Mr.

S is a 66 year old gentleman who has been admitted onto your unit from the emergency
department for suspected tuberculosis (TB). Mr. S had also had a heart attack about a year ago.
He has been started on TB medications prophylactically and he has routine blood work ordered
every morning. He has type 2 diabetes, he has been refusing to eat because his sugars have not
been persistent. He also has a previous diagnoses of hepatitis C. He has been on your unit for 3
weeks now, and has become feeling increasingly unwell and you notice he has become
edematous. Mr. S has symptoms of nausea, constant headaches and pain to the extremities. His
wife and son are visiting from out of town who he hasnt seen in 8 months, but Mr. S is upset
because he has been feeling extremely weak and he is worried that they may be shocked at how
sick he has become.
How will you prepare and what will you anticipate with Mr. S current health status? What will
you assess and consider before going in to see Mr. S? What can you do for Mr. S?

Lab Work:
Hemoglobin/RBC: Low
WBC: Normal @ 9.5, yesterdays elevated 11.1 [9-11]
Sodium: Normal @ 143 [135-145 mmol/L]
Potassium: Elevated @ 5.3, yesterdays 4.5 [3.5-5.1]
Urea/BUN: Elevated @ 36 [3.0-7.5]
Creatinine: Elevated @ 386 @ [35-110]
INR: Elevated @ 3.5

Medications
Ondansatron 4 to 8 mg PO PRN q4h
Tylenol 325-650mg PO PRN q6h
Hydromorphone 3mg PO PRN q4h
Amikakin 2g IVPB
Warfarin 5mg PO
Heparin 5 000 units SC q24h
acetylsalicylic acid (ASA)

Key/answers for us to teach back.

How will you prepare and what will you anticipate with Mr. S current health status?

We could anticipate that Mr. S could appear jaundiced because of increased liver panel
values. Assess if it is new.
Be able to assess DOH and provide support. Ask if there is anything we can do for Mr. S
while he is under our care. This can lead to referrals (SW for example).
We can anticipate that the antibiotics are working as the WBCs are decreasing.
Mr. S has a history of heart attack, the potassium is elevated. Potassium could potentially
stop the heart.
o Notify charge nurse about the elevated potassium. We can page for an order to
address the potassium. Kayexalate and/or lactulose
o If we look at paper charts, we can also see if the doctors have acknowledged this.
We realize that INR is elevated, but if we check our medications we see that the patient is
on warfarin.

What will you assess and consider before going in to see Mr. S? What can you do for Mr. S?

Assess pain using COLDSPA, offer Tylenol or hydromorphone ask what has been
effective.
Consider that perhaps Mr. S may not understand the diagnoses of diabetes and do patient
education. Why it is important that the patient eats and how insulin works.
o Mr. S is weak, perhaps we can help by setting up his food, cutting up his food and
providing encouragement.
o Encourage Mr. S to sit up for meals
Consider that Mr. S is anxious about seeing his family and at a time that his health is not
up to par. Ask if we can freshen him up/assist with a shower, observe the environment to
make sure it is safe and clean.
We can reassure Mr. S that we are there to support him and we will be there when his
family comes so they are up to date with what is going on with his health and diagnoses.
We can do our best to ensure Mr. S is comfortable by repositioning

SCM Daily Checklist and Setting Up Your Day

Create patient list

Turn flags on. Check orders and results
Clear flags that have been reviewed
Review EMAR for medications
Review orders tab
Check lab values. Compare abnormal values to previous day(s)

Use this short guide to keep track of your tasks for the day. Once your flags are cleared, you are
able to see new orders and results pop up when you re-login or refresh your SCM.

Interventions for Abnormal Lab Values

Check medications! Abnormal values may already be addressed and the patient may be
getting something to resolve the elevated or decreased lab values
Read the paper charts. Doctors will have written in the progress notes if an abnormal
value has been addressed or not.
Talk to your charge nurse, they are a great resource!
o Do these steps before paging the MD. Your charge nurse will assist you in
deciding when to page.
Consider non-pharmacological interventions
o Assess if your patient has had bowel movements or not, for example
Assess your patient. Are they symptomatic?

References
Adams, M. P., Holland, L. N., Bostwick, P. M., King, S. L. (2010). Pharmacology for nurses: A
pathophysiological approach. Toronto, ON. Pearson Canada. (pp. 334-336).
Day, R. A., Paul, P., Williams, B., Smeltzer, S. C., & Bare, B. (2010). Brunner & Suddaths
textbook of Canadian medical-surgical nursing. (2nd ed.) Philadelphia, PA. Lippincott
Williams & Wilkins. (pp. 308-315).
Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2013). Daviss drug guide for nurses. (13th ed.).
Philadelphia, PA. F. A. Davis Company.
Van Leeuwen, A. M., Poelhuis-Leth, D. J., & Bladh, M. L. (2012). Daviss comprehensive
handbook of laboratory diagnostic tests with nursing implications. Philadelphia, PA.
Dickinson and Company.