s mother tells the nurse that S. has received
nebulizer treatments at home and has taken several “hits” from the rescue inhaler with little relief.
1. What type of medication does the nurse expect S. will receive initially? By which route will the
medication be administered?
2. The patient is being discharged to home with a prescription for a new inhaler with a spacer. The
nurse asks the mother if S. has been using an inhaler with a spacer, and the mother replies that S. has
not. What will the nurse teach the mother about the benefits of using a spacer?
3. S. is also prescribed a long-term inhaler. The nurse anticipates that this inhaler will contain the drug
salmeterol. What patient teaching will the nurse provide about this medication?

14 Nursing Case Studies to discuss
Case Study 14
The camp nurse sees campers throughout the day to administer routine medications. In addition, the nurse
provides various OTC medications as needed for cuts, scrapes, diarrhea, nausea, and various allergy
complaints. The following patients have come to the clinic today:
 S., who is 12 years old, is complaining of mosquito bites that itch. S. has no other health problems
and no medication allergies.
 J., age 14 years, is complaining of a runny nose and itchy eyes. He has a history of seasonal allergies
and takes loratadine (Claritin) as needed. J. has an allergy to penicillin and sulfa drugs.
 K., who is 55 years old, is asking for a decongestant to treat her allergies. She has a history of
hypertension, which is controlled by medication.
1. What medication would the nurse recommend for S.? What route would the nurse recommend?
2. What medication would the nurse recommend for J.?
3. How will the nurse respond to K.’s request for a decongestant?
Case Study 15
The school nurse is reviewing the medications of D.N., a fourth grader who has multiple allergies,
including a severe nut allergy.
1. What education would be provided to the cafeteria staff to minimize the risk of D.N.’s having an
anaphylactic reaction?
2. What instructions would the school nurse provide to those who may be in a position to administer a
single dose of epinephrine?
3. What assessment data would be essential to determine the effectiveness of the epinephrine for D.N.
before and after an anaphylactic reaction?

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