Brief Summary
This video is a recording of a live pharmacology class as part of ReMar Nurse University's special event in June. It focuses on applying pharmacology knowledge to patient scenarios to prepare for the NCLEX exam. The session includes a case study of a patient named Myra Keller, a 54-year-old female with a history of asthma, anxiety, hypertension, cigarette smoking, and obesity, who was admitted with chest pain after jogging. The class works through a series of questions related to the patient's presentation, medications, and lab values, emphasizing critical thinking and clinical judgment. The session also previews the V2 virtual training system, highlighting the importance of understanding expected changes during the aging process.
- Focus on pharmacology and applying it to real patient scenarios.
- Case study of Myra Keller, a 54-year-old female with multiple health issues.
- Review of patient's medications, lab values, and vital signs.
- Emphasis on critical thinking and clinical judgment for NCLEX preparation.
- Preview of the V2 virtual training system and the importance of understanding the aging process.
Introduction to ReMar Nurse University and Money Back Guarantee
The host introduces a special event for every Monday in June, emphasizing the importance of doing the work to achieve the reward. She announces a money-back guarantee for the ReMar Nurse University program if students don't pass the NCLEX, along with a 50% discount on the program. The host mentions that the session is for both RNs and LPNs and also highlights resources for nursing students, including the Nursing School V2 program and TEAS prep materials.
Patient Report: Myra Keller
The session begins with a patient report on Myra Keller, a 54-year-old female admitted with chest pain after jogging. She has a history of asthma, anxiety, hypertension, cigarette smoking, and obesity. Her mentation is alert and oriented times four, lungs are clear, and she denies nausea and vomiting. A nurse's note from 6 p.m. indicates two episodes of shortness of breath and a hypertensive episode after lunch, triggered by watching the news. The patient is currently resting quietly after ambulating. The patient is a full code and is prescribed amlodipine, carvedilol, lisinopril, sodium bicarbonate, and calcium chloride.
Analyzing Lab Values and Vital Signs
The instructor reviews Myra Keller's lab values, noting several critical results that require interpretation. She emphasizes that the NCLEX provides normal lab values, and nurses must understand how to interpret them and identify the underlying causes. The instructor also reviews the patient's vital sign trends, including blood pressure, heart rate, respirations, temperature, and pulse oximetry, noting that a pulse oximetry of 92% on room air is considered abnormal.
Case Study Question 1 & 2: Initial Evaluation and Communication with Physician
The class begins working through a case study based on Myra Keller's presentation. The first question asks about the priority when first evaluating the client at the start of the shift. The correct answer includes reestablishing vital signs and performing a head-to-toe assessment. The second question asks to list four patient needs that must be communicated to the physician, including abnormal vital signs, sodium, potassium, and oxygen levels.
Case Study Question 3 & 4: Diagnostic Procedures and Causes of Hypertension
The third question asks for three diagnostic procedures the nurse should anticipate, with the expected answers being ECG/EKG, stress test, and liver function test due to concerns about the liver based on elevated alkaline phosphatase levels. The fourth question asks for three possible causes of hypertension in this patient, with the answers including diet, smoking, obesity, and anxiety, all modifiable risk factors.
Case Study Question 5 & 6: Medication Causing Hyperkalemia and Missing Information
The fifth question asks which medication is most likely causing the hyperkalemia, with the correct answer being lisinopril. Lisinopril, an ACE inhibitor, blocks aldosterone, which normally promotes potassium excretion. The sixth question asks what information is missing from the MAR before administering medication, with the answer being allergies, as this information is crucial for patient safety.
Case Study Question 7 & 8: Safety Concerns and Side Effects of Nitroglycerin
The seventh question addresses safety concerns about the new medications ordered on the MAR, noting that amlodipine and carvedilol have no route specified, and sodium bicarbonate and calcium chloride are scheduled to be given once but have been given multiple times. The eighth question asks about the expected side effect of nitroglycerin that would require pain medication, with the answer being a headache, which is a vascular headache due to vasodilation.
Case Study Question 9 & 10: Oxygen Therapy and Sodium Bicarbonate Treatment
The ninth question asks about the greatest risk when giving oxygen for the first time, with the correct answer being oxygen toxicity. The tenth question asks which condition sodium bicarbonate is an appropriate treatment for, with the answer being metabolic acidosis.
Grading and Evaluating Performance
The instructor reviews a grading sheet to evaluate performance on the simulation test. Scores are graded from F to A, with the goal being at least a B. The instructor emphasizes that the class is a learning environment and encourages students to identify areas for improvement.
Preview of V2: Expected Changes During Aging - Cardiac and Respiratory Systems
The session transitions to a preview of the V2 virtual training system, focusing on expected changes during aging. The lecture covers the cardiac system, noting decreased cardiac output, increased blood pressure, and the importance of understanding orthostatic hypotension. It also discusses the respiratory system, including increased oxygen demands and decreased lung expansion. The instructor emphasizes that oxygen is a medication and should be removed when no longer therapeutic, typically after about 6 hours for acute conditions.
Preview of V2: Expected Changes During Aging - Integumentary, Reproductive, and Musculoskeletal Systems
The lecture continues with the integumentary system, noting that skin becomes dry, thin, and wrinkled, with a decline in the ability to repair damaged tissues. For the reproductive system, hormonal changes are discussed, including decreased estrogen in women and decreased testosterone in men. The instructor highlights that elderly adults are still sexually active and need education on STDs. The musculoskeletal system section covers decreased range of motion, decreased calcium levels, and decreased muscle mass, noting that bone loss begins at age 40.
Preview of V2: Expected Changes During Aging - GU, GI, and Nervous Systems
The lecture addresses changes in the genitourinary (GU) system, including smaller kidneys and decreased bladder size, leading to urinary frequency and dehydration. Urinary incontinence is noted as common but not normal. Gastrointestinal (GI) changes include dry mouth, constipation, and decreased digestion of fatty foods. Tooth loss is not considered a normal part of aging. The nervous system experiences decreased activity in the central and peripheral nervous systems, leading to slower reaction and reflex times.
Preview of V2: Expected Changes During Aging - Immune, Endocrine, and Sensory Systems
The lecture concludes with the immune system, noting a decreased functioning that increases the risk of illness, emphasizing the importance of the seasonal flu vaccine. The endocrine system experiences decreased secretion of thyroid hormone and insulin production, leading to increased blood glucose levels. Finally, all senses (hearing, tasting, touching, smelling, seeing) decline with age, with a loss of high-pitched sounds being the first to go.
Conclusion and Invitation to Join ReMar Nurse University
The instructor summarizes the session, emphasizing the importance of returning to foundational knowledge and focusing on key areas for the NCLEX. She encourages students to join the V2 system for comprehensive preparation and announces a sale with a money-back guarantee. The instructor also mentions upcoming Winning Wednesday sessions and invites students to take the next step in their studies, whether it's setting a test date or enrolling in a course.
