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    Case Study # 3 UNRS 314 Name - Number - Ruptured Appendix

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    Sapiah Raman
    A 10-year-old male presented to the emergency room with abdominal pain and was diagnosed with a ruptured appendix after ultrasound. He underwent surgery to remove the ruptured appendix. You are now caring for him post-operatively. He is experiencing severe pain rated as 8/10. The orders include IV fluids, NG drainage, antibiotics (clindamycin and gentamicin), and morphine sulfate prn for pain. Critical thinking questions address the major side effect of clindamycin, appropriate gentamicin dosing and monitoring, and potential complementary therapies.

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    Case Study # 3 UNRS 314 Name - Number - Ruptured Appendix

    Uploaded by

    Sapiah Raman
    117 views2 pages
    A 10-year-old male presented to the emergency room with abdominal pain and was diagnosed with a ruptured appendix after ultrasound. He underwent surgery to remove the ruptured appendix. You are now caring for him post-operatively. He is experiencing severe pain rated as 8/10. The orders include IV fluids, NG drainage, antibiotics (clindamycin and gentamicin), and morphine sulfate prn for pain. Critical thinking questions address the major side effect of clindamycin, appropriate gentamicin dosing and monitoring, and potential complementary therapies.

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    case-study3_lecture

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    A 10-year-old male presented to the emergency room with abdominal pain and was diagnosed with a ruptured appendix after ultrasound. He underwent surgery to remove the ruptured appendix. You are now caring for him post-operatively. He is experiencing severe pain rated as 8/10. The orders include IV fluids, NG drainage, antibiotics (clindamycin and gentamicin), and morphine sulfate prn for pain. Critical thinking questions address the major side effect of clindamycin, appropriate gentamicin dosing and monitoring, and potential complementary therapies.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    117 views2 pages

    Case Study # 3 UNRS 314 Name - Number - Ruptured Appendix

    Uploaded by

    Sapiah Raman
    A 10-year-old male presented to the emergency room with abdominal pain and was diagnosed with a ruptured appendix after ultrasound. He underwent surgery to remove the ruptured appendix. You are now caring for him post-operatively. He is experiencing severe pain rated as 8/10. The orders include IV fluids, NG drainage, antibiotics (clindamycin and gentamicin), and morphine sulfate prn for pain. Critical thinking questions address the major side effect of clindamycin, appropriate gentamicin dosing and monitoring, and potential complementary therapies.

    Copyright:

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    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    Case Study # 3

    UNRS 314 Name _______________ Number _______


    Ruptured Appendix

    10 year old male presents to the ER with two day history of anorexia, loose stools x3, pain that
    started in umbilical area and settled in the right lower quadrant. He started feeling a bit better so
    mom encouraged clear fluids and gave him Tylenol for fever to 101.2. He was admitted during
    the evening with fever to 104, diffuse abdominal pain, and abdominal distension. Upon admission
    WBC is elevated and abdominal ultrasound is positive for ruptured appendix. He was taken to the
    OR for surgery to remove a ruptured appendix. You are caring for him the post-op day 1.

    Maintenance IV 24 hour fluid calculations ______________________


    1 ½ maintenance IV ________________________________________
    Weight 32.45 kg

    Physician orders:
    • IV Dextrose 5% in 0.45 Normal Saline @ 120 mL / hr
    • NG to low suction
    • Replace cc/cc NG drainage every four hours
    • NPO
    • Clindamycin IV 300 mg every 6 hours
    • Gentamicin IV 66 mg every 8 hours
    • Morphine Sulfate 3 mg IV every 3-4 hours prn for severe pain

    MAR states Morphine last given at 0700

    You are getting ready to prepare your am meds when the mother calls for pain medications. The
    patient rates his pain as 8/10 using the Universal Pain Scale. His NG output at 0700 was 76 mLs.

    At what rate would you regulate his IV fluids at ________ (mL/hour) to replace the NG fluid
    loss for the last 4 hours?

    Clindamycin 300 mg
    Dosing: 20 – 40 mg / kg / day
    Clindamycin is provided by the pharmacy in 50 mL of IV solution.

    Medication Action: mg/kg calculations Nursing


    Responsibilities
    Labs:

    Classification How fast can drug be Why this drug?


    administered IV?
    Gentamicin 66 mg
    Dosing: 2 – 2.5 mg / kg/dose (every 8 hours)
    Gentamicin is provided by the pharmacy in 50 mL of IV solution

    Medication Action: mg/kg calculations Nursing


    Responsibilities
    Labs:

    Classification How fast can drug be Why this drug?


    administered IV?

    Morphine Sulfate 3 mg
    Morphine is provided as 10mg / mL
    Dosing: 0.1 to 0.2 mg / kg / dose

    Medication Action: mg/kg calculations Nursing


    Responsibilities
    Labs:

    Classification How fast can drug be Why this drug?


    administered IV?

    How much would you need to draw up to provide the accurate dose of Morphine Sulfate
    _________________

    Critical thinking: What is the major side effect of Clindamycin therapy? What specific
    clinical manifestations would you need to watch for? What drug would need to be added
    to the medication regime if this complication develops? What CAM is often given to
    diminish the potential for this complication?

    In administering Gentamicin why might the physician ask for the pharmacy to do the
    dosing based on peak and trough lab values?

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