Assignment: Musculoskeletal And Integumentary Drug Treatment

Assignment: Musculoskeletal And Integumentary Drug Treatment

This case study will help you practice analyzing a patient record, which will assist you in preparing for the final project.

This case will focus specifically on musculoskeletal and integumentary drug treatment.

Prompt: Consider the following scenario: Ms. Craft, age 59, was brought by ambulance to the emergency room because she thought she was dying. She had difficulty breathing, was dizzy if she attempted to sit up, and felt a sense of impending doom. Ms. Craft assumed that she was having a heart attack, and so did the admitting emergency room personnel.

But the case was more complicated. Physical examination showed Ms. Craft to have weakness, malaise, warm skin, and hypotension. Ms. Craft said she felt nauseous. A blood glucose value was really high. Cardiac markers did not show that she was having a heart attack, nor did an EKG. When her history was taken, Ms. Craft said she had not seen a doctor in several years and was unaware that she had diabetes.

Her respirations were deep and rapid—Kussmaul respirations.

In this case, the ER physician diagnosed decompensated diabetes mellitus with metabolic acidosis. These were the medications prescribed:

· Oxygen by mask

· Hypertonic IV fluids

· Insulin orally

· Hydrochloric acid solution via IV

In a short paper, the following critical elements must be addressed:

· Identify the incorrect medication/drug classification/treatment and explain why it is incorrect.

· What drug classification would you use instead? Why?

· Provide an example of a generic medication from each drug classification. How would each of the medications/treatments in the scenario act on the patient’s body?

Support your answer with relevant resources.

Musculoskeletal and Integumentary Drug Treatment Example Approach

SNHU IHP-310

The medications which were prescribed to Ms. Craft were; oxygen by mask, hypertonic IV fluids, insulin orally, and hydrochloric acid solution via IV. The incorrect medications given to the patient were insulin orally, hydrochloric acid solution via IV, and hypertonic IV fluids. The patient seems to be going into diabetic ketoacidosis or DKA. The hydrochloric acid solution is used to treat metabolic alkalosis.” Metabolic alkalosis is a primary increase in bicarbonate with or without a compensatory increase in carbon dioxide partial pressure; pH may be high or nearly normal.”(Lewis, 2019) As for insulin, if insulin is taken orally, the digestive juices in your stomach and intestine will break down the insulin before it has a chance to get into your bloodstream to do its job. (Joslin Diabetes Center, 2019) If the patient is experiencing diabetic ketoacidosis, the patient should not be given hypertonic solutions. “Hypertonic solutions should not be given to any patient with any condition that causes cellular dehydration, such as diabetic ketoacidosis. Nor should any patient with impaired heart or kidney function receive an infusion of the hypertonic solution – their system just cannot handle the extra fluid.”(ROSENTHAL, 2019)

The correct drug classification would be regular insulin, potassium therapy, and an electrolyte supplement through IV. The initial priority in the treatment of diabetic ketoacidosis is the restoration of extracellular fluid volume through the intravenous administration of a normal saline solution. This step will restore intravascular volume, decrease counterregulatory hormones and lower the blood glucose level. (Wall, M.D. & Kitabchi, PH. D., M.D., 1999) The current recommendation is to give a low dose (short-acting regular) insulin after the diagnosis of diabetic ketoacidosis has been confirmed by laboratory tests and fluid replacement has been initiated. During rehydration and insulin therapies for diabetic ketoacidosis, the serum potassium concentration typically declines rapidly as potassium reenters the intracellular compartment. (Wall, M.D. & Kitabchi, PH. D., M.D., 1999).

Only short-acting insulin is used for the correction of hyperglycemia in DKA. Insulin Aspart (NovoLog) is insulin which as the onset of action of 5-15 minutes. The peak effect occurs within 30-90 minutes and its usual duration of action is 4 hours. (Osama Hamdy, 2019) Potassium chloride (Klor-Con, K-Dur, Kaon CI) is used for potassium therapy. Potassium replacement should be started with an initial fluid replacement if potassium levels are normal or low. Monitor the potassium level every 1-2 hours initially. (Osama Hamdy, 2019) The supplements of potassium chloride work to correct the electrolyte imbalances as well.

References

Joslin Diabetes Center. (2019). Diabetes Medication Misconceptions. Retrieved from Joslin Diabetes Center:

Lewis, J. L. (2019). Metabolic Alkalosis. Retrieved from Merck Manual Professional Version: https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/acid-base-regulation-and-disorders/metabolic-alkalosis

Osama Hamdy, M. P. (2019, May 31). Diabetic ketoacidosis (DKA) Medication. Retrieved from Medscape: https://emedicine.medscape.com/article/118361-medication#1

ROSENTHAL, K. R. (2019). I.V. ROUNDS: Intravenous fluids: The whys and wherefores. Retrieved from Nursing Center: https://www.nursingcenter.com/journalarticle?Article_ID=652137&Journal_ID=54016&Issue_ID=652101

Wall, M.D., B. M., & Kitabchi, PH. D., M.D., A. E. (1999). Management of Diabetic Ketoacidosis. American Family Physician, 455-464.