Exam 2 Case Study Questions

What is the mechanism of action of benzoyl peroxide in the treatment of acne?

Benzoyl peroxide is effective in combating acne because it slowly and continuously liberates active oxygen in the skin, resulting in antibacterial, antiseptic, drying and keratolytic action. These actions create an environment that is unfavorable for the growth of the P. acnes bacteria, and they soon die. Nurses must understand the mechanism of action of medication to be able to prepare a teaching plan for patients to be able to intervene appropriately

What are the indications for using capecitabine?

Capecitabine is indicated for metastatic breast, colon, and rectal cancer as well as adjuvant colon cancer. It is a prodrug of fluorouracil.

What concurrent condition, if present in the patient, would cause the nurse to question the order for albumin?

Heart Failure Albumin and other colloids cause fluids to shift from interstitial to intravascular spaces. This places more strain on the patient's cardiac and respiratory systems.

What patient education should be provided to a patient with second degree burns?

Teach the patient to watch out for adverse effects of silver sulfadiazine, which are similar to those of other topical drugs, including pain, burning, and itching. She would not use the drug if she had an allergy to sulfonamide drugs. It is applied topically to cleansed and debrided burned areas once or twice daily using a sterile-gloved hand. The previous application must be removed before a new application. Teach patient to monitor for signs of infection and report to HCP. She should avoid sunlight on the new skin for several months. Vitamin E can be applied after the epidermis is replaced.

The patient asks the nurse what diet changes she will have to make regarding her hypertension. How will the nurse respond?

The nurse will tell the patient to limit intake of potassium or keep intake of potassium consistent because this medication can cause a rise in serum potassium. Foods high in potassium include bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and legumes. The nurse will also tell the patient not to use a potassium-containing salt substitute while she is taking spironolactone

What patient outcome would indicate the nurse that the albumin infusions have been successful?

A decrease in edema and reduction in abdominal girth The therapeutic response to albumin therapy includes an elevation of blood pressure, decreased edema, and increase serum albumin levels

The patient has been prescribed a 1% silver sulfadiazine (Silvadene) cream to treat her burns. She asks the nurse why silver is used and if she will be taking antibiotic pills as well. What is the nurse's best response?

Applied directly to the burned tissue, silver sulfadiazine (Silvadene) is a synthetic antimicrobial drug produced when silver nitrate reacts with chemical sulfadiazine and has proved both effective and safe prevention and treatment of infections in burns Often, the blood supply to burned areas is drastically reduced, so systemically administered antibiotics are not sufficiently effective. Therefore, the best way to deliver the drug is apply it topically.

What nursing considerations will be essential to monitor in a client with dehydration?

Carefully assess BP, HR and RR, I+O's, Urine Specific Gravity, Blood Levels of Potassium, Sodium, and Chloride Administration of isotonic solutions requires constant monitoring during and after therapy with vital signs and observation for possible fluid overload, especially those at risk or those with heart failure

In a patient with Addison's disease, what would you anticipate Na++ and K+ values would be before treatment?

In Addison's disease, there is sodium loss and potassium retention The sodium loss is caused by adrenal insufficiency, specifically, a lack of aldosterone, when released, conserves sodium and water. When sodium values are low, K+ levels are high.

What would the nurse teach the patient about taking capecitabine?

It's tablet taken PO for 14 consecutive days and then a 7-day off period. The most frequent side effects are diarrhea, nausea, and vomiting, and foot and mouth syndrome. Affects rapidly dividing cells that effect the GI system and other rapidly dividing drugs

As the patient is leaving the office, the nurse overhears her talking on the phone. She says, "I'm having terrible cramps. I can't wait to get home and take some Tylenol." Is any further patient teaching necessary?

No, the patient may take acetaminophen for pain relief without any drug interactions with spironolactone. Concurrent use of NSAIDs (aspirin and ibuprofen) will result in decreased diuretic effects and should be avoided

What IV fluid would be indicated to increase intravascular volume and address fluid volume deficit?

Normal Saline 0.9% is indicated to replace volume and will increase BP Giving an isotonic solution such as normal saline causes no net fluid movement out of the vascular space and will increase the BP and help resolve the vascular collapse

What side effects should be included in the patient teaching about the use of benzoyl peroxide?

Side effects include peeling skin, red skin, or a sensation of warmth. Blistering or swelling of the skin is generally considered an allergic reaction to the product and is indication to stop treatment Overuse of this drug is common in teenage patients who are attempting to cure their acne quickly. The result can be painful, reddened skin, which usually resolves on return to use of these medications as prescribed.

What is the role of spironolactone in the treatment of hypertension?

Spironoloactone is a potassium-sparing diuretic that competitively binds to aldosterone receptors and therefore blocks the resorption of sodium and water that is induced by aldosterone secretion. This means extracellular fluid volume, plasma volume, and cardiac output, which causes a decrease in BP

What are two considerations the nurse will keep in mind regarding administration of albumin?

The nurse will keep in mind that albumin is contraindicated in patients with a known hypersensitivity to it and in those with heart failure, severe anemia, or renal insufficiency. The nurse will also make sure that the infusion of albumin is administered slowly and cautiously

The patient taking Benzoyl Peroxide asks, "how long until my faces gets better?" What should the nurse respond with?

The nurse will tell the patient that benzoyl peroxide generally produces signs of improvement within 4-6 weeks When patients expect immediate results from the med therapy, they can become dissatisfied and may become noncompliant

The patient asks the nurse why she is taking leucovorin if it is not directly treating her breast cancer. How will the nurse respond?

The nurse will tell the patient that methotrexate is associated with severe BMS and is always given in conjunction with the "rescue" drug leucovorin. Cells require folic acid to survive, and because methotrexate blocks the formation of folic acid, healthy cells die as a result. Giving leucovorin (which is rapidly converted to the active form of folic acid) provides the body with active folic acid, which prevents death oof normal cells

The patient calls into the clinic the following week and tells the nurse she is having lots of diarrhea, and her legs are so weak that she is having trouble putting one foot in front of the other. She has been irritable that the husband insisted she call in. What would the nurse suspect is occuring?

These are signs of hyperkalemia.