Pharmacology and the Nursing Process, 8e
Pharmacology and the Nursing Process, 8e
8th Edition
ISBN: 9780323358286
Author: Linda Lane Lilley PhD RN, Shelly Rainforth Collins PharmD, Julie S. Snyder MSN RN-BC
Publisher: Elsevier Science
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Chapter 50, Problem 7NERQ
Summary Introduction

To define:

Administration of cimetidine is 300 mg in 100 mL normal saline IVPB tid. The infusion should be completed over 30 minutes. If the infusion pump is programmed to deliver to the drug over 30 minutes, find the amount of mL/hour of cimetidine for each IVPB dose that is programmed by the nurse.

Concept introduction:

H2 receptor antagonists such as cimetidine, famotidine, ranitidine, and nizatidine are used to treat gastroesophageal reflux disease (GERO), peptic ulcer, and erosive esophagitis. Also, they are used as adjunct therapy for gastrointestinal tract bleeding. Cimetidine is the first prototypical H2 receptor antagonist released on the market. Cimetidine or other H2 receptor antagonists block the effect of histamine receptors, which are found in the parietal cells. These cells secrete hydrochloric acid (HCl) in the stomach. However, oversecretion of HCl may cause various gastrointestinal problems. The inhibition of histamine receptors by H2 receptor antagonists results in a reduced response of parietal cells to stimuli. This, in turn, leads to a decreased acid secretion. About 90% of acid secretion can be suppressed by H2 receptor antagonists.

Cimetidine has more risk in the case of drug interactions than other H2 receptor antagonists. Cimetidine can bind to enzymes of the liver cytochrome P-450, which is mainly involved in the metabolisms of several drugs (for example, phenytoin).

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Considering the kcals the patient is receiving from propofol and D51⁄2NS, what should be the rate (ml/hr) of the tube feeding you selected? 30 ml/hr 45 ml/hr 55 ml/hr 65 ml/hr
You are seeing a 68 year-old male patient admitted to the ICU. He is sedated on the ventilator with propofol at 20ml/hr, D51⁄2NS running at 75ml/hr. and a past medical history of DM2, obesity, CAD, HTN, and Pneumonia. Ht 172cm, Wt 72kg, Alb 2.3, VE=7.9 L/min, Tmax =38.4 C 4.1 What is the total kcal this patient is receiving before the initiation of TF (Hint: include propofol and D51⁄2 NS in calculation)? 306 kcal 528 kcal 678 kcal 834 kcal   What is the estimated kcal goal for this patient? 1787 kcal 1847 kcal 1927 kcal 2317 kcal What is the estimated protein need for this patient? 45 – 50 g/day 86 – 108g/day 108 – 180g/day 144 – 188 g/day What type of tube feeding formula would you recommend for this patient? Standard 1.5 kcal/ml formula Glycemic control product, 1.0 kcal/ml Low residue, high protein, nutritionally balanced,1.2 kcal/ml High protein, calorie control product, 2.0 kcal/ml
You are seeing a 68 year-old male patient admitted to the ICU. He is sedated on the ventilator with propofol at 20ml/hr, D51⁄2NS running at 75ml/hr. and a past medical history of DM2, obesity, CAD, HTN, and Pneumonia. Ht 172cm, Wt 72kg, Alb 2.3, VE=7.9 L/min, Tmax =38.4 C 4.1 What is the total kcal this patient is receiving before the initiation of TF (Hint: include propofol and D51⁄2 NS in calculation)? 306 kcal 528 kcal 678 kcal 834 kcal Which estimated prediction equation will you recommend to calculate the kcal need for this patient? Penn State Equation (2003b): Mifflin(0.96)+ VE (31) + Tmax (167)-6212 MifflinStJeor =(10xW)+(6.25xHt)–(5xAge)+5 Harris-Benedict equation: kcal/day (male) = 66 +13.8 (W) + 5.0(H) – (6.8 x A) Ireton-Jones equations (1992)(ventilator-dependent): 1925 – 10 (A) + 5 (W) + 281 (S) + 292 (T) + 851 (B) What is the estimated kcal goal for this patient? 1787 kcal 1847 kcal 1927 kcal 2317 kcal What is the…
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