Okay, enough repetition and going over that.
Let' see how you're gonna do all on your own.
I want you to put all the signs and system from head to toe on Cushing's
and then on the other side, Addison's.
So make sure to pause the video and invest the time to do that now.
Let's look at an NCLEX question you've already seen.
Remember back at the beginning of this series.
So the nurse assesses a client's at-home medication compliance.
Mrs. Baird, a type 1 diabetic,
and has been prescribed albuterol, lisinopril, methylprednisone, fludrocortisone for 10 years.
Which of the following patient statements requires immediate follow-up?
Right, that last sentence is my major focus.
I'm looking for the statement that requires immediate follow-up.
That means it's something wrong or unsafe for this particular patient.
Let's go back up and find out what's particular about this patient.
So I'm looking at their at-home medication compliance.
I know the patient, Mr. Baird, is a type 1 diabetic.
He's been prescribed albuterol, lisinopril, methylprednisone, and fludrocortisone for 10 years.
Okay, that matters. That's a pretty long length of time.
And I know they're diabetic and they've got albuterol
which is a bronchodilator, lisinopril which is an ACE inhibitor for blood pressure,
methylprednisone and fludrocortisone, those are corticosteroids.
So I'm looking for something. I don't know yet which one we're talking about.
If it's the diabetes, if it's any one of those medications,
but I know the topic of the question is looking at medication compliance
and what requires immediate follow-up.
Well, when you look at all 4 of these statements,
I know you read them before the last time you saw this question.
I've noticed that my face looks a lot fuller since taking my medications.
Well, we know that's due to corticosteroids.
My heartbeat is faster and I feel shaky when I stand up.
That could be a sign of low volume. That's also corticosteroids.
I use my inhaler when I feel short of breath after walking.
Does that require immediate follow-up? No. No, that's fine.
What about my blood sugars are difficult to control and my doctor has been --
has ordered sliding-scale insulin coverage. Does that require immediate follow-up?
Well, hopefully even though we gave you 60 seconds
and I know that seem probably short for a lot of you.
I hope you use this process of eliminating answer choices.
Now, which one do I feel most comfortable getting rid off? I'm gonna get rid of A.
Yes, that is a known side effect of the medication. It doesn't put the patient at risk.
Now, what am I gonna get rid of next? Right, I'm gonna get C.
We already said that one is fine. It doesn't require immediate follow-up or any follow-up.
That should be okay. But I'm left between B and D.
Now, I know that both of these have a connection to corticosteroids
but where's an actual problem and where's a potential problem?
In D, my blood sugars are difficult to control and my doctor's ordered sliding-scale insulin coverage.
Oh, that gives a patient options.
They can cover it so that doesn't require immediate follow-up that's why the correct answer is B.
Of these 4 statements, and remember, that's how you play the game.
It's like we're playing cards and I dealt you 4 cards.
You can't say oh, I wish I had another answer. I wish I had another card.
No, they're testing of the 4 options that you're presented with, which one is the most correct?
So requiring immediate follow-up is B because we're looking at we know heartbeat is faster,
I feel shaky when I stand up.
We wanna make sure the patient understands why they feel that,
what they're experiencing, and assess them for dehydration.