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NRSG 105Nursing Care Plan

Students Name____Tracy Riddle___________________________________

Dates of Care ___ 10/26/2013- resent ______ !ysician Dr" #ie$% &D____________

t" Dia'noses ()nclude any Sur'ical rocedures done since admission*+ Coronary ,rtery Disease% &)% Ri'!t !ifracture% dysli idemia% . RD% rior C, .% .laucoma% De ression% ressure lcer (left foot !eal*% so !a'ealas iration% arteriosclerosis

Gordons Functional Health PatternsAssessment Data ( nclude normal and a!normal"# Health Histor$%Health Perce&tion

S' )*C+ ,* - )*C+ ,*

Health &erce&tion. ) feel li4e my o5erall !ealt! is 'ood ri'!t no "7

rea4in' my !i as t!e orst t!in' t!at e5er !a ened

to me"7)n 8une of t!is year% one afternoon ) as at !ome $ymyself and ) started cou'!in'% c!o4in' and asstru''lin' to catc! my $reat!"7 ) fell to t!e 'round andfelt ain in my le'"7 ) tried to 'et u and t!e ain as so

$ad ) couldnt"7 ) !ad my cell !one and called 911 andlaid t!ere until t!ey came"7 T!ey too4 me to t!e !os italin t!e am$ulance and ) !ad emer'ency sur'ery on my!i "7 ) as in t!e !os ital for : days"7 ,fter t!at )came !ere $ecause ) li5e alone and ) couldnt ta4e care ofmyself% $ut ) am !o in' to 'et $etter so ) can 'o !omea'ain"7

/i est$le.;loor is one le5el at #TC facility"t" states ) am li5in' !ere for no $ut !o e to 'o !omeafter ) 'et $etter"7Health aintenance.Ha!its. use o alcohol. t" states none'se o to!acco. t" states none-ther Recreational or -+C Drugs.t" states nonePre2enti2e Health eha2iors.reast or testicular sel 3e4amination.t states No% ) dont"7Date o last dental e4aminationt states

General a&&earance + General a&&earance. Race. Caucasian

Gender. male Age grou&. elderly od$ !uild. a5era'e Stature. slender Grooming. t" as clean% clot!in' as clean% !airs!ort% strai'!t% fine% 'rey color"

ental Status + ,lert/oriented @3Signs o Distress + none-2erall health status +t eA erienced e5ident ain !is ri'!t !i !enassistin' t it! mornin' ,D#s" ts ina$ility toam$ulate it! use of ri'!t le' as e5ident it! full

assistance needed"t resently is a full time% ermanent resident%alt!ou'! !e still eA resses t!e desire to return to !is

reBadmittance residence"

,S. + 9 "2%RR 1 $ m% P 10>/69%- 96 room air

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Nursing Diagnosism&aired &h$sical mo!ilit$ r%t decrease strength andendurance secondar$ to hi& racture as e2idence &t#statement o &ain 6hen tr$ing to am!ulate on right leg

Ris7 or alls r%t histor$ o alls

De&ression r%t &resent ho&elessness o li2ing in /+Cacilit$ A* Pt# stating 6anting to go home#

# N TR)T)EN - & T, E#)C

S' )*C+ ,* - )*C+ ,*

Pre2ious Dietar$ nta7e.

Diet. ) !a5e to eat foods t!at are ureed and soft $ecause )!a5e ro$lems s allo in' since ) !ad my !eart attac4 ) also!a5e to eat a lo c!olesterol diet"7 ) as 'oin' to a s eec!t!era ist% to !el me it! my s allo in' ro$lems% $ut )told t!em ) didnt ant to 'o anymore% ) didnt feel li4e itas !el in' me"7,itamins or su&&lements. 5ery mornin' t!ey 'i5e me a5itamin $efore $rea4fast"7Food Pre erences. ) ould rat!er eat my food solid andnot ureed $ecause sometimes t!e meat and 5e'eta$lesdont loo4 as 'ood all smas!ed u li4e t!at and some!ot!ey Fust dont taste t!e same eit!er"7 A&&etite ) !a5e $een eatin' $etter in t!e last t o mont!sand 'ettin' my a etite $ac4"7Nutritional m&airment. Since ) !ad my !eart attac4 )!a5e ro$lems s allo in'"78eight Fluctuations /ast 9 months. ,fter ) !ad my fall )lost a$out >0 l$s" $ecause ) lost my a etite $ut in t!e lastcou le of mont!s ) !a5e $een eatin' $etter and 'ainin' $ac4some of my ei'!t"7 Dentures. ) !a5e !ad dentures since ) as in my middlet enties"7

Allergies. t" NGD,Histor$ o S7in%Healing Pro!lems t" states none'sual H$giene Practices. inc!es $ilateral* su erior midline of c!est related toC, . sur'ery% 10/2009% ale in4 in color" Ri'!t le' e5ident sur'ical scar (a roAimately 6inc!es lon'% $ilateral*% on anterior% su erior t!i'!%related to ri'!t !i fracture sur'ery 06/06/2013% ale

in4 in color" #eft le' e5ident sur'ical scar(a roAimately ? inc!es $ilateral*% on osterior%inferior t!i'!% related to C, . sur'ery% 10/2009% ale

in4 in color"+e4ture. smoot!% soft" +urgor. return immediate +em&erature and oisture. arm% dry*dema. none noted

HA R.Color. 'rey /ength. s!ort% at nec4 line +e4ture. fine Distri!ution. t!in on su erior art of !ead% e5enlydistri$uted ot!er ise% a ro riate for a'e Scal&. clean% no lesions/$um s some dry atc!esto ards fore!ead" -ral ucous em!ranes. Color. in4

Consistenc$. smoot!% moist

Gums. in4% moist% nonedematousNA /S. Color. in4 (ri'!t !and/ left !and* Sha&e. symmetrical to fin'er s!a e (ri'!t !and/(left!and* +e4ture. smoot! (ri'!t !and/left !and* Nail !ed. in4 (ri'!t !and/left !and* 3H Ca&illar$ Re ill. 1-2 sec (ri'!t !and/left !and*Decu!itus Ris7 Factor. none noted+eeth. dentures u er and lo er full late

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Condition. fit ro erly u er and lo er late Color + !iteDietar$ nta7e. c!arts states soft foods ( urred orsoftened*% lo c!olesterolAmount eaten. ;5?m'/d#% c!olesterol 220m'/d#%#D# 1>?m'/d# all disad5anta'eous"C!art recordin' states t" declined t!e need tocontinue s eec! t!era y rescri$ed $y !ealt! care

ro5ider after four mont!s of t!era y"E$ser5ation of t" !ile eatin' $rea4fast 11/0?/2013eA ressed e5idence of t" need to resume s eec!t!era y due to difficulty in s allo in' !ile eatin'and ris4 for as iration"

Nursing Diagnosis.)m aired s allo in' r/t neuromuscular im airment ,need for t" to recei5e diet of soft ureed food $ecause ofina$ility to s allo solid food due to re5ious &)

Ris4 for ad5anced de5elo ment of decreased cardiac out utr/t increased 5ascular resistance

Ris4 for as iration r/t im aired s allo in'

)neffecti5e ,ir ay Clearance r/t neuromuscular dysfunction, t" states e isode of as iration

Ris4 for )m$alanced Nutrition+ less t!an $ody reIuirementsr/t ei'!t 20 less ideal for !ei'!t and frameDia'nostic studies+ ,#T% ,1C% #) )D RE;)#

# */ NA+ -N

S' )*C+ ,* - )*C+ ,*

Pre2ious 'rinar$ Pattern.) !a5e to !el usin' t!e $at!room $ecause ) am una$le tostand or al4 $ecause of my !i ain"7

Fre=uenc$ o 2oiding + t" states !e 5oids a roA" > @s aday

Pro!lems + t" stated nonePre2ious o6el Pattern. ) !a5e a $o el mo5ementusually once a day% in t!e mornin'"7 &y doctor orders me&iralaA if ) 'et consti ated"7Presence o hea2$ &ers&iration%dia&horesis t" statesnone"

'rinar$ C!art states need for full assistance at all times" seof s!o er c!air" ode. Toilet it! aid of s!o er c!air Color. #i'!t yello Characteristics. Clear% lo odor o6el%stool o6el Sounds. audi$le eIually in all four IuadrantsA!dominal a&&earance.

Contour. round% flat S$mmetr$. symmetrical Sur ace motion + no mo5ementFeces. Color. li'!t $ro n Amount. med

Consistenc$. semi solid Characteristics. aromaticDrainage. None notedt" uses incontinence $riefs consistently daily"

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Nursing Diagnosis.N%A

Dia'nostic studies+ none

,# AC+ , +> 3 *?*RC S*

S' )*C+ ,* - )*C+ ,*

Pre2ious &attern o acti2it$.) usually dont eat in my room"7 ) 'et do n to t!e dinin'

room usin' my !eel c!air"7

) am not a$le to 'et dressed on my o n or e5en 'et out of $ed% and t!at is one of t!e reasons ) !a5e to stay !ere"7 ) li5ealone and ) do not !a5e anyone to !el me t!ere"7

,idin' t from c!air to $ed ) s end most of my time int!e !eel c!air $ecause ) cannot 'et u on my o n"7 T!e

ain in my ri'!t !i doesnt allo me to ut muc! ei'!ton t!at side so if ) ant to ta4e a na or 'o to slee for t!eni'!t ) !a5e to !a5e t!e nurses come and !el me"7* ersonal Ky'iene noted in c!art" Turnin' around (need of full !uman assistance* notedin c!art"

&o5in' on/off toilet (not steady need of full !umanassistance* and use of s!o er c!air"usculos7eletal.Posture. relaAed% sli'!t 4y !osis

uscle tone. sli'!t resistanceuscle strength. er eAtremities (>* #o er

eAtremities ri'!t le' (1*% left le' (3*t" facial 'rimacin' !en testin' ri'!t le' musclestren't!"

Gait. una$le to assess% t" is una$le to am$ulateit!out full assistance"alance. needs full assistance Range o motion. Ran'e of motion in u ereAtremities full /limitations liftin' arms o5er !ead"Ran'e in motion in lo er eAtremities is limited /

ain"

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8eight !earing. C!art states left le' 90 ri'!t le'

30 " t" ri'!t le' demonstrates ea4ness and ain"

Cardiores&irator$./ungs. reat!in' smoot!% unla$ored

reath sounds. clear in all Iuadrants% eAterior/interior

Rate. 1 $reat!s er min" @unla$ored Rh$thm. re'ular De&th. re'ular Cough. a$sent Heart.A&ical &ulse. 6 /minRadial ulse+ 6 /min Rh$thm. re'ular Peri&heral ,ascular. una$le to attain eri !eral t"non-com liantSensation. not tender can identify li'!t and deetouc! all eAtremities"otor. Kand 'ras s noted as eIual (>* ;ootmo5ement as eIual (3*Present tolerance or acti2it$.t" !as e5ident ain/ ea4ness in ri'!t lo ereAtremities needed assistance in all ,D#s it! t!eeAce tion of self-feed" Noted in c!art t!at t" ro'ressin !ysical t!era y for increased am$ulation in ri'!t!i and le' !as $een slo ro'ressin'" t" am$ulatesit! aid of !eel c!air and mo5es from c!air to $edand use of toilet it! full assistance"

Nursing Diagnosis.C!ronic ain r/t !i fracture 06/2013 , t" self states

ain le5el on scale of 0-10 at : and often recorded in c!art 9Ris4 for fall+ Ris4 factor+ im aired !ysical mo$ility inlo er eAtremities r/t ain due to ri'!t !i fracture

Dia'nostic studies+ ;luid and electrolyte tests ric acid test% Kemo'lo$in% ,1C

,# S/**P 3 R*S+

S' )*C+ ,* - )*C+ ,*

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Slee& &atterns. ) normally 'o to $ed around 12+00 ,&and 'et u around 6+00 ,&"7Routine. ,fter $rea4fast sometimes ) ta4e a na % until t!eycome and 'et me for my !ysical t!era y"7Slee& aides used + t" states !e ta4es Tylenol ca sules @ 2"E% RN for ain in !is ri'!t !i " Some ni'!ts my !icauses me a lot of ain and 4ee s me a a4e"7Pro!lems. T!e ain in my ri'!t !i causes me not to $ea$le to slee many ni'!ts"7

-!ser2e a&&earance. t" !ysical a earance s!o sno si'ns of slee de ri5ation"-!ser2e !eha2ior.

t"s roommate eA ressed t!at !e is often not a$le to'et adeIuate slee due to t"s restlessness durin'slee !ours"

t" num$er of slee !ours is less t!an a5era'e r/t to t"a'e"

Nursing Diagnosis.;ati'ue r/t slee , t" statin' t!at ain in ri'!t u er le'and !i area 4ee s !im a a4e many ni'!tsSlee de ri5ation r/t rolon'ed !ysical discomfort , t"statin' ain in ri'!t !i causes slee lessness many ni'!ts

Dia'nostic studies N/,

, # C-GN + ,* 3 P*RC*P+'A/

S' )*C+ ,* - )*C+ ,*

:no6ledge /e2el *ducational le2el achie2ed.t" states n'lis! lan'ua'e is only lan'ua'e racticed andeA ressed"

) 'raduated !i'! sc!ool 19>2"7 ) attended colle'e for 2years for auto mec!anics% and soon after ) finis!ed ) 'ot a

Fo$ or4in' at a 'ara'e fiAin' car transmissions"7

A!ilit$ to ollo6 2er!al%6ritten instructions. LesDe2elo&mental /e2el. No co'niti5e im airment itnessedor eA ressed $y t"nsight. ) really enFoy or4in' on cars"7 ) am 5ery 'oodat fiAin' transmissions% my customers ere al ays referrin'me to t!eir friends and ) could Fust a$out fiA anytransmission out t!ere"7Past Histor$ +t" states !e !as ositi5e erce tion of !eat/cold" Couldyou lease ut t!at s eater on me% ) 'et cold sometimes"7

t" !as ositi5e erce tion to taste/smell+) li4e c!ocolate mil4 to drin4 for my mid-mornin' snac4"7

) dont ear any !earin' aids% ) !a5e ne5er !ad any ro$lems !earin'"7

emor$t"s lon' term memory a ears intact t" can reciteand re eat factual e5ents and dates of !is life"t"s s!ort term memory a ears intact t" can reciteand re eat !at food as ser5ed and consumed for

$rea4fast t!is mornin'"S&eech. Paralanguage. t"s s eed of s eec! is a ro riate%5oice is soft% audi$le" Articulation. t" articulation is sli'!tly im aireddue to c!art notation of re5ious &) attac4 incidence"E$ser5ed sli'!t slur at t!e end of ords eA ressed")m airment did not affect my com re!ension of t"seA ressions as a$le to identify all eA ressions" Se=uencing. #o'ical" t" uses correct order ofeA ression !en communicatin'"

A&&ro&riateness o content. a ro riateNeurological. -rientation. t" is alert/ orient to erson/ lace/time

Pu&il reaction + RR#, Gras& Strength. Kand 'ri (>* ;oot mo5ement+ leftfoot (>*% ri'!t foot (2* /e2el o consciousness. t" is alert and res onsi5e to5er$al and en5ironmental stimuli"Perce&tual Cogniti2e.

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t" states 5isual im airment in $ot! ri'!t/left eyes% useseye'lasses for aid in 5isual acuity at all times"Could you lease !and me my 'lasses t!ere on t!e ta$leM7t" correctly identified 5er$ally% difference $et een li'!tand dee touc!" T!at as li'!t/dee etc"""Pain Assessment.t" states !e !as radiatin' ain in !is ri'!t u er le' and !iarea" Rates ain intermittently :- on scale from 0-10"

Hallucination. a$sent Delusions + a$sent Attention s&an + )ntact

Nursing Diagnosis.Ris4 for falls r/t ain

Dia'nostic studies+ N/,

, # S*/F P*RC*P+ -N 3 S*/F C-NC*P+

S' )*C+ ,* - )*C+ ,*

De2elo&mental stage o li e. t" is in ric4sons 'o)nte'rity 5ersus Des air"7 t" reminisces a$out life e5entst!at ere si'nificant to !is life" ) or4ed in a 'ara'e as amec!anic for >? years and my $oss as al ays tellin' me!o 'ood ) as at re airin' t!ose transmissions"7 &y lateife told me after e 'ot married t!at ) needed tounderstand t!at s!e as al ays ri'!t and to Fust acce t it"7t" smilin' !ile statin' t!is"A!ilit$ to accom&lish age le2el tas7s. ) am 'oin' to

!ysical t!era y so t!at ) can 'ain my stren't! $ac4 in myle' so t!at ) can 'o $ac4 !ome"7 Ho6 do $ou see $oursel B t" states ) !a5e t o dau'!tersand ) am a roud 'randfat!er of t o $eautiful'randdau'!ters"7Strengths. )f ) as !ysically a$le% ) could fiA anytransmission out t!ere"7 ) feel as far as my !ealt!% ) am

retty 'ood"78ea7nesses. ) am 'oin' to my !ysical t!era y $ut t!e

ain in my le' doesnt seem to $e 'ettin' any $etter and it issto in' me from 'ainin' my stren't! $ac4 in t!at le'"7Perce&tion to achie2e goals. ) ant to 'et my stren't!

$ac4 in t!is le' ( t"s !and on ri'!t le'* so ) can 'o $ac4!ome"7 T!at is my 'oal% ) ant to li5e at !ome a'ain"7 )

Posture*$e contact. resent t" ma4es a ro riate eyecontact" Facial e4&ression (a ect". animated t" ma4esa ro riate facial eA ressions"Grooming.Hair groomed. yesH$giene. 'ooda7eu&. a$sentSha2en. yesDress. neat clot!es fit a ro riately% clean/dry"A ect. uses !ands !en tal4in'Descri!e. smilin' !en reminiscin' a$out ast lifeaccom lis!ments fro nin' !en eA ressin' ain andina$ility to re'ain stren't! in ri'!t le' and ina$ility toal4 and li5e at !is re5ious residence"Attitude. leasant% a'reea$le% ositi5e t" eA ressesa ositi5e attitude to ards ast life eA eriences andaccom lis!ments" Kas ositi5e outloo4 to ards 'oalof 'ainin' stren't! $ac4 in ri'!t le' and $ein' a$le toreturn to !is re5ious residence e"*4&ressed eelings a!out sel .Sel 3a irmation comments. t" eA resses

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!a5e to $e a$le to al4 on my o n $efore ) can 'o !ome"7od$ mageood. rea4in' t!is !i as t!e orst t!in' t!at !as e5er!a en to me% $ut ) am 'oin' to 'et $etter so ) can li5e at!ome"7

'ratification for !is accom lis!ments !e ac!ie5eddurin' occu ation as a mec!anicSel 3derogator$ comments. resent t" o enlyeA resses on'oin' uncertainties a$out !is a$ility tore'ain stren't! in !is ri'!t le' and current immo$ilityt!at in!i$its !im from returnin' to !is re5iousresidence"A&&ro&riateness o !eha2ior + a ro riate t"s

$e!a5ior is a ro riate to ric4sons sta'es of syc!osocial de5elo ment" t" reminisces of e5ents in!is life t!at are si'nificant to !im" t"s facialeA ressions and $ody lan'ua'e reflect non-re'retfullife c!oices" t" !as a ositi5e outloo4 for reac!in'!is 'oals" t" con5eys a !ealt!y self-conce t/self-esteem"

Nursing Diagnosis.Ris4 for com romised Resilience

, # R-/* R*/A+ -NSH P

S' )*C+ ,* - )*C+ ,*

) !a5e enFoyed tal4in' to you today"7

$ecause ) cant al4 on my o n% so for no ) !a5e to stay!ere"7 5eryone !ere is nice and !el s me anytime ) needit"7,'e+ >&arital Status+ 3 R*PR-D'C+ ,*

S' )*C+ ,* - )*C+ ,*

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&y ife and ) !ad t o dau'!ters% t!ey are ??and ?: yearsold"7&y ife assed a ay 12 years a'o"7

Present se4ual acti2it$ + did not assess'se o !irth control + did not assessProstate e4am. did not assess

reasts. flat% in4

Areola + in4 to li'!t $ro n% round% e5en% nodisc!ar'e resent% scarce distri$uted !air

Genitalia + resence of u$ic !air% scarce distri$ution No 5isi$le lesions No odor No draina'e

)na ro riate SeAual e!a5ior+ N/,

Nursing Diagnosis.N%ADia'nostic studies+

N/,

?# C-P NG 3 S+R*SS +-/*RANC*

S' )*C+ ,* - )*C+ ,*

) meet it! a counselor a$out e5ery t o ee4s to tal4a$out !o ) am feelin'"7 ) 'et de ressed sometimes a$out!o lon' it is 'oin' to ta4e me to 'et my stren't! $ac4 inmy le'"7)t is ta4in' lon'er t!an ) t!ou'!t to start al4in' a'ain onmy o n"7&y dau'!ters 'ot me a cell !one and ) call t!em !en )feel t!e need to tal4 to someone"7

eha2ior &atterns +

A!use to sel or others + a$sent

Pt# !eha2ior is controlled /relaAed a ro riate

A&&earance + a ro riate it! eA ressions"

t" a ears to ma4e sound decisions"&eets it! counselor e5ery t o ee4s to address !isde ression r/t to ina$ility to am$ulate effecti5ely intime frame eA ected"t" ro'ress to $i- ee4ly counselin' re'ardin'de ression recorded in c!art states t" is anAious toreturn to !is re5ious residence% and ants t!is su$Fectto $e addressed at eac! meetin'"


? # ,A/'*S 3 */ *FS

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S' )*C+ ,* - )*C+ ,*

Concern 6ith meaning o li e%death. a$sent t" did noteA ress any concern it! meanin' of life/deat!"Concern 6ith meaning o su ering. a$sent t" did noteA ress any concern it! sufferin'"Anger to6ards God%religion. a$sent ) am a mem$er of

t!e% ;irst a tist C!urc!"7

S$m!ols o Faith. resent i$le and c!urc!ne sletter ere o$ser5ed on t" side ta$le in room"

t" s!o s no unusual facial eA ressions or a$normal $ody lan'ua'e !en ta4in' a$out reli'ion"

No $e!a5ioral atterns of des air o$ser5ed"


D SCHARG* N**DS

#ist treatments+ N/,__

S ecial care or needs+ N/,___

S ecial teac!in'+ N,__

;ollo u care or a ointments+ N/,___

#ife eA ectancy+ Sur assed a'e :

Reha!ilitation s&eci $ t$&e + N/,

Return to+ #on' term care is final for t" !ome at resent time"

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*D CA/3S'RG CA/ +R*A+ *N+, t" t!at is dia'nosed it! C,D ty ically is rescri$ed medications to re'ulate t!eir and!i'! serum li id le5els" )n addition t!ey are 'i5en as irin or r!eolo'ical a'ents to increase ;t!rou'! $loc4ed arteries" Sur'ical rocedures may $e im lemented to o en $loc4ed arteriesand may include rocedures of an'io lasty% at!erectomy% or arterial $y ass"

Nursing Care ( nclude +eaching"A ress t!e im ortance im lementin' a diet t!at is lo in salt% fat% and c!olesterol"

Teac! t" to eAercise to increase $lood flo "%e alert to ad5erse reaction related to a$ru t discontinuation of $eta-adrener'ic $loc4er andcalcium c!annel $loc4er t!era y" T!ese dru' must $e ta ered to re5ent a re$ound

!enomenon7 tac!ycardia% increase in c!est ain% and !y ertension"Teac! t" t!e im ortance of ta4in' rescri$ed medication as ad5ised"A lain to t!e atient t!e im ortance of anAiety reduction to assist to control an'ina"Teac! t!e atient relaAation tec!niIues"Re5ie it! t" s ecific factors t!at affect C,D de5elo ment and ro'ression !i'!li'!t t!ose

ris4 factors t!at can $e modified and controlled to reduce t!e ris4"

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*D3S'RG +*?+ --: P C+'R*

Patho&h$siolog$ . H>P*R+*NS -N 3,dult KTN a disorder in !ic! readin's are'reater t!an 1>0 mm K' systolic or 90 mm K' diastolic on 3 isolated readin's documentednumerous ee4s a art" KTN is one of t!e maFor t!reats for 4idney failure% coronary arterydisease% retino at!y% eri !eral 5ascular disease% !eart failure% and stro4e" )t !as an effect on

a$out ?0 million eo le in t!e "S" Si'nificant in5esti'ation !as s!o n t!at re'ulatin' KTNescalates rolon'ed eAistence and !el s a5oid cardio5ascular illnesses"

S GNS AND S> P+- S.KTN is often an asym tomatic disease in t!e first fe decades of its de5elo ment and isreferred to as t!e silent 4iller"7 T!e maFority of atients usually s!o no sym toms until

ro$lems arise% $ut t!e seriousness of KTN s!ould $e addressed" Eften t !o suffer fromKTN ill com lain of K/," "9 can aid in 4ee in' le5els it!in normal limits as ell as% restrictin' total inta4eof saturated fat and c!olesterol" ,lco!ol s!ould $e limited to one drin4 a day% and smo4in's!ould $e discontinued" Eften times alon' it! lifestyle c!an'es% dru' t!era y is also

included for treatment of KTN" KTN (sta'e )* consists of lo dose t!iaJide diuretics%an'iotensin con5ertin' enJyme (,C * in!i$itors% $eta $loc4ers% calcium c!annel $loc4ers"&edications can $e used indi5idually or can $e com$ined% de endin' on indi5idualcircumstances" )n t!e case of KTN (sta'e ))*% usually t o-medications are rescri$ed to'et!era t!iaJide-ty e diuretic alon' it! a ty e of $eta $loc4er"

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N'RS NG CAR* ( NC/'D* +*ACH NG". needs to $e measured at e5ery !ealt! care 5isit" t" s!ould $e educated on t!e meanin' of readin' results" Constructi5e lifestyle alterations s!ould $e encoura'ed" &edical re'imens

need to $e em !asiJed% and atients need to $e instructed to notify t!eir KC of any

increased/decreased altercations or ne'ati5e S/S of t!era y t!ey may $e eA eriencin' as t!esecan freIuently $e mana'ed it! dosa'e modification or an adFustment in medication"&onitorin' at !ome can $e tau'!t to t"s t!at are rece ti5e" readin's s!ould $emeasured and documented for $ot! ri'!t and left arms" )f t!ere is a medical ro$lemsto in' measurement of eit!er arm% t" s!ould s ecify !ic! arm as measured on"

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*D3S'RG +*?+ --: P C+'R*

Patho&h$siolog$. FRAC+'R* -F +H* PR-? A/ F* 'R., discontinuity or disru tion in t!e continuity of a $one t!at commonly affects mo$ilityand sensation" T!e sim le7 (closed* fracture does not eAtend t!rou'! t!e s4in so t!ereis no 5isi$le ound on t!e outside surface of t!e le'" Ki fractures are measured as% any

art of t!e u er t!ird of t!e femur and are classed as intraca sular (inside t!e Fointca sule* or eAtraca sular (on t!e outside of t!e Foint ca sule" T!ese 4inds of fractures!a5e a !i'! mortality rate as a result of multi le difficulties related to sur'ery% sustainedimmo$ility% and de ression amon' t!e elderly"

S GNS AND S> P+- S. Si'ns include loss mo5ement% ain it! acute ainfulness and ossi$le immflamationo5er t!e site of fracture% and ossi$le immediate onset of $ruisin'% deformity and

otential s!ortenin'% irre'ular mo$ility% and cre itus or 'ratin' o5er!eard !en t!e endsof t!e $one ru$ to'et!er"

D AGN-S+ C S+'D *S. )mmediate first aid consists of s lintin' of t!e fracture site and Foints directly a$o5e and

$elo it to reduce furt!er mo5ement and dislocation" , lyin' a cold ac4 to t!e

fracture site and ele5atin' it a$o5e t!e !eart may reduce ain and inflammation"Radio'ra !y is used to classify t!e fracture and t!e eAact location of t!e $onefra'ments"

*D CA/3S'RG CA/ +R*A+ *N+., !ysician decreases t!e fracture" T!e $one is 4e t in osition $y a cast or s lint untilunion !as set" T!e lim$ is t!en restored to full function it! t!e aid of !ysical t!era yand eAercise" )n o en or com ound fractures% $leedin' must $e re5ented $efore t!efracture is considered" T!e o en fracture needs to $e co5ered it! sterile dressin' and

t!e fracture site restrained" E en reduction could ossi$ly $e necessary" T!e ound iscleaned it! sterile saline" ,fter t!e ound is clean% a sterile dressin' is a lied $y a $anda'e" T!e $one t!en can $e restrained $y eAternal fiAation in antici ation of t!e

ound !ealin'" )f t!e $one doesnt !eal% a ea4 electric current may need to $e a liedto t!e $one ends% t!is romotes !ealin'" Ki fractures reIuire moderate !andlin' andrestriction to a5oid dis lacement of t!e fracture or interru tion of a el5ic !ematoma"

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N'RS NG CAR*.,ssess t" ain le5el daily to determine com lications due to ost sur'ery !ealin'% usin'

ain scale to rate ain of 0-10" ,dminister rescri$ed ain medication to mana'e ain"one !ealin' and re$uildin' stren't! rely on adeIuate nutrition% t!erefore it isim erati5e to ma4e sure t" recei5es ro er nutrition es ecially !os !orus% 5itamin D%calcium% and rotein" ,ssess t" for lo er eAtremity edema t!is is t!e most common

site for ro$lems in t" !o eA erience musculos4eletal trauma" Reinforce teac!in' ro5ided $y !ysical t!era ist to increase re!a$ilitation rocess" ,ssess t" a$ility tosafely use !eelc!air" ,ssess t" for syc!olo'ical manifestations of de ression% orstressors related to inFury and delayed eA ectations of re!a$ilitation" ,ssist t" it!daily ,D#s" &a4e sure t!at call li'!t is it!in reac! for t" to call for assistance !enneeded"

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C/ N CA/ C-'RS*

11/01/2013% 1000+ > y"o" !ite male% ei'!t 60 4' (133 l$"*% !ei'!t 1 3 cm(6* " lon' term carresident" ,dmitted 06/13/2013 for ina$ility to am$ulate self safely and erform ,D#s due tofracture of t!e roAimal femur" PS+ T+ 99"2Q; tym anic% 10>/69 electronic/ri'!t arm%sittin'% R 6 /min% radial ulse 6?/min left rist% sittin'% E 96 % ,,EA3" t" KTN

a ears to $e under control it! administration of rescri$ed medications it! recordedreadin's in c!art for t!e last mont! $et een 11 /:9 = 10>/69" t"s c!olesterol le5el remainsele5ated des ite administration of rescri$ed medications% last c!art recorded le5el0 /01/2013 c!olesterol ele5ated at 220 m'/d#% tri'lyceride ele5ated at 3>? m'/d#% #D# le5elele5ated at 1>? m'/d# and CKE#/KD# ratio ele5ated at 10"2 (not it!in ran'e*" t" !as a!istory of &) related to !i'! 'rade stenosis of t!e coronary arteries due to ersistent ele5atedc!olesterol le5els and KTN" t" under ent C, . sur'ery 10/2009 roceedin' &) e isode",s a result of &) e isode t" !as difficulty s allo in' t" !as a restricted diet of soft foods

( ureed* alon' it! lo salt and lo c!olesterol" t" states !e suffers from acute ain in ri'!t!i and u er le' from re5ious fracture of t!e roAimal femur 06/06/2013 rates ain on ainscale of 0-10 at a 9 on 11/01/2013 c!art reflects ain scale used daily to assess t" ain le5eland is recorded usin' same ain scale in last t o ee4s $et een : and 9" t" attends !ysicalt!era y 2 @s ee4ly for re!a$ilitation to stren't!en ri'!t !i and u er le'" t" needscom lete assistance in all ,S#s" t" uses !eelc!air to am$ulate" ro'ress from t!era ynoted in c!art states t"s ro'ress !as $een in!i$ited $ecause of on'oin' ain restrictin' !isa$ility to $ear ei'!t on ri'!t le'" t" is 'i5en ain medication RN er t" reIuest" t" isdia'nosed it! 'laucoma in $ot! left and ri'!t eyes medicated rescri tion 'laucoma eyedro s administered daily to $ot! eyes (DorJolamide% 0"0? % one dro 2@s daily*" t"eA resses desire to 'ain stren't! in ri'!t !i and u er le' so t!at !e can return to !is riorresidence" t" attends syc!olo'ical screenin's once e5ery t o ee4s to assess on'oin'de ression r/t t" delay in re!a$ilitation allo in' !im to return to !is re5ious residence" t"c!art reflects de ression and sli'!t a'itation durin' sessions" t" de5elo ed a $lister ressureulcer 10/1?/2013 located on left !eal% sta'e (1* noted in c!art t!era y im lemented includesdaily assessment of area it! dressin' c!an'es daily (Aerofom 'auJe* and air $oot a lied toleft foot !ile in $ed" t" self feeds" t" is on room air and does not reIuire oAy'en t!era y"

11/12/2013 0 00% initiated communication it! t" concernin' non-com liance to attendin's eec! t!era y sessions t!at aid in im ro5in' !is a$ility to s allo roducti5ely" ncoura'ed

t" to eA ress !is concerns and reasons to discontinue attendin' s eec! t!era y" t" eA resseddisa ointment r/t im ro5ed ro'ress o$ser5ed" t" eA ressed conflict it! t!era y sc!edulin'times and days t!at t" felt interfered it! ersonal needs of relaAation and rest and oftencaused t" to feel o5er !elmed"

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11/12/2013 1100% educated t" on t!e im ortance of attendin' s eec! t!era y to aid inim ro5in' s allo in' and re5entin' as irations" ducated t" on dan'ers r/t as irations"11/12/2013 1?00% su''ested t" ro ose modifications concernin' t!era y times% days andlac4 of eA ected im ro5ement in order to come to a resolution for !im to resume t!era y inaddition to meetin' !is ersonal needs for rest resol5in' feelin's of $ein' o5er !elmed"11/1:/2013 educated t" on non- !armacolo'ical ain relief tec!niIues and !eelc!air

eAercises" A lained diet to romote $one and muscle 'ro t!" .a5e t" nutritional dieticiancontact information" t" recited learnin' and contacted dietician" ducated t" on ainassessment and ro er ays to re ort" t" recited leanin' and understandin' ro erly"11/20/2013 educated t" on ro er use of !eel c!air and safety recautions% fall re5entionsafety measures and need for t" to call for assistance !en am$ulatin'" t" recited learnin'and understandin' ro erly"

D AGN-S+ C S+'D *S

/a! studies and 43ra$s ordered.,u'ust/01/2013+ Hemoglobin AIC Result+ ?"9 Normal Ran'es ?": 6">

8uly 2013+ ALT (SGPT) Result+ 22 ) /m# Normal Ran'es 10-30 ) /m#

#i id rofile+

T ST R S #T NER&,# R,N. S

C!olesterol 220 m'/d# 200 m'/d#

Tri'lyceride 3>? m'/d# 0-1?0 m'/d#

KE# 3? m'/d# >0-60 m'/d#

#D# 1>? m'/d# 63-130 m'/d#

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Signi icance (&ur&ose o test@ nursing &re&aration@ e4&lain a!normal 2alues as the$relate to the &atient".

Pur&ose.T.s identify ris4 of de5elo in' CKD" Test is art of a li id rofile and includesmeasurement of CKE and li o roteins"

A!normal ,alues.,s a erson a'es li id $rea4do n in t!e $ody decreases% t!erefore t!ey are at ris4 for !i'!erc!olesterol le5els !ic! can lead to stenosis of t!e coronary arteries and encoura'e transientisc!emia" T!is can lead to stimulation of 5entricular arr!yt!mias and ro'ress into 5entricularfi$rillation leadin' to deat!" )nta4e of fatty foods can increase le5els of T.s" eo le !olead a sedentary lifestyle can !a5e increase in T. le5els"Nursing Pre&aration.

1* A lain rocedure to atient"

2* )nstruct atient t!is is a fastin' test and t!ey !a5e to remain N E for 12-1> !ours $eforetest" Enly ater is allo ed3* A lain no alco!ol is allo ed for 2> !ours $efore test">* )nform atient t!at dietary indiscretion for as muc! as t o ee4s $efore test ill

influence test"?* Collect a 5enous $lood sam le in a red-to tu$e6* , ly ressure or a ressure dressin' to t!e 5eni uncture site:* ,ssess t!e 5eni uncture site for $leedin'* &ar4 atients a'e and 'ender on t!e la$ sli9* )nstruct atients it! increased T. le5els re'ardin' diet% eAercise% and a ro riate

ei'!t

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*D CA+ -NSedicationGeneric randName

Dose Range ClientDose

Classi ication ndication and Action Side * ects%Druginteractions

NursingConsiderations andContraindications

Trade Name(s*#i itor

rand Name,tora5astatin

E+ (,dults* 10=20 m'once daily initially(may start it! >0m'/day if #D#-Cneeds to $e $yU>? * may $e e5ery2=> 4 u to 0m'/day Concurrent

nelfina5ir t!era y= Dose s!ould noteAceed >0 m'/dayConcurrentclarit!romycin%itraconaJole%saIuina5ir/ritona5ir%daruna5ir/ritona5ir%fosam rena5ir% orfosam rena5ir/ritona5ir t!era y=Dose s!ouldnot eAceed 20 m'/day"

0m'ta$E1@ d

!arm" Class"!m' coareductasein!i$itorsT!er" Class"li id-lo erin'a'ents

ndications. ,dFuncti5emana'ement of

rimary!y erc!olesterolemiaand miAeddysli idemia"rimary re5ention ofcoronary !eart disease

(myocardial infarction%stro4e% an'ina% andcoronaryre5asculariJation* inasym tomatic atientsit! increased total andlo -density li o rotein(#D#* c!olesterol anddecreased !i'!-densityli o rotein (KD#*c!olesterol"

CNS+ amnesia%confusion% diJJiness%!eadac!e% insomnia%memory loss% ea4nessNT+ r!initis

Res + $ronc!itisCP+ c!est ain%

eri !eral edema

.)+ a$dominal cram s%consti ation% diarr!ea%flatus% !eart$urn%altered taste% dru'-induced !e atitis%dys e sia% li5erenJymes% nausea%

ancreatitisndo+ !y er'lycemia. + erectiledysfunctionDerm+ ras!es% ruritus&S+RK, DE&LE#LS)S%art!ral'ia% art!ritis%myal'ia% myositis&isc+KL RS NS)T)P)TLR ,CT)ENS)NC# D)N.,N.)EN RET)CD &,

-!tain a diethistor$@ es&eciall$6ith regard to atconsum&tion#/a! +estConsiderations.*2aluate serumcholesterol and

trigl$ceride le2els!e ore initiating@a ter 67 othera&$@ and&eriodicall$therea ter#onitor li2erunction tests &riorto initiation othera&$ and asclinicall$ indicated# s$m&toms o

serious li2er inEur$@h$&er!iliru!inemia@or Eaundice occursdiscontinueator2astatin and donot restart# a$also cause al7aline&hos&hatase and!iliru!in le2els# &atient de2elo&s

muscle tendernessduring thera&$@CP: le2els should!e monitored# CP: le2els are 10

/0: NS. 111NCDe'lin% 8" K"% Pallerand% ," K"% V Sanos4i% C" ," (2010*" Davis's drug guide for nurses " 12t! ed" " !iladel !ia+ ; , Da5is Co"

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times the u&&erlimit o normal orm$o&ath$ occurs@thera&$ should !ediscontinued#

Actions. )n!i$its 3-!ydroAy-3-met!yl'lutaryl-coenJyme , (K&.-Co,* reductase% anenJyme !ic! isres onsi$le forcatalyJin' an early stein t!e synt!esis ofc!olesterol"T!era eutic ffect(s*+#o erin' of total and#D# c!olesterol andtri'lycerides" Sli'!tlyincreases KD#c!olesterol"Reduction ofli ids/c!olesterolreduces t!e ris4 ofmyocardial infarctionand stro4e seIuelae"Slo s t!e ro'ressionof coronaryat!erosclerosis it!

resultant decrease icoronary !eart disease= related e5ents"

/0: NS. 111NC

% 8" K"% Pallerand% ," K"% V Sanos4i% C" ," (2010*" Davis's drug guide for nurses " (12t! ed"*" !iladel !ia+ ; , Da5is Co"

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edication n ormation FormedicationGeneric rand Name

Dose Range Client Dose Classi ication ndication and Action Side * ects%Druginteractions


(meto rolol*Lopressor

PO: (Adults) Antihypertensive/antianginal 25100 mg/day as a singledose initially or 2 divideddoses; may be q 7 days asneeded up to 450 mg/day(immediate-release or 400mg/day (e!tended-release("or angina# give in divideddoses $ %!tended-releaseprodu&ts are given on&edaily$ MI 2550 mg (starting15 min a"ter last ' dose q )*r "or 4+ *r# t*en 100 mgt,i&e daily$ Heart failure12$525 mg on&e daily (o"e!tended-release # &an bedoubled every 2 , up to200 mg/day$ Migraine

prevention 50100 mg 24times daily (unlabeled $

IV: (Adults) MI 5 mg q 2min "or . doses# "ollo,ed byoral dosing$

2?m' E Wta$"(12"?m'*2@s daily

+her# Class +antian'inalsanti!y ertensi5es

Pharm# Class . $eta $loc4ers

Indications: ypertension$ ngina pe&toris$

revention o" ' and

de&reased mortality in

patients ,it* re&ent '$

anagement o" stable#symptomati& (&lass '' or '''*eart "ailure due to is&*emi*ypertensive or&ardiomyopat*& origin (maybe used ,it* 3% in*ibitors#diureti&s and/or digo!in;oprol L only $

Actions :6lo& s stimulation o"beta 1(myo&ardial -adrenergi&re&eptors$ oes not usuallya""e&t beta 2(pulmonary#vas&ular# uterine -adrenergi&re&eptor sites$

Side Effects :

CNS: fatigue #weakness # an!iety#depression#di88iness#dro,siness#insomnia# memoryloss# mental status&*anges#nervousness#nig*tmares

EENT: blurredvision# stu""y nose

Resp:bron&*ospasm#,*ee8ing

CV: 69 :3 9 ' ## 9:

% % #*ypotension#perip*eralvaso&onstri&tion

GI: &onstipation#diarr*ea# drug-indu&ed *epatitis#dry mout*#"latulen&e# gastri&pain# *eartburn# liver en8ymes#

nausea# vomitingGU: erectiledysfunction # libido# urinary"requen&y

De !: ras*es

Endo:*ypergly&emia#*ypogly&emia

"S: art*ralgia#ba& pain# ?ointpain

NursingConsiderations +&onitor % C.%and ulse freIuentlydurin' doseadFustment and

eriodically durin't!era y"X&onitor freIuencyof rescri tion refillsto determinecom liance"X &onitor 5ital si'nsand C. e5ery ?=1?min durin' and forse5eral !ours after

arenteraladministration" )f!eart rate >0 $ m%es ecially if cardiacout ut is alsodecreased%administer atro ine0"2?=0"? m' )P"X &onitor inta4e an

out ut ratios anddaily ei'!ts" ,ssessroutinely for si'nsand sym toms of K;(dys nea%rales/crac4les%ei'!t 'ain%

eri !eral edema% Fu'ular 5enousdistention*",n'ina+X,ssess freIuency

/0: NS. 111NCDe'lin% 8" K"% Pallerand% ," K"% V Sanos4i% C" ," (2010*" Davis's drug guide for nurses "

12t! ed" " !iladel !ia+ ; , Da5is Co"

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and c!aracteristics oan'inal attac4s

eriodically durin't!era y"

(References*De'lin% 8" K"% Pallerand% ," K"% VSanos4i% C" ," (2010*" Davis'sdrug guide for nurses "

(12t! ed"*"!iladel !ia+ ; , Da5is Co"

Drug3Drug.X.eneralanest!esia% )P

!enytoin% and5era amil maycause myocardial

Contraindications.ncom ensated K;

X ulmonary edemaXCardio'enic s!oc4X radycardia% !eart

$loc4% or sic4 sinu

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de ression"XConcurrent useit!am !etamines%cocaine% e !edrine%e ine !rine%nore ine !rine%

!enyle !rine% or seudoe !edrinemay result inuno osed al !a-adrener'icstimulation(eAcessi5e!y ertension%

$radycardia*"XConcurrentadministration oft!yroidadministrationmay effecti5eness"X&ay alter t!eeffecti5eness ofinsulins or oral!y o'lycemica'ents (doseadFustments may

$e necessary*"

X se cautiouslyit!in 1> days of&,E in!i$itor

syndrome (ina$sence of a

acema4er*"

De'lin% 8" K"% Pallerand% ," K"% V Sanos4i% C" ," (2010*" Davis's drug guide for nurses " (12t! ed"*" !iladel !ia+ ; , Da5is Co"

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Dose Range Client Dose Classi ication ndication andAction

Side * ects%Druginteractions


(ome&raIole"Pri/osec

PO: (Adults)GERD/erosiveesophagitis 20 mgon&e daily$ Duodenalulcers associated withH pylori 40 mg on&edaily in t*e morning,it* &larit*romy&in"or 2 , # t*en 20 mgon&e daily "or 2 , or20 mg t,i&e daily,it* &larit*romy&in500 mg t,i&e dailyand amo!i&illin 1000mg t,i&e daily "or 10days (i" ul&er ispresent at beginningo" t*erapy# &ontinueomepra8ole 20 mgdaily "or 1+ moredays ; *as also beenused ,it*&larit*romy&in andmetronida8ole$Gastric ulcer 40 mgon&e daily "or 4), $ Reduction of therisk of GI !leeding incritically ill patients40 mg initially# t*enanot*er 40 mg )+ *rlater# "ollo,ed by 40mg on&e daily "or upto 14 days$ Gastrichypersecretoryconditions )0 mgon&e daily initially;may be in&reased upto 120 mg . timesdaily (doses @+0mg/day s*ould be

20 m' E ca sule1@s daily

T!er" Class"antiulcer a'ents

!arm" Class" roton umin!i$itors

( Reference *Deglin@ )# H#@ ,allerand@A# H#@ Sanos7i@ C# A#( 010"# Davis's drug

guide for nurses # (1th ed#"#

Philadel&hia. F A Da2is

ndications.. RD/maintenanceof !ealin' in erosi5eeso !a'itis"XDuodenal ulcers( it! or it!out anti-infecti5es forKelico$acter ylori*"XS!ort-term treatmentof acti5e $eni'n'astric ulcer"X at!olo'ic!y ersecretoryconditions% includin'Yollin'er- llisonsyndrome"XReduction of ris4 of.) $leedin' incritically ill atients"ETC+XKeart$urn occurrin'

Zt ice/ 4"Actions.inds to an enJymeon 'astric arietalcells in t!e resenceof acidic 'astric K%

re5entin' t!e finaltrans ort of !ydro'enions into t!e 'astriclumen"

Side Effects :

CNS: di88iness#dro,siness# "atigue#*eada&*e# ,ea ness

CV: &*est pain

GI: a!do"inal pain #a&id regurgitation#&onstipation# diarr*ea#"latulen&e# nausea#vomiting

# and E:*ypomagnesemia(espe&ially i"treatment duration A.mo

De !: it&*ing# ras*

"S: bone "ra&ture

Drug3DrugXEme raJole ismeta$oliJed $y t!eCL >?0 enJymesystem and maycom ete it! ot!era'ents meta$oliJed

$y t!is system"X&ay si'nificantly effects of ataJana5irand nelfina5ir(concurrent use notrecommended*"X&ay ris4 of

$leedin' it!arfarin (monitor)NR/ T*"

Nu sin$Conside ations Bssess patientroutinely "or epigastri&or abdominal pain and"ran or o&&ult blood int*e stool# emesis# orgastri& aspirate$

Cont aindications BXKy ersensiti5ityX#actation+Discontinueome raJole ordiscontinue

$reastfeedin'"

se Cautiously in +X#i5er disease (dose may $e necessary*XE + #actation+ edi+Safety not esta$lis!edin re'nant or

$reastfeedin' omen%or c!ildren 1 yr X atients usin' !i'!-doses for U1 year (ris4 of !i % rist% ors ine fractures*"

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(tamsulosin*;lomaA

PO: (Adults) 0$4 mgon&e daily a"ter ameal; may be a"ter24 , to 0$+mg/day$

Refe ence:

eglin# C$ $#allerand# $ $# DEanos i# 3$ $(2010 $ Davis&s drugguide for nurses $ (12t* ed$ $*iladelp*iaB avis 3o$

0"> m' ca sule1 ca sule E 1@sdaily

T%e & Class&none assigned

P%a !& Class &perip*erally a&tingantiadrenergi&s

Indications :anagement o"out"lo, obstru&tion inmale patients ,it*prostati& *yperplasia$Actions:

e&reases&ontra&tions insmoot* mus&le o" t*eprostati& &apsule bypre"erentially bindingto alp*a 1-adrenergi&re&eptors$

T%e apeuticEffect(s):

e&reased symptomso" prostati&*yperplasia (urinaryurgen&y# *esitan&y#no&turia $

Side ffects+CNS: di''iness #headache

EENT: r*initis

CV: ort*ostati&*ypotension

GU: priapism#retrograde/diminis*ede?a&ulation

Drug3DrugXCimetidine may

$lood le5els and t!eris4 of toAicity"X ris4 of!y otension it!ot!er eri !erallyactin' anti-adrener'ics(doAaJosin% raJosin%teraJosin* concurrentuse s!ould $ea5oided"XStron' CL 3,>in!i$itors and

CL 2D6 in!i$itorsmay $lood le5els(concurrent uses!ould $e a5oided"

NursingConsiderations.,ssess atient forsym toms of rostatic!y er lasia (urinary!esitancy% feelin' ofincom lete $ladderem tyin'% interru tionof urinary stream%im airment of siJe andforce of urinarystream% terminalurinary dri$$lin'%strainin' to start flo %dysuria% ur'ency*

$efore and eriodically durin't!era y"X,ssess atient forfirst-dose ort!ostatic!y otension andsynco e" )ncidencemay $e dose related"E$ser5e atient

closely durin' t!is eriod and ta4e recautions to re5entinFury"X&onitor inta4e andout ut ratios and dailyei'!t% and assess foredema daily%es ecially at $e'innin'of t!era y" Re ortei'!t 'ain or edema"XRectal eAams rior tand eriodically

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t!rou'!out t!era y toassess rostate siJe arerecommended"Contraindications. Ky ersensiti5ity"se Cautiously in+X atients at ris4 for

rostate carcinoma(sym toms may $esimilar*X atients under'oin'cataract sur'ery ( ris4of intrao erati5eflo y iris syndrome*XSulfa aller'y"


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(t!era-m- lus*Cerne5it 12

E+ ,dult1 dose unitta$let% ca suleday or amountrecommended $yindi5idual manufac"

References+

De'lin% 8" K"% Pallerand%," K"% V Sanos4i% C" ,"(2010*" Davis's drug

guide for nurses " (12t! ed"*"

!iladel !ia+ ; , Da5isCo"

1 ta$let E 1@sdaily it! $rea4fast

&ulti-5itamin ndications +E+ Treatment and

re5ention of 5itamindeficiencies" S ecialformulations area5aila$le for atientsit! articular needs%includin'+ [ renatal

multi le 5itamins( it! lar'er doses offolic acid*%[ reconce tionalmulti le 5itamins%[&ulti le 5itaminsit! iron%[&ulti le 5itaminsit! fluoride%[&ulti le 5itaminsit! ot!er mineralsor trace elements"

,ctions+XContain fat-solu$le5itamins (,% D% and* and most ater-solu$le 5itamins ( -com leA 5itamins1% 2% 3% ?% 6%12% 5itamin C%

$iotin% and folicacid*" T!ese 5itaminsare a di5erse 'rou ofcom oundsnecessary for normal'ro t! andde5elo ment" &any

Side * ects +)n recommendeddoses% ad5ersereactions areeAtremely rare

. + urinediscoloration

( re arations it! 5itamins*

&isc+ aller'icreactions to

reser5ati5es%additi5es% orcolorantsD u$'D u$

Large amounts o"vitamin 6 mayinter"ere ,it* t*ebene"i&ial e""e&t o"levodopa $

Nursin'Considerations +ssess patient "or signso" nutritional de"i&ien&ybe"ore and t*roug*outt*erapy$ atients atris in&lude geriatri&patients and t*ose ,*oare debilitated# burned#or unable to ta e oralnutrition and t*ose,it* malabsorptionsyndromes or &*roni&al&o*olism$

To icit O*e dose:o!i&ity rarely o&&urs,it* multivitaminpreparations be&auseo" t*e small amountsper unit o" "at-solublevitamins$ orsymptoms# seeindividual vitaminentries$

'" overdose o&&urs#treatment in&ludesindu&tion o" emesis orgastri& lavage# &al&iumglu&onate ' i"*ypo&al&emi andmaintenan&e o" *ig*urine output$

Cont aindications Bssess patient "or signso" nutritional de"i&ien&ybe"ore and t*roug*outt*erapy$ atients atris in&lude geriatri&patients and t*ose ,*oare debilitated# burned#or unable to ta e oralnutrition and t*ose

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http://www.drugguide.com/ddo/ub/view/Davis-Drug-Guide/51444/all/carbidopa_levodopahttp://www.drugguide.com/ddo/ub/view/Davis-Drug-Guide/51444/all/carbidopa_levodopa

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act as coenJymes orcatalysts in numerousmeta$olic rocesses"X#iIuid roducts donot contain folic acid"

+hera&eutic* ect(s".X E+ re5ention ofdeficiency orre lacement in

atients !osenutritional status isIuestiona$le"X)P+ Re lacement in

atients !o areuna$le to in'est oralfeedin's or 5itamins"

,it* malabsorptionsyndromes or &*roni&al&o*olism$

To icit O*e dose:o!i&ity rarely o&&urs,it* multivitaminpreparations be&auseo" t*e small amountsper unit o" "at-solublevitamins$ orsymptoms# seeindividual vitaminentries$

'" overdose o&&urs#treatment in&ludesindu&tion o" emesis or

gastri& lavage# &al&iumglu&onate ' i"*ypo&al&emi andmaintenan&e o" *ig*urine output$


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lantano&rost(?alatan"

1 dro of 0"00?solution once dailyin t!e e5enin'

1 dro 2@s daily in $ot! eyes

rosta'landin &ana'ement ofo en-an'le 'laucoma(increase of outfloof aIueous !umor*

#ocal irritation%forei'n $odysensation% increaseeyelas! 'ro t!%increase $ro n

i'mentation in iris

t" s!ould as! $ot!!ands $efore eac! useof DorJolamide or anyot!er eye medicationto re5entcontamination of t!eeye" Contact lensess!ould $e remo5ed"T!e !ead is tilted

$ac4% and t!e lo ereyelid is ulled do nit! t!e indeA fin'erto form a ouc!" T!e

$ottle is sIueeJedsli'!tly to allo t!e

rescri$ed \ of dro sinto t!e ouc!" T!e tiof t!e dro er s!ouldnot touc! t!e eye oreyelid" T!e eye t!en isclosed 'ently for oneto t o minutesit!out $lin4in'"


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Attach a medication in ormation sheet including generic and trade name@ classi ication@ dosage range@ route@ indication and actions@ contraindications@side e ects@ drug interactions@ and nursing considerations and contraindications#





(sertraline"Jolo t

De ression/ECD

E+ (,dults* ?0m'/day as a sin'ledose in t!e mornin'or e5enin' initiallyafter se5eral ee4smay $e at ee4lyinter5als u to 200m'/day% de endin'on res onse"

E+ (C!ildren 13=1:yr*+ ECD=?0 m'once daily"

E+ (C!ildren 6=12yr*+ ECD=2? m'once daily"

anic Disorder

E+ (,dults* 2?m'/day initially% may after 1 4 to ?0m'/day"

TSD

E+ (,dults* 2? m'once daily for :days% t!en to ?0 m'once daily may t!en

?0 m' 1 ta$let E1@s daily

Re erences.

De'lin% 8" K"% Pallerand%," K"% V Sanos4i% C" ,"(2010*" Davis's drug

guide for nurses " (12t! ed"*"

!iladel !ia+ ; , Da5isCo"

T!er" Class"antide ressants

!arm" Class "selecti5e serotoninreu ta4e in!i$itorsSSR)s

ndications.X&aFor de ressi5edisorder"X anic disorder"XE$sessi5e-com ulsi5e disorder(ECD*"X ost-traumatic stressdisorder ( TSD*"XSocial anAietydisorder (social

!o$ia*"X remenstrualdys !oric disorder( &DD*"

Actions.)n!i$its neuronalu ta4e of serotoninin t!e CNS% t!us

otentiatin' t!e

acti5ity of serotonin"Kas little effect onnore ine !rine ordo amine"

T!era euticffect(s*+X,ntide ressantaction"XDecreased incidenceof anic attac4s"XDecreased o$sessi5e

Side e ects +

Drug3DrugX Serious% otentiallyfatal reactions(!y ert!ermia%ri'idity% myoclonus%autonomic insta$ility%it! fluctuatin' 5italsi'ns and eAtremea'itation% !ic! may

roceed to deliriumand coma* may occurit! concurrent&,E in!i$itors"&,E in!i$itorss!ould $e sto ed atleast 1> days $eforesertraline t!era y"Sertraline s!ould $esto ed at least 1>

days $efore &,Ein!i$itor t!era y"X&ay imoJidele5els and t!e ris4 of

otentially life-t!reatenin'cardio5ascularreactions"XDru's t!at affectserotoner'icneurotransmittersystems% includin'

NursingConsiderations +,ssess for suicidaltendencies% es eciallydurin' early t!era y"Restrict amount ofdru' a5aila$le to

atient" Ris4 may $eincreased in c!ildren%adolescents% and adu]2> yr" ,fter startin't!era y% c!ildren%adolescents% andyoun' adults s!ould

$e seen $y !ealt! care rofessional at least

ee4ly for > 4%e5ery 3 4 for neAt >4% and on ad5ice of!ealt! care

rofessional t!ereafter"

X&onitor a etite andnutritional inta4e"

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$e if needed atinter5als of at least :days (ran'e ?0=200m' once daily*"

Social ,nAietyDisorder

E+ (,dults* 2? m'once daily initially%t!en ?0 m' oncedaily may $e atee4ly inter5als uto 200 m'/day"

&DD

E+ (,dults* ?0m'/day initiallyeit!er daily or dailydurin' luteal !aseof cycle" Dailydosin' may $etitrated u ard in?0-m' increments att!e $e'innin' of acycle" )n luteal

!ase=only dosin' a?0 m'/day titration

ste for 3 days at t!e $e'innin' of eac!luteal !ase dosin'

eriod s!ould $eused (ran'e ?0=1?0m'/day*"

and com ulsi5e $e!a5ior"XDecreased feelin'sof intense fear%!el lessness% or!orror"XDecreased socialanAiety"XDecrease in

remenstrualdys !oria"

lineJolid% tramadol%tri tans% and fentanyl ris4 of serotoninsyndrome"X&ay sensiti5ity toadrener'ics and t!eris4 of serotoninsyndrome"XConcurrent use it!alco!ol is notrecommended"XCimetidine $loodle5els and effects"

Dru'-Naturalroducts+

ris4 of serotiner'icside effects includin'serotonin syndromeit! St" 8o!n s ortand S,&e"

!allucinations% comaautonomic insta$ility^tac!ycardia% la$ile% !y ert!ermia %

neuromusculara$errations ^!y er-refleAia%incoordination % and/.) sym toms ^nausea%5omitin'% diarr!ea *%es ecially in atientsta4in' ot!erserotoner'ic dru's(SSR)s% SNR)s%tri tans*"

Contraindications.XKy ersensiti5ityXConcurrent &,Ein!i$itor t!era y (mayresult in serious%

otentially fatalreactions*XConcurrent imoJideXEral concentratecontains alco!ola5oid in atients it!4no n intolerance"

se Cautiously in+XSe5ere !e atic orrenal im airmentX atients it! a!istory of maniaXKistory of suicideattem t


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Attach a medication in ormation sheet including generic and trade name@ classi ication@ dosage range@ route@ indication and actions@ contraindications@side e ects@ drug interactions@ and nursing considerations and contraindications#





(DorIolamide"+imolol

Not to eAceed moret!an > dro s dailyeac! eye

1 dro eac! eye2@s daily

Car$onic an!ydrasein!i$itor

Indications:anagement o" open-angle glau&oma orot*er "orms o" o&ular*ypertension ( "ormation o" aqueous*umor $

Actions:

Side e ects.Eystemi& absorptionmay result in adverse&ardiovas&ular and3>E rea&tions(espe&ially in patients,it* &ardiovas&ular

disease ; avoid use inpatients predisposedto a&ute angle-&losureglau&oma$D u$ to D u$ BF*en used ,it* ot*ereye drops "or redu&ingintrao&ular pressure#administration o" bot*drugs s*ould beseparated by at least10 minutes$

t" s!ould as! $ot!!ands $efore eac! useof t!is dru'" To

re5ent contaminationof t!e eye do not toucti of eye drocontainer to surface oft!e eye or any ot!ersurface" Ta4e contactlenses out $eforea lyin' eye dro s"Close eye for one tot o minutes aftera lyin' dru' it!out

$lin4in'"


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N'RS NG CAR* AND +R*A+ *N+S

*4am&les o treatments. Dressings@ irrigations@ incenti2e s&irometer@ CP a&&lication@A, or SCD !oots@ s&lints

1* Pitals daily+ com are it! $aseline*2* S4in assessment daily+ assess for ressure ulcers% s4in irritation% lesions% etc"*3* ain scale daily+ assess t" le5el of ain*>* Dressin' c!an'e daily left !eal ressure ulcer resent

a" Aerofom 'auJe lus $anda'e daily until !ealed $" air $oot to $e a lied to left foot !ile in $ed

?* ressure reduced mattress+ re5entati5e measure used to reduce incidence of ressure ulcers

6*

9* S!o er c!air for assistance !en $at!in'

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Nursing Diagnosis. 1" Ris4 for as iration and ineffecti5e air ay clearance r/t im aireds allo in' from neuromuscular dysfunction

,alidating Assessment Factors. (T!is is to REP t!at a Nursin' Dia'nosis is necessary to resol5e t!is ro$lem"*

t" self-re orts difficulty s allo in' food and liIuid due to re5ious incidence of

&) 0:/200:" C!art reflects incidence of as iration initiatin' fall resultin' in ri'!t!i fracture 06/2013" t" self-re orts incident as r/t ineffecti5e air ay clearancedue to as iration and ina$ility to s allo effecti5ely" C!art reflects t!era yinitiated it! s eec! t!era ist 06/2013 to increase t" a$ility to effecti5ely s alloand re5ent as iration" C!art reflects t" attended t!era y 2@s ee4ly and

ro'ress as noted as ositi5e" t" states !e declined to continue to attend s eec!t!era y 10/2013% statin' !e did not feel li4e it as effecti5e alt!ou'! !e continuesto eA erience im aired s allo in' a$ility" C!art reflects !ysicians reIuest !econtinue s eec! t!era y to aid in t" a$ility to effecti5ely s allo and re5entcurrent and future as iration e isodes" t" self-re orts non-com liance to attends eec! t!era y"

Goal. t" ill eA ress understandin' of t!e need to resume s eec! t!era y to aid inincreased a$ility to s allo t!us re5entin' current and future as iration e isodesand recommence t!era y sessions $y end day"

Actions 6ith rationale. (&inimum of t!ree*

1" ncoura'e t" to eA ress current attitude concernin' ast eA erience it!s eec! t!era y in5ol5ement and t"s reasons for non-com liance",llo in' t" to eA ress feelin's concernin' unsatisfactory results relatin' to

ro'ress of increased s allo in' a$ility and !is lac4 of need to continuet!era y ac4no led'es t" concerns and aids in $etter understandin' ofreasons for non-com liance to t!era y"

2" ducate t" on im ortance of attendin' s eec! t!era y to im ro5es allo in' a$ility and decrease incidences of as iration t!at can lead tofuture accidents and inFuries" Communicate to t" t!e ris4s r/t as irationsconcernin' restricted air ay clearance and ina$ility to $e a$le to $reat!e t!atcan lead to increased falls and ossi$ly deat!" Ka5e t" re eat and relate toeducation tau'!t and si'nificance of increasin' s allo in' a$ility"

3" resent ossi$le resolutions and modifications to t"s concerns re'ardin'incon5enient t!era y times and eAcessi5e ee4ly t!era y a ointments t!at

t" states is often o5er !elmin' and tedious" ncoura'e t" to ro osedesira$le adFustments a lica$le t!at ould increase !is desire to resumeand artici ate roducti5ely in t!era y" roducti5ely in5ol5in' t"s

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su''estions to modify !is concerns re'ardin' t!era y to aid in meetin' !is ersonal needs romotes t" to as ire roducti5ely artici ate int!era eutical re!a$ilitation" )n addition% t!is confirms to t!e t" t!at !isconcerns are 5alid" Contact s eec! t!era ist to discuss t" concerns" )nstruct

t" on !o to contact s eec! t!era ist to resume needed s eec! t!era y andencoura'e t" to address concerns stated for non-com liance to s eec!t!era ist to aid in ossi$le modifications discussed"

*2aluation.(

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('S* S*PARA+* SH**+ F-R *ACH N'RS NG D AGN-S S"

Nursing Diagnosis . C!ronic ain r/t !i fracture 06/2013 , t" self-states ainle5el on scale of 0-10 at : and often recorded in c!art 9

,alidating Assessment Factors.(T!is is to REP t!at a Nursin' Dia'nosis is necessary to resol5e t!is ro$lem"*

t" self -states ain le5el on scale of 0-10 at :" C!art reflects t" suffered a fall t!atresulted in a fracture of t!e roAimal femur $one to ri'!t lo er eAtremity (!ifracture* 06/2013" t" states ina$ility to $are ei'!t on ri'!t le' due to ain in ri'!t!i and u er ri'!t le'" t"s a$ility to am$ulate currently is restricted to!eelc!air mo$ility only" t" states ain intensity often a a4ens !im at ni'!t anddisru ts !is normal slee atterns" t" currently attends re!a$ilitation !ysicalt!era y 2@s ee4ly" C!art reflects t" !ysical t!era y results as slo

ro'ression7 due to t" com laints of ain in ri'!t le' !en attem tin' to erformt!era eutic eAercises" C!art reflects additional factor in t!e slo ro'ress of t

!ysical t!era y results is r/t t!e t" un illin'ness to ro'ressi5ely increase RE&

or attem t to $ear any ei'!t on ri'!t le'" t" !as im aired a$ility to s allo roducti5ely resultin' in decreased a$ility to consume needed nutrients for ro er $one !ealin' c!art recordin' states t" current ei'!t reflects a ei'!t loss of >0l$s" since admission% !o e5er% t" !as resumed to 'radually 'ainin' ei'!t in t!elast mont!"

Goal. 11/1:/2013 t" ill self-re ort t!e im ortance of consumin' needed caloriesand nutrients to romote !ealt!y $one !ealin'" t" ill eAercise non- !armacolo'icinter5entions to relie5e ain" t" ill eA ress and self-re ort ays to eAerciseoutside of !ysical t!era y sessions t!us increasin' muscle stren't! and increasin'am$ulation" t" ill eA ress decrease in ain le5el from current ain le5el of : toless t!an or eIual to ? usin' ain scale 0-10" t" t" ill com lete 'oals $y11/19/2013

Actions 6ith rationale . (&inimum of t!ree*

1" ,ssess t" current diet" ,ssess foods t!at a eal to t" or t!at t" refers to

eat" ducate t" on t!e im ortance of consumin' adeIuate calories andnutrients to aid in ro er !ealin' of t" $ones" A ress consumin' foods !i'!in calcium and ma'nesium li4e s4im mil4% yo'urt% $roccoli% carrots andoatmeal can increase $one !ealin'" .i5e t" list of foods t!at romote $one!ealin' so t" can c!oose foods on list to add or su$stitute in !is current diet"A lain to t" t!ese foods also romote !ealt!y $ody tissue formation andit! eAercise can romote increase in muscle mass and can contri$ute toincreasin' stren't! in !is left le'"

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ei'!t to assess if furt!er ei'!t loss attern is recurrin' Contact dietitian tomeet it! t" to !el it! meal lannin' to add foods su''ested" Ka5e t"re eat teac!in' and understandin'"

2" ,ssess t" current re'ime for eAercise !en not in !ysical t!era y" ducate t" on non- !armacolo'ic met!ods to relie5e ain" A lain t!at listenin' tomusic t" enFoys or mental ima'ery eAercises can decrease ain sensations", lyin' !eat/cold can aid to relie5e ain and ele5ation or re ositionin' cansometimes relie5e ain" .i5e t" instructions on ays to eAercise!ile sittin' in !eelc!air $y doin' small le' lifts" A lain t!at t!is ill

$uild muscle 'radually it!out eAcessi5e ei'!t $arin' to le'" Ka5e t"re eat learnin' and demonstrate !eelc!air eAercises and non-

!armacolo'ic ain relie5in' eAercises"3" ,ssess ain le5el !ile erformin' eAercise in t!era y and outside of

t!era y" ,ssess location% Iuality and Iuantity of ain" ,ssess !en and if ain is more or less at different occurrences or times of day" ducate t!e t"on ro er communication of eA ressin' ain" ncoura'e t" to 4ee a diaryof ain scale recordin's to com are if ain is increasin' or declinin'"

ducate t" to re ort increasin' attern of ain to !ealt! care ro5ider"

*2aluation.(

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Nursing Diagnosis . Ris4 for fall+ Ris4 factor+ im aired !ysical mo$ility in lo ereAtremity r/t ain due to ri'!t !i fracture and !istory of falls

,alidating Assessment Factors.(T!is is to REP t!at a Nursin' Dia'nosis is necessary to resol5e t!is ro$lem"*

t" is una$le to erform daily ,D#s it!out full !uman assistance" t" suffered afall resultin' in ri'!t !i fracture 06/2013" t" is una$le to am$ulate use of !eelc!air for mo$ility" t" self-re orts ina$ility to stand or $are any ei'!t on ri'!tle'" t" needs full assistance for transferrin' from $ed to c!air% !eelc!air to toilet%and ta4in' s!o er usin' s!o er c!air" C!art reflects am$ulation as 1 on scale of 1-> and transferrin' as a 1 on scale of 1-> Ecto$er 2013"

Goal. 11% 0% 01K t" ill remain free of falls" t" ill understand and recite t!eim ortance to o$tain assistance !en need arises to am$ulate" t" ill understand%demonstrate% and recite safety recautions for o eratin' !eelc!air" t" ill meet'oal $y end of day"

Actions 6ith rationale. (&inimum of t!ree*

1" Teac! t" im ortance of o$tainin' !uman assistance !en assistance isneeded in all ,D#s to minimiJe incidence of falls and inFury" Teac! t" notto attem t to am$ulate it!out assistance eA lainin' t!is could cause furt!erinFury to eAistin' ri'!t !i fracture and in addition could also result inaddition inFuries"

2" ducate t" on ro er use of !eelc!air" Teac! t" !en not mo$ile to ma4esure !eel $rea4s are in loc4ed osition" Teac! !ile mo$ile in !eelc!air

ay s ecial attention to s illed su$stance or et floors t!at could cause!eels to sli or !eelc!air to slide and ossi$ly fli o5er causin' inFury"Teac! t" to ne5er attem t to na5i'ate stee slo es alone and do not try toreac! for an o$Fect if you !a5e to mo5e to t!e ed'e of t!e seat to reac! it" )n

addition to t!is% teac! t" not to reac! for an o$Fect $et een your le's"A lain t!at t!ese acti5ities may cause you to fall out of your c!air and on tot!e floor" Ka5e t" re eat and demonstrate learnin'"

3" Ka5e call li'!t assessa$le at all times so t" can alert staff !en in need ofassistance" T!is ill re5ent incidents of t" falls" &a4e sure at all-times t"!as c!air and $ed monitor alarms resent and o eratin' ro erly to notifystaff !en/if t" !as fallen or is attem tin' to am$ulate it!out assistance"

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*2aluation.(

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R ; R NC S

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pt. 2 med surg

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