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Bridging the gap between theory and practice for nurses in transition : synthesis project Hu, Karen; Mann, Karen; Voelker, Heidi 2014

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Bridging the Gap Between Theory and Practice for Nurses in TransitionSynthesis project  2013/2014  Karen Hu, Karen Mann, Heidi Voelker Our project The goal of the project was to come up with a workable case study Create a patient, create a medical history and create scenarios to help facilitate learning for new grads or nurses in transition Augustine GloopWe introduce ... Ms. Augustine Gloop is a 74 year old Caucasian female.  She weighs 170lbs and is 5?4. She works in a flower shop part time.  She lives in an apartment on the second floor with her 2 cats.  She tries to take the stairs when she feels up to it although there is an elevator as well.  The flower shop is on the bus route and her bus stop is three blocks from her apartment.   She is single, has no children, but does have a couple of good friends that she gets together with twice a week.Patient History 1 Running Head: A. Gloop Case Scenario                          Unfolding Case Scenario:             Augustine Gloop Dehydration, Hypoglycemia and Small Bowel Obstruction  Karen Hu, Karen Mann, Heidi Voelker      2 A. Gloop Case Scenario  Contents Patient History: ............................................................................................................................................. 3 SCENARIO 1 ................................................................................................................................................... 4 Scenario 1 description: ................................................................................................................................. 5 Simulation Based Learning Activity ............................................................................................................... 6 SCENARIO 1: info sheet for participant ......................................................................................................... 7 CLINICAL COURSE OF THE SIMULATED SCENARIO EVALUATION TOOL ........................................................ 8 SCENARIO 2 ................................................................................................................................................. 13 Scenario 2 description: ............................................................................................................................... 14 Simulation Based Learning Activity - 2 ........................................................................................................ 15 SCENARIO 2 : information sheet for participant ......................................................................................... 16 CLINICAL COURSE OF THE SIMULATED SCENARIO 2 ................................................................................... 18 SBAR COMMUNICATION TOOL ................................................................................................................... 20 SBAR ? PHYSICIAN SIMULATION RESPONSE ............................................................................................... 22 AUGUSTINE GLOOP CHART ......................................................................................................................... 23 MAR AND LAB VALUES ................................................................................................................................ 32 Scripts .......................................................................................................................................................... 33          3 A. Gloop Case Scenario   Patient History: Ms. Augustine Gloop is a 74 year old Caucasian female.  She weighs 170lbs and is 5?4. She works in a flower shop part time.  She lives in an apartment on the second floor with her 2 cats.  She tries to take the stairs when she feels up to it although there is an elevator as well.  The flower shop is on the bus route and her bus stop is three blocks from her apartment.   She is single, has no children, but does have a couple of good friends that she gets together with twice a week. Past Medical History (PMH) Coronary artery disease (CAD), hypertension (HTN), Type 2 Diabetes, overweight (BMI 29.2), osteoporosis, patient reported history of bowel problems (constipation/diarrhea) Past Surgical history (PSH) Appendectomy and hysterectomy. Current Medications: Atenolol (Tenormin), Atorvastatin (Lipitor), Lisinopril, Aspirin,  Metformin,   Allergies: She has reportedly multiple allergies including penicillin (PCN), Morphine, Altace (ramipril), Prevacid (lansoprazole), Norvasc (amlodipine)            4 A. Gloop Case Scenario                SCENARIO 1         5 A. Gloop Case Scenario    Scenario 1 description: Objectives: Assess competency in:  1. Comprehensive physical assessment 2. Communication 3. Critical thinking Scenario 1 Description:  A 74 year-old female with type 2 diabetes diagnosed for 5 years.  Her friend brought her to the emergency department because of drowsiness, confusion, abdominal pain, states 3 day history of nausea/vomiting, one week history of loose stools.  Nursing Report:   74 year old female treated in ED for hypoglycemia and dehydration related to low CBG (1.8 mmol), a one week history of loose stools and a 3 day history of nausea and vomiting.  She also complained of distended abdomen with crampy abdominal pain. She had no urinary complaints.   The patient has been transferred to medical unit for observation and insulin management.  Query further investigation of abdominal pain, diarrhea and nausea.  Physician to follow up.            6 A. Gloop Case Scenario    Simulation Based Learning Activity   Date Created:   Janurary 24th 2014                                          Date Revised:                     File Name:  UBC NURSING SYNTHESIS PROJECT  Authors:   Heidi Voelker, Karen Mann, Karen Hu  Institution Affiliation:   UBC School of Nursing and Vancouver Coastal Health    Subject/Topic:   Simulation Activity for New Grads or other nurses in transition    Participant Level:           Please tick the appropriate box    Beginner     Intermediate    Advanced        (Student)   (Novice RN/New graduate) Learning Domains     Critical Thinking                        Psycho-motor skills                 Communication and Attitudes  Learning Objectives/Outcomes for the simulation:  1.  Complete a comprehensive and thorough physical assessment  2.  Practice appropriate communication with patients   3.  Using history and assessment data to critically think and plan care for a patient with type 2 diabetes, HTN, and not yet diagnosed abdominal pain    Expected Activity Run Time:   15 minutes Guided Reflection/debriefing Time:  10 minutes  7 A. Gloop Case Scenario Location: TBA  Location for Reflection:  TBA    SCENARIO 1: info sheet for participant   A 74 year old female was brought into the emergency department at 0400 and was treated in the ED for hypoglycemia and dehydration related to low CBG ( 1.8 mmol). She also has not yet diagnosed abdominal pain, reported a one week history of loose stools and a 3 day history of nausea and vomitting. The patient has just been transferred to your medical unit for observation, insulin and hydration management. Physician to follow up tomorrow morning. It's 0730, you are the nurse admitting this patient to the unit. You receive the following nursing report from the Emergency Department  Vital signs stable, afebrile. Complaining of nausea/vomiting and abdominal pain since admission. Gave 50mg dimenhydrinate at 0600. Patient is a type two diabetic with a history of other diagnoses. Blood sugars stabilized. IV was inserted in the ED, running at 120cc/ hr, no issues with voiding. Can ambulate and mobilize independently with supervision.     8 Running Head: A. Gloop Case Scenario CLINICAL COURSE OF THE SIMULATED SCENARIO EVALUATION TOOL  TIME  9 A. Gloop Case Scenario  PHASE 1   Initial Assessment ? Admission to medical unit at 0730   Patient Presentation : Neuro  - alert and oriented, all normal findings  Vital Signs  - BP 138/78 - HR 90  - RR 18  - O2 Sat : 99%  - Tempt: 36.5  - CBG 8.9 mmol   Resp - breath sounds clear throughout all lung fields - equal entry bilaterally to both bases  - no adventitious sounds  - no complaints of chest pain or shortness of breathe or accessory muscle use   Cardiac  - heart rhythm regular -  S1 S2 sounds noted -  weak pedal dorasalis and posterior tibial pulses palpated with +1 edema in lower extremities - strong radial pulses, cap refills less than 3 seconds Pain  - rates 7/10 at lower abdomen  - sharp, crampy and colicky and has been on-off over the past few days  - no analgesics taken prior  - moving makes it worse, nothing seems to help  In this phase, participants should?  - collect baseline data and complete admission assessment  - complete focus assessments on GI - identify risk factors for deterioration of status   Demonstrated actions   introduces self  Safety equipment check   Assess level of consciousness   Complete full pain assessment, including use of pain scale    Performs a head to toe assessment   Vitals   takes oral temperature   palpates and auscultates pulse, noting quality of heart rate, sounds and rhythm   manually obtains BP   uses oximeter to obtain SpO2   Assess respiratory rate, depth and WOB   Records vital signs in appropriate documentation   Interprets any significant findings and trends in vitals   Checks blood sugar   Respiratory   Evaluates client?s respiration rate and WOB  Ask about coughing, sputum, SOB and chest pain   Auscultates anteriorly and posteriorly bilaterally    Documents any significant findings appropriately  15 mins 10 A. Gloop Case Scenario  Skin - warm, pink scaly skin particularly on lower extremities - normal skin turgor  - no rashes or pruritis   Mucous Membranes  - dry, chapped lips  - oral cavity dry   Gastro-Intestinal *  - abdomen is distended  - bowel sounds in all four quadrants with hyperactive bowel sounds in LUQ  - surgical scar from previous surgical incision below umbilicus  - diffuse tenderness upon palpation  - no palpatable masses  - colour of abdomen matches overall skin  - increased pain in abdomen upon palpation  - mild nausea at this time, no vomiting since admission - last BM was loose, liquid stool before admission  GU  - voiding clear, dark yellow urine 3 hours ago reported by patient  - no pain or burning sensation with voiding    Cardiac  Auscultates for heart sounds and HR, recognizes S1 and S2 sounds and checks heart rhythm  Palpates radial and pedal pulses  Recognizes edema in lower extremities   Pain  performs pain assessment using PQRST guideline  recognizes pain as nursing priority and uses data obtained to formulate nursing diagnoses and potential causes  Skin  Assesses CWMS, particularly due to dehydration diagnose   Mucous Membranes  Assesses mucous membranes particularly due to dehydration diagnose  Gastro-Intestinal  Performs GI assessment, recognizes abnormal data Assesses Hx of bowel movements, nausea and vomiting    notes distention, previous scars, auscultating first for bowel sounds, then palpating   Interprets data and further performs a focused GI assessment and formulates nursing diagnoses and potential causes   GU  Assesses voiding frequency and urine quality as per patient report   11 A. Gloop Case Scenario   OTHER  - participant has access to patient?s chart which includes:   - client history  - transfer orders  - admission history  - Medical orders  - Lab work  - Diabetic record  - MAR  - Fluid balance ( last 24hours)  - SBAR sheet   reviews medical orders and confirms they are appropriate for the client?s situation  Reviews patient Hx, lab work and assessment data, able to predict and identify potential clinical problems and risk factors for deterioration of status   using data collected, recognizes and justifies any medical orders that should be included or changed at this point in time, proceeding to call physician  Uses SBAR if necessary           12 A. Gloop Case Scenario  Debriefing/Guided Reflection Questions for This Simulation (Identify important concepts or curricular threads that are specific to your organization; use general prompts and focused questions to guide reflection and discussion) Use an organized and systematic debriefing process such as reaction, analysis, summary (see below)  Reaction Phase (beginning)  Participants are encouraged to express their initial emotional reactions to the simulation and the instructor provides information or facilitates a conversation that clarifies the facts underlying the simulation Questions are directed toward feelings, reactions, observations. ? What went on/happened? ? How did you feel about that? ? Who else had the same experience? Who reacted differently? ? Were there any surprises/puzzlements?  Analysis Phase (middle) Allows participants to make sense of simulation events, their concerns, and to move toward accomplishing simulation objectives. Questions are directed toward making sense of the experience for the individual and the group and drawing on the principles or generalizations ? How did you account for what happened? ? How might it have been different? ? What do you understand better about yourself/your group? ? What might we draw/pull from this experience? ? What did you learn/relearn? ? What does that suggest to you about [communication/conflict/etc.] in general? ? Does that remind you of anything?  What does that help explain? ? How does this relate to other experiences you?ve had?  Summary Phase (end) Signals the end and reviews salient points. Translate lessons learned from the debriefing into principles that participants can take with them to improve their practice. The debriefer may summarize important points if the participants did not cover them or may recommend reading or activities participants can pursue to improve. Questions are directed toward having participants summarize what they learned and how they will apply this learning to practice ? How could you apply/transfer that? ? Given similar circumstances, what might you do differently next time?  ? How could you make it better? ? What modifications can you make work for you in your practice? 13 A. Gloop Case Scenario             SCENARIO 214 A. Gloop Case Scenario Scenario 2 description: Objectives: Assess competency in:  1. Comprehensive physical assessment 2. Communication 3. Critical thinking 4. Clinical Decision Making  The Participant receives the following information: 4 hours later:   As you are gathering the glucometer machine to do Ms. Gloop?s CBG, you note that her call bell is activated and you respond. Ms. Gloop is vomiting over the side of her bed. Her friend is in the room holding a basin and a towel, trying to help. The friend is concerned and asking a lot of questions.  SBAR communication, anticipated interventions and clinical decision making around the care of a patient with diabetes and suspected small bowel obstruction               15 A. Gloop Case Scenario  Simulation Based Learning Activity - 2  Date Created:   Janurary 24th 2014                                          Date Revised:               Feb 2 2014  File Name:  UBC NURSING SYNTHESIS PROJECT  Authors:   Heidi Voelker, Karen Mann, Karen Hu  Institution Affiliation:   UBC School of Nursing and Vancouver Coastal Health    Subject/Topic:   Simulation Activity for New Grads or other nurses in transition    Participant Level:           Please tick the appropriate box    Beginner     Intermediate    Advanced        (Student)   (Novice RN/New graduate) Learning Domains     Critical Thinking                        Psycho-motor skills                 Communication and Attitudes  Learning Objectives/Outcomes for the simulation:  1.  Completes a focused abdominal assessment  2.  Communicates with physician using SBAR tool  3.  Demonstrates critical thinking around the care of a patient with a possible abdominal obstruction  4.  Engages in clinical decision making around care of a patient with a possible abdominal obstruction   Expected Activity Run Time:   15 minutes Guided Reflection/debriefing Time:  10 minutes  Location: TBA  Location for Reflection:  TBA   16 A. Gloop Case Scenario  SCENARIO 2 : information sheet for participant  4 hours later:  As you are gathering the glucometer machine to do Ms. Gloop?s CBG, you note that her call bell is activated and you respond. Ms. Gloop is vomiting over the side of her bed. Her friend is in the room holding a basin and a towel, trying to help. The friend is concerned and asking a lot of questions.  Vital Signs  - BP 132/82 - HR 100 - RR 20 - O2 Sat : 99%  - Tempt: 37.8  - CBG 10.6  = sliding scale                  17 A. Gloop Case Scenario  18 A. Gloop Case Scenario CLINICAL COURSE OF THE SIMULATED SCENARIO 2  In this phase, participants should?  - manage patient who is vomiting - manage friend?s concerns and questioning  - perform a focused abdominal assessment and collects data  - Communicate findings with Physician using SBAR communication tool   - Engage in critical thinking and clinical decision making regarding the care of a diabetic patient with a possible bowel obstruction and identify rationales for nursing interventions  TIME  15 min   PHASE 2   Focused GI assessment  ? Prior to lunch on medical  unit at 1130  Patient Presentation : The Patient is Vomiting:  - physically Vomiting (projectile)  - Vomit is odorless slightly yellow and mucousy   Neuro  - alert and oriented, all normal findings  Vital Signs  - BP 132/82 - HR 100 - RR 20 - O2 Sat : 99%  - Tempt: 37.8  - CBG 10.6  Gastro-Intestinal   - nausea persists  - abdomen distended - no bowel sounds upon auscultation  - surgical scar from previous surgical incision below umbilicus  - increased pain in abdomen upon palpation  - no BM since admission  - has had sips of juice and water  - Abdominal pain is 8/10 ? cramp like and colicky subsided minimally after vomiting  Demonstrated actions:   the nurse dons appropriate PPP    the nurse provides support and reassurance for patient   the nurse positions patient in appropriate position to avoid aspiration   obtains vitals    obtains CBG  Completes focused GI assessment  Gastro-Intestinal  Performs GI assessment, recognizes abnormal data Assesses Hx of bowel movements, nausea and vomiting    notes distention, previous scars, auscultating first for bowel sounds, then palpating   Interprets data and further performs a focused GI assessment and formulates nursing diagnoses and potential cause Indicates nursing interventions  19 A. Gloop Case Scenario  20 A. Gloop Case Scenario SBAR COMMUNICATION TOOL   21 A. Gloop Case Scenario  SBAR DIALOGUE SIMULATION CHECKLIST  S ?  Situation         Hi, Dr. Hakika, this is ______ and I?m calling about  Augustine Gloop, patient code status is FULL CODE,   I am calling because I am concerned about her abdominal pain and vomiting  B ? Background   Vital signs (now)  BP 132/82, HR 110, RR 21, Temp 37.2, CBG 10.5   previous vital signs : BP 140/88, HR 92, RR 18, Temp 36.4,   IV running at 120 cc/ hr on D5 ? NS with 20mEq KCL   allergic to morphine, altace, lansoprazole, amlodipine    Hx of CAD, HTN, osteoporsis, overweight   patient reports history of bowel problems ? frequent constipation and diarrhea   type 2 diabetic, abdominal pain for past 3 days with loose stools + n/v    history of appendectomy and hysterectomy   patient charts, flow sheets, MAR, nurses notes on hand and READY   A ?  Assessment  I think the problem is Ms. Gloop is experiencing a small bowel obstruction she is vomiting large amounts of fecal smelling emesis.   Abdomen is distended, was tender now is firm, and there are no bowel sounds   pain is 8/10, continuous and sharp in the LUQ of the abdomen   awaiting Abdominal 3 view x ?ray  R ? Recommendation   Can you put an order in for the patient to be NPO, and an NG insertion to suction with x-ray to verify placement   Can you also put in orders for replacement fluids and electrolytes?   Do you need any other further tests/orders right now?   Are you going to come see the patient?   What parameters do you want me to keep monitoring?   When should I call you again?   ADDITIONAL CONCERNS - reflects critical thinking and clinical decision making    What about patient?s abdominal pain of 8/10  - Recommendation  What about patient?s persistent nausea?  - Recommendation  The patient has sliding scale insulin due, and is now NPO? ? Recommendation     22 A. Gloop Case Scenario SBAR ? PHYSICIAN SIMULATION RESPONSE   PHYSICIAN ORDERS  - Change to NPO status,  insert NG tube with continuous suction at 100mm Hg - x ray to confirm NG placement  - insert foley catheter, strict monitoring of Ins and Outs  - Increase IV infusion to 150 cc / hr  + replacement fluids  - Increase Vitals to Q4H  - Repeat CBC, lytes, creatine, BUN STAT  - Change Xray order to STAT    Nurse/ simulation participant partakes in closed loop communication, repeats all orders back to physician   ADDITIONAL PHYSICIAN COMMENTS  - page me again if no symptom relief within 4 hours  - page me if temp > 38.0 Celsius  - page if WBC > 15.0  - page if SYS > 90mm Hg or drops by 30mm Hg  - page if urine output is < 100cc over the next 4 hours   - will come see patient later this evening  -            23 A. Gloop Case Scenario          AUGUSTINE GLOOP CHART        24 A. Gloop Case Scenario  25 A. Gloop Case Scenario  26 A. Gloop Case Scenario  27 A. Gloop Case Scenario  28 A. Gloop Case Scenario  29 A. Gloop Case Scenario  30 A. Gloop Case Scenario  31 A. Gloop Case Scenario 32 A. Gloop Case Scenario  MAR AND LAB VALUES  See attached documents accompanying this project                       33 A. Gloop Case Scenario  Scripts   Subjective Data specific to the Abdomen Has there been any change in appetite?  Not been able to drink/ eat adequate amounts due to persistent nausea and vomiting over the past 3 days. Other than your prescribed medications, have you taken any other drugs or medications in the past week or few days?  In the past few days I?ve taken Gravol at home to help with the nausea but it didn?t seem to relieve much of it. I?ve taken laxatives in the past when I get constipated but that?s it.   What have you eaten in the past 24hrs? Salty crackers, chicken noodle soup, bit of pasta, apple juice  Who prepares your food or buys groceries?  Herself most of the times once a week, however her friends occasionally drop off some groceries if they are visiting    Do you eat alone? Yes, I live alone and don?t go out to eat at restaurants much. Occasionally my friends and I go to the nearest coffee shop, or they drop by to have dinner with me at my apartment.  Have you gained or lost weight recently? Recently, I?ve gained some weight. I?ve been having more and more trouble mobilizing around my apartment and I?m getting tired more easily.  Do you have any difficulty swallowing?  No, not that has been noticed.  Are you allergic to any foods? Bananas and pineapples.  Are you experiencing any abdominal pain? Yes. It comes in waves.. like a pulse. It?s sharp and excruciating and gets worse when I move around. I?ve never felt this pain before.  34 A. Gloop Case Scenario How often do you have a bowel movement?  I have a bowel movement about every 2-3 days, sometimes it can be every 4 to 5 days.   Has there been a recent change in your bowel movements?   I feel as if I?ve been getting more and more constipated in the past two months. I?ve been straining at a lot more when I go to the bathroom and sometimes I get cramps. I started taking laxatives in the past few months and it has helped with my constipation a bit.    Has there been any change to the consistency of the stool? I?ve had a few instances lately with really watery stool like diarrhea. My stool has been harder to pass lately. Like I mentioned I?ve been straining more and the stool is more rigid and stiff.   Do you have a history of any problems with your gastrointestinal system? As I?ve mentioned, I?ve been experiencing constipation and diarrhea over the past few years since my surgeries. It?s not too bad but recently I find that it has worsened. I had an appendectomy 7 months ago and was hospitalized for a few days.  Do you exercise at all? If so, what do you do and for how long? I don?t exercise much? it?s sometimes hard for me to manoeuvre around the house and apartment let alone have a full workout! I get out of breath more easily now when I try to go up the stairs or walk far distances. The most exercise I do is commuting to work at the flower shop and walking back to my apartment or picking up groceries at the supermarket across the street.      Laboratory Results  Date: January 24th 2014  Time: 0630   Blood Serum Chemical  Value Reference   Indication Sodium (mmol/L) 120 135-145  L Potassium (mmol/L) 3.2 3.5-5.0  L Chloride (mmol/L) 89 98-106  L Calcium(mmol/L)    Total  2.19 2.18-2.58   Ionized 1.06 1.05-1.30   Magnesium (mmol/L) 0.80 0.75-0.95   Bicarbonate (mmol/L) 20 24-30  L Creatinine  (?mol/L)  89 50-90   Glucose (mmol/L) 2.2 3.3-5.8  L Phosphorus (mmol/L) 0.9 0.8-1.5   Blood Urea Nitrogen ( BUN) (mmol/L) 8.9 2.5-8.0  H pH 7.41 7.35-7.45   Urinalysis   Colour  Dark Yellow   pH 7.1 4.8 ? 7.5  Specific Gravity 1.037 1.010 ? 1.030 H Protein (mg/ dL)   Y - 50 <30 H Glucose  N Negative  Ketones (mg/ dL)   Y - 35 Negative  H Nitrites  N Negative  RBCs  N Negative  WBCs  N Negative   CBC     Hematocrit  (Hct)  0.53 0.37-0.46 H Hemoglobin (Hgb)  g/L  135 123-157   Red Blood Cells ( RBC) 1012/L 6.1 4.0 -5.2 H Platelet count 109/ L 200 130-400  White blood cell count ( WBC) 109/L 7.1 4-10    Band neutrophils 109/L 0.3 <0.7     Basophils  109/L 0.02 <0.10     Eosinophils 109/L 0.32 <0.45     Lymphocytes 109/L 3.0 1.5-3.4     Monocytes 109/L 0.58 0.14-0.86   Name:  Gloop, Augustine  MRN#:   94236841687 Date of Birth:  May 04 1939  Physician: Hakika, B (MD)  Be    Laboratory Results  Date: January 24th 2014  Time: 0630   Blood Serum Chemical  Value Reference   Indication Sodium (mmol/L) 120 135-145  L Potassium (mmol/L) 3.0 3.5-5.0  L Chloride (mmol/L) 100 98-106   Calcium(mmol/L)    Total  2.20 2.18-2.58   Ionized 1.00 1.05-1.30   Magnesium (mmol/L) 0.73 0.75-0.95   Bicarbonate (mmol/L) 20 24-30  L Creatinine  (?mol/L)  60 50-90   Glucose (mmol/L) 4.0 3.3-5.8   Phosphorus (mmol/L) 1.0 0.8-1.5   Blood Urea Nitrogen ( BUN) (mmol/L) 9.1 2.5-8.0  H pH 7.35 7.35-7.45      CBC     Hematocrit  (Hct)  0.50 0.37-0.46 H Hemoglobin (Hgb)  g/L  135 123-157   Red Blood Cells ( RBC) 1012/L 5.7 4.0 -5.2 H Platelet count 109/ L 210 130-400  White blood cell count ( WBC) 109/L 12.3 4-10 H   Segmented neutrophils 109/L 7.9 2-7 H   Band neutrophils 109/L 0.9 <0.7  H   Basophils  109/L 0.11 <0.10  H   Eosinophils 109/L 0.45 <0.45  H   Lymphocytes 109/L 2.0 1.5-3.4     Monocytes 109/L 1.0 0.14-0.86  H    Name:  Gloop, Augustine  MRN#:   94236841687 Date of Birth:  May 04 1939  Physician: Hakika, B (MD)                    MEDICATION ADMINISTRATION RECORD  Name:     Gloop, Augustine    MRN#:      94236841687 Date of Birth: May 04 1939  Age:      74 years old   Allergies: Penicillin, Morphine, Altace, amlodipine, lansoprazole  Physician (MD):  Hakika, B                            Orders checked by_____                                               Time________  Medication Start/Stop Date  07   08   09   10   11    12    13   14   15    16   17   18   19   20   21   22   23   24   00  01  02  03  04  05  06  Atorvastatin ( Lipitor)  20mg PO qD          0800 ASA  81mg PO qD              0800 Lisinopril 10 mg PO qD         0800 Metformin 500mg PO BID         0800                                                                1600  Insulin glargine (Lantus)  15units  qD         0800 Blood Glucose Acucheck q.d.s  a.c. (before meals)       0730            1130                             1630                            2200              MEDICATION ADMINISTRATION RECORD  Name:     Gloop, Augustine    MRN#:      94236841687 Date of Birth: May 04 1939   Age:      74 years old   Allergies: Penicillin, Morphine, Altace, amlodipine, lansoprazole   Physician (MD):  Hakika, B                            Orders checked by_____                                               Time________   Medication Start/Stop Date  07   08   09   10   11    12    13   14   15    16   17   18   19   20   21   22   23   24   00  01  02  03  04  05  06  Dimenhydrinate 50mg q3 - 6hrs PRN       Metoclopramide 10mg IV q4hrs PRN          Hydrocodone PO 2.5 -  10mg q4 -6hrs PRN      Hydrocodone IV 2.5 -  10mg q4 -6hrs PRN           Acetaminophen PO 325 -  650mg q4 - 6hrs PRN        

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