A patient returns to your unit after having a right knee surgery. As you start y

Question

A patient returns to your unit after having a right knee surgery. As you start your morning shift, the patient asks for pain medications. He states that his pain is 7 on a scale of 10. Past medical history indicates that the patient has Type 2 Diabetes and Congestive Heart Failure (CHF) Earlier, the patient had his blood drawn, and the results have returned 30 minutes ago. The patient is prescribed Digoxin (medication for CHF) and Insulin (with a sliding scale). The instruction is to withhold Digoxin if Systolic Blood Pressure is

Explanation / Answer

Ans)1) Firstly, there is need to check HGT premeals so before breakfast, HGT checking is needed.

- If HGT above 60mg/dl, then inform to Dr. & as per sliding scale administer the fixed dose of insulin & if below then too inform Dr. & Hold insulin & follow the Dr. Instruction carefully as Patient may go in hypoglycemia.

2) The next priority action is to let patient have his breakfast & after 15-30 mins check his vital signs especially HR & BP.

Consider HR> 60/min or BP>100 systolic then Inform Dr. & Administer tab digoxin as per Dr. Order. If HR< 60/min & BP<100 systolic then too inform Dr. As Dr. Will advise to with hold tab digoxin.

Regarding tab digoxin as before administering this medication it is essential to monitor HR & BP.

Note: if patient is in hypoglycemic condition then first monitor him & then plan for his physical therapy as priority is his health condition.

- Also he highlights pain score 7/10 so after breakfast administer analgesic as per Dr. Order.

- As Pain is the 6th vital sign after temperature, pulse, respiration, blood pressure, SpO² saturation. Pain complaint should not be neglected.

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