Mr. David, an 83-year-old man, is admitted to your unit after an ...

[ts19998]

Mr. David, an 83-year-old man, is admitted to your unit after an emergency cholecystectomy (gallbladder removal) under general anesthesia. It has been 12 hours since surgery, and although arousable, Mr. David is still very groggy and sedated.
 
  His family is concerned and thinks there is something wrong. As the LPN in charge, you
  a. Call the physician immediately; the family is right, he should not be groggy 12 hours after surgery
  b. Decide you will refuse to medicate him for pain if he asks because he is still heavily sedated
  c. Increase his IV rate
  d. Explain to the family that because of normal age-related changes, it takes longer for the effects of anesthesia to wear off

Question 2

Protein binding
 
  a. Refers to the time required for half the medication to be excreted or inactivated
  b. Refers to the capacity of proteins in the bloodstream to be binding sites for drugs
  c. Is how medications move into and through the body
  d. Refers to the effect of specific medications at the site of action

[GCabra]

Answer to Question 1

D
Anesthesia, a drug normally excreted by respiration, may have an increased effect on an older patient because of decreased respiratory and vital capacity. Responses A and B would be incorrect because it is normal for the patient to be groggy. The nurse should be checking vital signs to determine that there is no other problem (response C). The nurse would need a physician order to change the IV rate. Because anesthesia is excreted through respirations, it will probably not speed up the wakening process.

Answer to Question 2

B
Response A is the definition of half-life. Response C is the definition of pharmacokinetics. Response D is the definition for pharmacodynamics. Response B is correct; proteins are the binding sites for drugs. The percentage of medication that binds to a protein is inactive. Only a free drug is active to have the desired effect. Not all drugs are protein bound, but if a patient is taking two drugs that are, they are competing for the same number of sites. There is an increased percentage of free drug in the bloodstream. In this scenario, there is an increased impact on the effects and possible adverse effects of both drugs.