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Name:Bukola Simeon Assignment: Case study School Name: Capscare Academy For Healthcare Case Study, Chapter 1, Health Care Delivery and Evidence-Based Nursing Practice Suzanne Jones, 76-year-old patient with COPD is admitted to the ICU. Mrs. Jones is placed on mechanical ventilation to assist with her breathing. After 2 days on the ventilator, Mrs. Jones is extubated and then transferred to a medical-surgical unit. The medication regimen is adjusted during the hospitalization. Mrs. Jones is discharged home after 6 days. She and her family are pleased with the care she receive in the hospital. (Learning Objectives 3 and 6) Describe the quality performance tools that may be used to demonstrate that the care and treatment rendered are both cost-efficient and of high quality. Limited stay in the healthcare facility which lower the cost or expense tag during your stay. Limited stay on the ventilator and the transfer to the intensive medical department- the ventilator cost are much more compared to the cost place in the medical surgical unit. Describe the quality performance tools that may be used to demonstrate that the nursing care utilized is evidence-based care and high quality, resulting in patient satisfaction and good patient outcomes. Client are put on medical ventilator to assist clients breathing with plenty oxygen. Remove the tube from a hollow organ or passageway of the client before transfering to the medical surgical unit. Refixed the medication during the period of the client stay in the facility.
- The registered nurse working in the cardiac care clinic is tasked with implementing quality improvement measures. To educate the clinic staff, the nurse plans an in-service program to introduce concepts of quality improvement and evidence-based practice. Additionally, the role of the case manager will be included in the presentation. The nurse plans on using care of the patient with Congestive Heart Failure as a template, and prepares sample clinical pathways, care maps, and multidisciplinary action plans. (Learning Objective 3) a. Describe how clinical pathways are used to coordinate care of caseloads of patients. The clinical lane are numerous disciplinary ideas of the most excellent clinical practice for a particular group of client having a specific diagnosis that will assist in accommodating a well organized quality care. The clinical lane are organized in a way that will assist in proper fulfilment of the clinical instruction and protocols. However, to attained success in the making of clinical lane, elderly management committee and a vivid medical and nursing advance are important. The adoption of clinical lane not only elevate numerous disciplinary correspondence but it include the communication of the client and clinicians. This advance to consistent use of
resource that crossed out the duration of the stay. It also minimise the errors and copy of the deed. It assist to know the identity of the issue from onset and rectify it appropriately. As clinical leads to achieve at developing the distinct of care through a numerous disciplinary approach, this equalized the care render to different client base on their diagnosis or caseload. What is the role of the case manager in evaluating a patient’s progress? A case manager is an individual who assist the clients or people who are in hard situation, the case manager assist with advise, assist to source the best service, modify plan of care for treatment and recovery, correlate with other healthcare provider to monitor client progress during the care and the treatment plans. A case manager play an important role to make sure client is render with the most high level of care they deserve. The case manager make sure client is given the quality of care they deserve in a timely manner, a good services from healthcare staff during their stay and making sure the client is improving on the diagnosis that brought them to the facility, by making sure the service is render timely, adequately and meet up with the minimum standard that will progress positively. The case manager evaluate the client progress to know if the expected outcome of the care was rendered adequately according to the expectation to provide cure to patient diagnosis during their stay. To ensure all the treatment was completed and safe for the client the case manage will kept on monitoring the progress to see if there is any additional treatment that need to be added, adjust or implement during the client stay and this can be communicate to the healthcare provider. What are examples of evidence-based practice tools used for planning patient care? Infection Control : This is one of the evidence based practice and the nurses play an important role in this aspect. This curve the risk of infection in between the client and the healthcare providers. Adequate utilization of hand hygiene, PPE, barriers precautions and making sure the environments are clean are one of the authentic ways of controlling infection according to evidence based. Use of Oxygen for Congestive Heart failure Client : This evidence based practice curve the hypoxia and continuous organ failure. Supplying oxygen to a congestive heart failure client is a right treatment based on evidence when boost the attributes of life in between them. Monitoring Intake and Output : Intake and output over seeing is very crucial in evidence based practice due to these client with congestive cardiac failure will assist to curve fluid overload and therefore lower the workload on heart. Case Study, Chapter 2, Community-Based Nursing Practice
- Mr. Jones, who is 74 years of age, is being discharged home after having a right knee replacement. The discharge orders from the orthopedic surgeon include: continuous passive motion (CPM) at the current setting of 0-degrees extension worn when walking with crutches (non-weight-bearing post-discharge day 1, and may begin weight-bearing postdischarge day 2); and home nurse visits, as needed. Physical therapy should begin the day after discharge at an orthopedic center. The orders will be faxed to the center. The following medications with prescriptions attached include: Lovenox (enoxaparin) 70 mg subcutaneously once daily for 7
Check for oxygen saturation Check activities for daily living Check the dressing site for infection Perform dressing using aseptic precaution Provide chest Physiotheraphy Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing Process Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort. (Learning Objective 4) a. What ethical dilemma exists? The ethical dilemma exits are Beneficence and Non-Maleficence Beneficence is said to be moral obligation to consistently make actions that favor the clients. In this case study the transfusion that will be administer to the client will extend the life of the client and the clients request Non Maleficence: by abstaining all the practical and actions that leads to hurt or harm. b. Who are the stakeholders and what gains or losses do each have? The stakeholder in this case study are the nurses, the clients, and the antoney of the client The expected outcome of the case is design to make the client benefit from all the actions and decision made. c.What strategies should the hospice nurse take to resolve the ethical dilemma? The hospice nurse will resolve the ethical dilemma by evaluating the clients request relating to clients directive. Every clients orders should be offer a first priority in the decision making action. Every actions should be render to favor the client
- The nurse receives a 12-year-old girl from the operating room after an emergent appendectomy due to ruptured appendix. Upon arrival to the postanesthesia care unit, the patient
is drowsy, but arousable to voice; she was extubated in the operating room and is receiving oxygen by facemask at 40%. She has two peripheral IVs in her left arm that are infusing Lactated Ringers solution at 100 mL/hr. A nasogastric tube is attached to low constant suction, and a small amount of aspirate is noted. She has a urinary catheter that is draining clear, yellow urine. Her abdominal dressing is dry and intact. Upon arousal, she complains of abdominal pain. (Learning Objective 5) a. What NANDA-approved nursing diagnoses may be relevant to this patient? Nursing Diagnosis Acute pain related to the presence of surgical incision as evidenced by reports of pain and facial grimacing The risk for Deficient Fluid Volume similar to insufficient to primary defence like rapture of the appendix, surgical incision, and invasive procedures. Deficiencies Knowledge similar to lack of exposure or information misinterpretation evidenced by questions and voicing their issues/ matters. B. Once the nursing diagnoses are determined, what steps does the nurse take to complete the Planning Phase of the Nursing Process? Steps the nurse take to complete the planning phase of the Nursing process are: Data Validation and interpretation Prioritized the nursing diagnosis Determine the Outcome criteria Problem Oriented assessment C. What is the difference between nursing diagnoses and collaborative problems? The difference between nursing diagnosis and collaborative problems are as follows: Nursing Diagnoses
- nursing prescribes the definitive treatments
- assessment involves data collection to identify actual or risk nursing problems
- client outcomes or goals are used While collaborative Problems are: treatments are both nurse prescribed and provider prescribed
- assessment focuses on determining physiologic stability or risk for instability, "potential complications" (PC)
- client outcomes or goals are not used
- the focus of the outcome or goal is nurse oriented Case Study, Chapter 4, Health Education and Health Promotion
Perceived barrier Perceived susceptibility Perceived Benefit Perceived Severity a. Describe four components of health promotion. The people’s perception of susceptibility of a disease. Example: client should have the knowledge related and know the risk of heart disease The individual belief to an illness. This is attracted by demographic variables,sociopsychological variables, feels the threats of the disease. Example client may not feels the effect of the illness and seek for enlightenment from the relatives and friends. Accommodating the preventing process to in order to cob the illness from occuring. Example: changes in lifestyle and elevating physical activity. Barriers that prevent action that needs to be taken. Example individual lack of participating in the healthy behavior activities due to one thing or the other. Case Study, Chapter 5, Adult Health and Nutritional Assessment
- Mrs. Jones, a 40-year-old female patient, is presenting for a history and physical. The nurse gathers a family history from the patient. She shares that her mother died at 70 years of age of colon cancer and had adult onset diabetes controlled with oral agents, hypercholesterolemia, and hypertension. She had a stroke before passing away. Her father died at 67 years of age from a stroke. He had a long history of alcoholism and smoked two packs per day of cigarettes for 50 years. He had hypertension, hypercholesterolemia, and two heart attacks; the first heart attack was at 30 years of age and the second at 52 years of age. He had adult onset diabetes controlled with oral agents since 50 years of age. He had renal stenosis that was unsuccessfully treated with a renal angioplasty and he developed end-stage renal failure requiring hemodialysis. Mrs. Jones has two brothers. One brother developed hypertension, hypercholesterolemia, and adult onset diabetes controlled with oral agents at 50 years of age. The second brother has no health problems. The maternal grandmother died at 88 years of age of a stroke and had hypertension. The maternal grandfather died at 70 years of age of a massive heart attack and had a history of hypertension. The paternal grandmother died at 80 years of age of a heart attack. The paternal grandfather died at 50 years of age from bleeding esophageal varices related to long-standing alcoholism. The patient shares that her mother’s first cousin, George, died at 52 years of age of Hodgkin lymphoma. She has another first cousin Mabel, 72 years of age, who is alive but has had cancer of the colon and had a recent stroke, and has a history of hypertension, hypercholesterolemia, and adult onset diabetes controlled with diet. Her mother’s sister, who is 68 years of age, is alive and has a history of hypertension and hypercholesterolemia. Her mother’s brother died at 68 years of age of renal cancer and had a history of hypertension, hypercholesterolemia, and adult onset diabetes controlled with oral agents. He also had a heart attack at 45 years of age and a coronary artery bypass graft operation of three vessels at 55 years of age. He smoked cigarettes for 50 years. The patient’s father was an only child and her father’s family all lived to be over 80 years of age. (Learning Objective 5)
a. What genetic-related diseases do the patient’s first-order relatives have? The genetic-related diseases do the patient’s first-order relatives have are: Patient first-order relatives:Offspring, parents, or siblings Mrs Jones:- Parents Mother:- Colon cancer, hypertension, stroke, diabetes and hypercholesterolemia Father:- stroke, smoker, hypertension, hypercholesterolemia,alcoholism, heart attack, adult onset diabetes and renal stenosis Brother 1: Hypertension, hypercholesterolemia, adult onset diabetes Brother 2: Healthy Genetic related diseases among first degree relatives are: Hypercholesterolemia, hypertension, stroke, heart attacks and adult onset diabetes etc... B. What genetic-related diseases do the patient’s second-order relatives have? Second-degree related: grandparents and cousins Maternal grandmother:-stroke and hypertension Maternal grandfather:- Heart attacks and hypertension Paternal grandmother: Heart attacks Paternal Grandfather:- Alcoholism First cousin (George):Hodgkin lymphoma First cousin (Mabel): colon cancer, stroke, hypertension, hypercholesterolemia, and, adult onset diabetes Patient’s mother sister: Hypertension and hypercholesterolemia Patient’s mother sister:- Renal cancer, hypertension, hypercholesterolemia, smoker, heart attack, adult onset diabetes. Genetic related disease among second degree relatives are:-Hypercholesterolemia, hypertension, stroke, heart attack.
- The registered nurse prepares to conduct a nutritional assessment on Mrs. Varner, a 52-year- old Caucasian female who describes herself as “overweight most of my adult life.” The client states that her health is good. She works part time as a receptionist and volunteers about 10 hours per week in her church. The nurse obtains Mrs. Varner’s height as 64 inches and her weight as 165 pounds. (Learning Objective 8) a. What is the rationale for computing body mass index? What is Mrs. Varner’s BMI? The body mass index is mostly utilized by health workers to calculate the client’s height and
nurses settle Mr. Smith into his room. The youngest son, 13 years of age, is at a friend’s house. The teenage daughter is staying at the bedside of the critically ill eldest son. The wife blames her eldest son for her husband’s heart attack and told the emergency department nurse that she does not care to see her son at all. (Learning Objectives 6, 10, and 11) a. What maladaptive responses to stress may have contributed to Mr. Smith’s development of an illness? Risk of complications from the surgery Ambulation Psychologic disturbance b.Based on the case study, what family assessment data may be used to determine coping strategies being currently used by the family in crisis? Give anticoagulation to fight thrombotic events Consistent cardiac monitoring to fight acute decompensation Call the attention of the psychologic counselor for him and the family Consult the relevant specialty, the cardiology team before transfer Educate client on relevant cardiac diet c. What nursing interventions should be used to promote effective coping for the patient and his family? Make available related client teaching concerning his new condition Making sure client is transferred to a room where he can be monitored continuously for a limited time Make an arrangement for follow up later for the client.
- Mary Turner stepped on a nail 5 days ago and sustained a puncture about 1 inch deep. She immediately cleaned the area with soap and water and hydrogen peroxide, and applied triple antibiotic ointment to the site. Today she comes to the clinic with complaints of increased pain and swelling in her foot. On assessment, the nurse notes that the puncture site is red and edematous, and has a moderate amount of yellowish drainage. (Learning Objective 9) a. Describe the sequence of events that caused the local inflammation seen in Mary’s foot. The sequence of events that caused the local inflammation seen in Mary’s foot is due to the body generally produced leukocyte cells at the site of the wound to prevent infection. The cause are redness, swelling and inflammation. a. What is the role of histamine and kinins in the inflammatory process? The role of histamine and kinins in the inflammatory process are very crucial because when there is injury or wound the mast cells produce proinflammatory mediator
histamine versus vasoactive and kinins is bioactive peptides and this action can leads to vasodillator, smooth muscle contraction-leaky, capillary-edema, swelling-pain,hyperalgia and inflammation b. Which of the five cardinal signs of inflammation does Mary exhibit? Swelling Discharge from the wound Redness Pain Edema c. Because Mary’s injury occurred 5 days ago, the nurse should assess for what systemic effects? The nurse needs to assess for fever as the system effect to prevent infection. Case Study, Chapter 7, Overview of Transcultural Nursing
- Mrs. Perez, 32 years of age, is a Hispanic patient who is admitted for early stage cancer of the uterus. The surgeon stated that in order to treat Mrs. Perez’s cancer successfully, the uterus will need to be removed surgically through a procedure called a simple hysterectomy leaving the ovaries, fallopian tubes, and vagina. The surgeon requests that the nurse make arrangements for an interpreter, so they can both use the interpreter’s services. The patient only speaks Spanish, but her mother and one of the patient’s sisters are bilingual. They are currently visiting the patient. Her husband is also visiting and he only speaks Spanish. The patient’s two children are with her sister Maria. The family stated they are devout Catholics and request to see a priest while in the hospital. Today is Ash Wednesday. (Learning Objective 4) a. Which interpreter is the most appropriate choice to communicate with Mrs. Perez and why? The interpreter that is most appropriate choice to communicate with Mrs. Perez is the client’s mother who is bilingual. Mrs. Perez will have trust in her mother and she will believe everything her mother will communicate to her. Inclusively the families of Mrs perez are devoted Catholics. b. After critically analyzing the cultural influences, what nursing actions are appropriate for the patient? The nursing actions that are appropriate for the client is closely to Hispanic. The healthcare worker should locate an interpreter that can communicate to the client with in spanish and this said interpreter have to be a female hispanic who can communicate the treatment plans and regimen. The crucial aspect here is that it is ASH Wednesday which is an important day for christian due to our religion belief. However, the healthcare provider have to conduct a settlement on how the priest can come in to visit the client and this will assist the client both
culture to work with the clients. Case Study, Chapter 8, Overview of Genetics and Genomics in Nursing
- A patient who is 38 years of age is diagnosed with autosomal dominant polycystic kidney disease, a hereditary disease that results in fluid-filled cysts occupying space in the kidneys. The cysts can interfere with the function of the kidney and may burst and cause bleeding inside the kidney. The patient with polycystic kidney disease may or may not have a berry aneurysm of a blood vessel in the brain that could lead to bleeding and death, cysts on the ovaries, and a mitral valve prolapse (in females) that can lead to dysrhythmias (irregular heart rhythms), or diverticula (outpouching of the bowel) that are susceptible to infection and inflammation and may lead to gastrointestinal bleeding. The patient is susceptible to retaining fluid in the abdomen so the abdomen is large to constipation, and to hypertension. There is no cure for the disease. The patient receives supportive care for the various symptoms or complications the patient may have. (Learning Objectives 1 to 3) a. When explaining to the patient and family about polycystic kidney disease, the nurse should explain what characteristics about an autosomal dominant genetic disease? PKD is an hereditary illness of renal cyst formation causing continuous enlargement of both kidney and other organs. Blockage of fluid-filled sacs called cysts, develop in the kidneys and affect with their ability to filter waste product from the blood. The development of cyst can make the kidney to started enlarging and can result to kidney failure. Cysts can also be form in other organs, especially the liver. Consistent disorder PKD can lead to dangerous elevate blood pressure, discomfort at the side or back, hematuria, recurrent urinary tract infections, kidney stones and heart valves abnormality. Inclusively, individuals with PKD illness have an eleveate risk of an abnormal bulging in large blood vessel named aorta or in blood vessels at the base of the brain. This can be life threatening if they rupture or tear. b. How does variable expression of genetic characteristics play a role in the course of polycystic kidney disease and how can the nurse further predict the level of the disease? Individuals with such disease are born with one muted copy of the PKD1 or PKD2 gene in each cell. 90% of the individual that has this related case are affect through inheritance from one of their parent while the remaining 10% were affected through new mutation in one of the genes and it show up in individuals with no history of this illness in their family. PKD can be inherited in an autosomal recessive form. Individuals with these form of illness have dual altered duplicate of the PKD1 gene in each cell. The wellspring of a child who has an autosomal recessive disorder are not affected but have the symptoms of a duplicate of the altered gene. The healthcare professional predict the level of the illness taking note of the reduction in the serum creatinine and if the BUN is raised linearly.
C. Identify the roles of the nurse in integrating genetics in the nursing care provided for the patient. Advocate for patient families Provide accurate information Access coping skill Maintain confidentiality Provide support for them and families Understand ethical concern and genetics
- Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition. (Learning Objective 2) a. Describe the pattern of autosomal dominant inheritance. The pattern of autosomal dominant inheritance is said to be seen in every child-bearing and there is 50% of opportunity for the baby to develop the illness. The autosomal dominant inheritance can also be termed as vertical inheritance due to the transmission from the parent to the baby. Inadition a single mutated gene is said to be present in autosomal dominant inheritance. b. Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond? The nurse will state to Mr. Wayne that he is at risk for developing hypercholesterolemia due to autosomal dominant inherited condition that the outcome is vertical transmission illness. This illness has not yet been found in Mr. Wayne so the chance that the children will develop this illness is not certain. But if Mr. Wayne act as a carrier with single mutated gene noted the the children will have 50% chances of developing or not developing the illness. c. Explain the phenomenon of penetrance observed in autosomal dominant inheritance. The phenomenon of penetrance observed in autosomal dominant
adherence to a medication regimen. The disease also affects ADLs for the patient and her family. Additionally, because myasthenia gravis is characterized by exacerbations that may require hospitalizations, Ms. Fulton has had to resign from her position as president of a marketing firm. She has remained as an employee of the same company, but now serves as a consultant with more flexible work hours. (Learning Objective 3) a. In discussing management of her chronic disease, the nurse focuses on what types of strategies? The healthcare professional pay attention on his/her strategies in terms of controlling of this severe illness on this factors, consistent assessment of muscular strength, that after strict care plan, drugs management, education strategy, stress management, signs and symptom management of other alternatives. Researcher Johns Hopkins medical health library stated that myasthenia gravis is a serious autoimmune confusion in which antibodies destroy the connection between nerves and muscles outcome in weakness of the skeleton muscles” these illness can destroy both male and female of any age. b. Describe supportive nursing care that may be helpful to Ms. Fulton. The highly crucial supporting nursing care that may be of assistant to Ms. Fulton begins with consistent assessment of muscular strength followed with thorough care plan, second crucial factor is for the healthcare professional to mindful of accommodating the five rights, which are, the right dose, time to avoid exacerbations, and to stabilized muscle strength, utilized stress minimization strategy by adequate period of activities and that of rest period, try to enlightened both Ms. Fulton and her family the wants of utilizing offer adaptive device when ambulating in other to curve injury from falls, in addition the client needs to be enlightened about how crucial it is to be compliance to treatments, and for the client to adopt a good nutrition to assist to maintain good weight, and the client will be refer to physical therapist for necessary activities program. Case Study, Chapter 10, Principles and Practices of Rehabilitation
- Mrs. Adams, 72 years of age, is admitted to the rehab unit with the diagnosis of stroke. The stroke affected the limbic area in the brain, which has caused the patient to have emotional liability (her mood changes rapidly because she misinterprets situations). As a result of the emotional liability, she sometimes refuses to be repositioned or to participate in physical or occupational therapy. She sometimes also refuses to eat and drink. The patient’s right side is paralyzed and flaccid. She has no feeling on her right side. She has reddened areas on her coccyx and both heels at least 1 cm in diameter that do not go away with repositioning. She is incontinent of urine and stool. She has problems with communication called global aphasia (difficulties understanding speech and the written word and difficulties with speaking and writing). She is 5 feet tall and weighs 178 pounds. She has a tendency to develop skin tears because her skin is thin, and she has several bandages on her arms. The family states they are concerned because the staff on the previous medical-surgical unit would drag their mother up in bed when she slid down. The staff would chart when their mother refused to be repositioned and then would not reposition her for hours. (Learning Objectives 2 and 4)
a. Explain the pathophysiology of the risk factors that predispose Mrs. Adams to developing pressure ulcers? The pathophysiology risk factors that predispose Mrs. Adams to developing pressure ulcers are lack of nutrition, alterted skin moisture, compromised immobility, immobility,prolong pressure on tissue, deseared tissue perfusion, friction and shear forces b. What nursing measures need to be instituted for Mrs. Adams based on the information presented in the case study? Keeping skin clean and dry Using pillow for adequate cushioning Friction and shear to the skin to be reduce and moisture to the skin avoided Client inability to communicate need to to monitor Encourage exercise Fluid and Electrolyte balance needs to be encourage
- You are assigned to care for David Ramsey, a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord, but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility.(Learning Objective 4) a. What assessments are indicated based on this nursing diagnosis? This are divided into 4 categories Stage 1: walk, general pace, on level uncertainly Stage 2:Climb one flight one after the other without halting Stage 3:unable to climb one trip of stairs without stopping Stage 4:short of breath and weakness very still b. List other major nursing diagnoses based on David’s clinical presentation. List for trauma:Fall Deficient Knowledge related to treatment Risk for infection related to prolonged hospital stay
Oxycodone pain relieved drug is utilized to suppress moderate to severe pain which entails both narcotic discomfort and discomfort relieve which is oxycodone. It works in the brain to turn how body adapt and accommodate to discomfort. The nurse should look out for the level of pain the client have at the moment such as the intensity, location and grade of pain utilizing the scale of 0-10, then offer the pain drugs and reassess the client to check for the medication effectiveness of after 30 minutes and do some observation to check for the adverse effect for and if there is any complication that may occur. This drugs may cause withdrawal reactions if taken for long time or high doses. B. What measures should the nurse provide the patient to prevent adverse effects of analgesic agents from occurring? The nurse should teach the client the side effect of this drugs which entails restlessness, respiratory depression, watering eyes, nausea and vomiting, sweating, constipation needs close attention, report any withdrawal reactions or side effect immediately. The healthcare professional need to teach the client to slowly turn when repositioning in other to guide against nausea and vomiting, offer the client to eat high fiber diet, laxative and fluid all this will assist to lower constipation. C. What nonpharmacologic pain management methods should the nurse teach to Mr. Will to assist with pain management? The non-pharmacological pain relieved methods the healthcare professional need to educate Mr. Will for are pain drugs that entails, heat and cold pack, relaxation techniques, physical therapy, and light activities as prescribed.
- Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). As the nurse assumes care of Mr. Rogers, he is alert and fully oriented, and states that his current pain is 2 on a 1-to-10 scale. His vital signs are 37.8 – 92 – 12, 138/82. (Learning Objective 6) a. What are benefits of epidural versus systemic administration of opioids? Pain relief Epidural can be given for form of surgery and effectively relieves pain even for postoperatively due to the analgesic is gently been released into central nervous system maintain client discomfort. While systemic analgesic administration can not manage pain strongly most especially the post-operative pain because the analgesic is not gently disburse from its source but it is constantly diffused and it pain management relieved constantly fade off. B. The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments? The nurse monitor client vital signs every 2 hours to check the temperature for fever and
assess for pain, check the blood pressure to determine deviations from regular aspect such as chronic positional head pounding and anuria which is one of the side effect of epidural analgesic which may cause a change in blood pressure. The client may have fever due to cold that may occur in post-operative room. All this are monitor to make sure client is safe to prevent any complication that may want to occur. C. The nurse monitors Mr. Rogers for what other complications of epidural analgesia? The nurse should monitors the client for persistence of positional headaches. Cold or fever due to reduce metabolic activities of the body system, tinnitus featured by ringing in the ear. a. Mr. Rogers complains of a severe headache. What should the nurse do? The nurse need to assess the level of Mr. Rogers pain from the scale of 0-10 before administering the medication. The medication for pain can be acetaminophen and other NSAID like Ibuprofen B. Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation? Drinking plenty of water to stay dehydrated is very important. This assist all the food to digest easily into the digestive system. Client are encouraged to drink a lots of water so that constipation can be prevented. Case Study, Chapter 13, Fluid and Electrolytes: Balance and Disturbance
- Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. (Learning Objective 4) a. What are possible causes of a low potassium level? Hypokalemia and it can also be termed as low potassium: this is describe as a lower than normal potassium level in individual’s bloodstream. the regular level of potassium are between 3.5 and 5.0 mmol/l, if the figure are lower than this it is considered low potassium. Potassium assist to lift electrical signals to cells individual’s body. It is chronic to the appropriate expected of nerve and muscles cells, especially heart muscle cells.
