Describe opioid receptors – classification, mechanism of action, synaptic location, synaptic effects. (4pts)

What type of monitoring will this patient need and when will we get level(s)? (If the first dose is due today at 1800, give an exact time and date) . *Patient already received a loading dose, 1st maintenance dose is due tonight at 1800.  

Patient #1   Charlie Fox is a 25-year-old male admitted to Parks Hall Hospital for a craniotomy and developed a post-op craniotomy infection (cerebrospinal fluid (CSF) shunt infection) positive for MRSA. Patient is having shunt drainage but is otherwise doing well and in no distress. The prescriber has ordered vancomycin to treat his infection and has consulted pharmacy for dosing and monitoring per hospital policy. Using the patient’s profile answer the following questions.      Patient information:   Weight – 113 kg  Height – 6’  Allergies – NKDA   Problem list   TBI/SAH/SDH s/p decompressive craniotomy   Respiratory failure s/p trach Skull Fractures   Current Labs   BUN – 8mg/dL CO2 – 26 mmol/L SCr – 0.53 mg/dL Glucose 112 mg/dL  Cl – 99 mmol/L K – 3.9 mEq/L Na – 138 mEq/L    *Patient already received a loading dose, 1st maintenance dose is due tonight at 1800.  

This patient needs conventional dosing due to her age. Using the initial dosing table in your protocol what is a starting dose/frequency for this patient and explain your reasoning?  Include loading dose, if needed and maintenance dose.  

What is this patient’s creatinine clearance? (Using the Cockcroft-Gault equation, round to the nearest hundredth, except no trailing zeros)   [crcl] mL/min 

What is this patient’s creatinine clearance? (Using the Cockcroft-Gault equation, round to the nearest hundredth, except no trailing zeros)    [crcl] mL/min

The nurse calls you to a patient room who is using Vapotherm and states the patient went to the restroom and the unit was put in standby, when the patient returned the device was started and water began flowing out of the nasal cannula, You explained this happened because 

The physician calls you to set up Vapotherm HFNC on an adult patient.  Upon entering the patients room you notice the patient is using accessory muscles, RR 28, HR 110, SpO2 91%. Which of the following setting would be appropriate

Which condition may result from excessive PEEP like affects in the lungs when using Vapotherm (HFNC)

A 60 year old 90kg (198 lb.) man is admitted to the ICU following smoke inhalation.  The RR is 28/min and the patient is on a NRM.   ABG’s are as follows:   pH 7.58, paC02 22torr, pa02 90 torr, HC03 22 meq/L, Base Excess -2.  What is your recommendation?