The Client Stated That All That Acetaminophen I Took At Home Is Not Working Anymore Upon Further Questioning The Clie 1 (202.65 KiB) Viewed 28 times
The client stated that "all that acetaminophen I took at home is not working anymore" Upon further questioning, the client states they took over 30 acetaminophen. He requests something for pain and said his pain is now above a 10/10 to his RUQ and RLQ. The client states he is also very nauseated and feels lightheaded when standing. The patient states he has not been able to void for the past 6 hours. Bladder is feit during palpation of abdomen. The CT scan reveals a large kidney stone in the left ureter. 2. Use an X for the nursing actions listed below that are indicated (appropriate or necessary), contraindicated (could be harmful), or Non-Essential (makes no difference or not necessary) for the client's care at this time. Only one selection can be made for each nursing action. Indicated Contraindicated Non-Essential Nursing Action Draw an acetaminophen level Give Zofran 4 mg !VP for nausea Obtain a 12 lead ECG Administer hydrocodone 5 mg/acetaminophen 325 mg PO Administer Morphine IVP Perform urinary catheterization Serve a regular food diet
2. Use an X for the nursing actions listed below that are indicated (appropriate or necessary), contraindicated (could be harmful), or Non-Essential (makes no difference or not necessary) for the client's care at this time. Only one selection can be made for each nursing action. Indicated Contraindicated Non-Essential Nursing Action Draw an acetaminophen level Give Zofran 4 mg IVP for nausea Obtain a 12 lead ECG Administer hydrocodone 5 mg/acetaminophen 325 mg PO Administer Morphine IVP Perform urinary catheterization Serve a regular food diet
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