Barruch’s complaining of dry cough since he started taking lisinopril (Zentril) 1 month ago. As a nurse, we may suspect that his cough was an adverse effect from the drug, but this will be reversible with discontinuation of taking Zentril (Lilley, Harrington & Snyder, 2011). According to Drugs.com 2019, ACE inhibitors are similar to kininase, an enzyme that degrades bradykinin, though it will increase the levels of bradykinin and may affect the vasodepressor peptide, the therapeutic effect will stay the same. Colds that Barruch’s usually catch could be a nonallergic rhinitis.
According to WebMd 2019, nonallergic rhinitis is unknown, this condition was confirmed only after other conditions such as allergic rhinitis or infection was ruled out and some medication can trigger this includes blood pressure medication like ACE inhibitors. Also, neutropenia is one of the adverse effects that the patient may experience. A low level of neutrophils in the body may result in a weak immune system to fight the bacteria and other organisms that will invade the body. That’s why it is important also to check a complete blood count before and during the therapy, as ordered (Lilley et al., 2011).
According to Lilley et al. 2011, sodium nitroprusside is a potent vasodilator that needs to be diluted properly all the time. There will be the farthest decrease to the patient’s blood pressure that’s why it is necessary to closely monitor the patient to prevent further complication. It can lead to irreversible ischemic injuries or even death. It should only be infused using a volumetric infusion pump with continuous monitoring of blood pressure. If blood pressure was not controlled after the maximum dose rate of 10 minutes the order should be discontinued.
Properly use of the medication will also prevent the complication of cyanide and thiocyanate toxicity. It is very important to carefully watch the patient during the infusion of sodium nitroprusside. As a nurse, we should know that sodium nitroprusside is very sensitive to lights, heat, and moisture. The solution will deteriorate roughly to 20% if exposed to lights, even faster in a plastic container. It is very important that we wrap the bottle with aluminum foil to protect from any factors that may affect the concentration of the solution. By doing this, the drug will be stable for 24 hours once open. It is important to remember also that any changing color noticed to the solution must be discarded right away and properly (Toyofuku, M. & Yoon, S. 2018). Using the formula of (36.5C x 9/5) + 32 it will be converted to 97.7⁰F.
Next is 6 foot and 1 inch, 1 foot is equal to 12 inches. So, 6 feet multiplied by 12 is equal to 72 inches + 1 inch will equal to 73 inches high. In converting pounds to kilograms, we will just divide them. 1 kilogram is equal to 2.205 pounds, dividing it to with 189 pounds, will get 83.9 kilograms, if round it off it will be 84 kilograms. As prescribed, 500mg of IV clarithromycin to be given in 250ml bag of NS over an hour with 10gtts/ml. Using the IV formula, (TI)/(TT) X hourly rate. (250ml)/(60mins) x 10gtts/ml will be equal to 42gtts/min consume it for 1 hour.