Twenty minutes into my shift, I walked into this client’s room to administer his pre-operative intravenous antibiotic. When suddenly, the client held his hands to his head and started to complain, “My head is splitting into two!” I did not even have a chance to ask any prudent questions about his pain, nor even had a chance to get his vital signs. The client had a sudden onset of right upper extremity paresis and left sided visual loss. The client’s vital signs at change of shift were B/P 143/79, AP 83, RR 18, Temp. 98.5 F.
Mr. X is a 5’6 220 lbs, 74 yr. old Haitian male, widowed, who has lived in the United States for the past 11 years with his adult daughter, who is his medical power of attorney. He speaks mostly Creole, is able to write and understand English, however, he does have a small amount of limitations with the English language. He has a history of Type 2 Diabetes, Hypertension, Dyslipidemia, Myocardial infarction, and Osteoporosis. Prior to admission to the hospital, he had been taking his routine medications at home, which included oral hyperglycemic agent, calcium channel blockers, Celebrex, and a statin. He has no history of smoking or drinking alcohol and lives a sedentary lifestyle, since the death of his wife 11years ago.
The rapid response/stroke team had raced to the client’s bedside. Intravenous recomb...
... middle of paper ...
...ad the routine mild pain to his knees, which he had experienced for years. I administered Tylenol 650mg PO as ordered. The client reported a one, on the 0-10 pain scale. I had concerns about the client’s routine use of his prescribed bilateral knees pain relief medication, Celebrax, a COX-2 inhibitor that he would resume, once he returned home as prescribed. I had the opportunity to discuss and receive some insight from the client’s orthopedic surgeon, about the reports pertaining to the use of NSAIDs and how they may increase the risk for stroke related blood clot, in clients. The physician was aware of Celebrax’s ability to increase the risk of stroke related to a clot, and would discontinue the Celebrax for the time being, and instead prescribe Tylenol for Mr. X’s mild pain to his bilateral knees. Also, Mr. X’s total bilateral knees surgery is pending for now.
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