Question

please complete the case study questionnaires for Care Plan  homework

Critical Thinking and Nursing Practice

Nursing Care Plan/homework

Part A

Maria J., an 86-year-old, has a history of cerebrovascular accident (CVA), 3 years ago. She has right sided weakness and expressive aphasia with minimal dysphagia. Maria J. also has a medical history of atrial fibrillation and hypertension. She lives with her daughter since the stroke. Since admission to an acute care facility 4 days ago, Maria J. has gained some strength, has become more oriented to person and place, and is anxious to start her rehabilitation program.

Admission orders to the rehabilitation hospital.

Admission Orders

• Zolpidem 5 mg PO at bedtime prn for sleep
• Diet: mechanical soft, low sodium with ground meat
• Foley catheter to gravity drainage, and then begin bladder training
• Referrals for speech therapy, occupational therapy, and physical therapy to evaluate and treat swallowing, communication, and functional abilities
• During the interdisciplinary care conference, you reported the plan is in progress to discontinue the indwelling Foley catheter if Maria J.‘s mobility and communication abilities have progressed. The group agrees to the plan as long as bladder training is in progress prior to removal of the Foley catheter.

1. Provide the following information for each of the drugs listed above.
   1. Classification
   2. Contraindication
   3. Action
   4. Major side/adverse effects (3-10)
   5. Nursing implication/management (3-7)
   6. Patient teaching (2-5)
2. Which lab orders would you anticipate as a result of this specific list of orders? Provide a rationale for each response. (list at least 5)
3. Identify four problems (nursing diagnosis) that Maria H. is at risk for developing after the removal of her Foley catheter. Then provide specific nursing interventions for each problem.
4. Identify 3 nursing diagnosis based on subjective and objective data presented in the case study.
5. Three days after discontinuing the Foley catheter, you noted that Maria J. urine is cloudy and concentrated and malodorous.   What are your immediate actions? (list at least 4)
6. Maria J. is started on sulfamethoxazole 800mg/trimethoprim 160 mg, 1 tab PO twice a day for 10 days. However, 2 days later, she is in the bathroom and is very upset. She has just voided; there is blood on the toilet, and the water is bright red with blood. You help the UAP clean her and put her back to bed. Describe your assessment steps. (List at least 4).
7. Identify at least 3 possible causes of Maria J.’s hematuria.
8. Using SBAR, what information would you provide to the HCP when you call?
9. Maria J.’s HCP changes her antibiotic to oral ciprofloxacin and holds the warfarin for 2 days. Two days later, Maria’s urinary tract infection is responding to antibiotics and she has had no further hematuria. You need to prepare for possible discharge. What specific issues must be considered in the teaching and discharge planning to prevent a recurrence of infection? (List at least 3 with rationale for each).
10. You discuss with Maria and her daughter how certain foods and drinks may irritate the bladder and should be avoided. (List at least 4)

Answer 1

Answer a: Classification of drug: The drug Zolpidem belongs to class of drug called sedatives or hypnotics. These drugs are being used in the treatment of severe sleep disorder i.e. insomnia.

Answer b: Contraindication: This class of the drug should not be used in the patient who is suffering from a severe hepatic problem as it may cause encephalopathy and it is also contraindicated in lactation.

Answer c: Action: The mechanism of action of the drug is that it act on GABA receptors that are present in the brain. They target specifically the GABA-A receptors which cause the release of a neurotransmitter in the brain known as GABA.

Answer d: Side effects:

1. Dry mouth
2. Nausea
3. Diarrhea
4. Weakness

Answer e: The nursing implication consists of that withdrawing of the drug gradually if the patient has used drug long-term. Nurse should assess respiratory function in patients, monitor the level of depression etc.

Answer f: Patient teachings include that drug should be taken only the amount that has been prescribed and should not consume for long duration. If any kind of major side effects occurs such as dry mouth, rashes, immediately report to the physician. Avoid taking alcohol or other CNS depressants.