Reference no: EM133848513

Question 

1. Kelsey is 83-year-old women who has been having upper abdominal pains that have awakened her at night for the last 2 weeks. In addition to having upper abdominal pains, Kelsey has been feeling nauseated, fatigued, and weak, and has a feeling of being full quickly when eating, a feeling accompanied by heartburn. She also has been using over-the-counter calcium carbonate without relief of her symptoms. After several nights of losing sleep, her husband decides to take her to the emergency department (ED).

In the ED, Kelsey has blood drawn, gives a urine sample, has an electrocardiogram done, and has an intravenous (IV) drip started. Her past medical history includes osteoarthritis, hypertension, elevated cholesterol, and hypothyroidism. She takes ibuprofen (800 mg) as needed for joint pains; according to her husband, she takes it three times a day. She also takes amlodipine every day for blood pressure (BP), atorvastatin for her cholesterol, and levothyroxine for her thyroid. Her vital signs in the ED are BP, 118/60 mm Hg; heart rate (HR), 90 beats/min; respiratory rate (RR), 22 breaths/min; and an oral temperature of 37.3°C.

After a few hours, her blood work shows a decreased hematocrit and hemoglobin, and the ED health care provider decides to send Kelsey to the endoscopy unit for an esophagogastroduodenoscopy (EGD). In the endoscopy laboratory, she receives midazolam 3 mg intravenous and fentanyl 100 mcg intravenous.

1. In pre-procedure teaching to Kelsey, what will you as nurse say is the purpose of midazolam?

2. After you give this medication to Kelsey, which adverse effects of midazolam should you watch for and monitor?

3. As the nurse, you know that administering fentanyl to Kelsey will produce which effects?

2. Kelsey undergoes a successful EGD and wakes up from the procedure without any difficulty. The prescriber informs her and her husband that she has peptic ulcer disease and erosive gastritis. He prescribes omeprazole 20 mg by mouth, to be taken 30 minutes to 1 hour before eating in morning, and ranitidine 300 mg by mouth after dinner.

1. Kelsey asks you why she is being prescribed medication (omeprazole) that she has to take in the morning before eating. How will you explain this to her?

2. What discharge instructions will you give Kelsey regarding omeprazole?

3. Kelsey is curious about why she is receiving ranitidine as a second medication. As you will explain to her, what is ranitidine's mechanism of action?

4. You are aware that while Kelsey is taking omeprazole and ranitidine, she should be assessed periodically for which symptoms?