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

• Furosemide 20 mg/day PO
• Digoxin 0.125 mg/day PO
• Warfarin 5 mg/day PO
• Acetaminophen 325 mg q6h PO prn for pain
• 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

1. Furosemide is a LASIX

THERAPEUTIC ACTION :

antihypertensive

PHARMACOLOGIC

loop-or-high-ceiling type diuretics

USED FOR:

Acute edema associated w liver cirrhosis, renal impairment, or HF

MECHANISM OF ACTION -prevents the reabsorption of sodium & chloride by blocking the symporter in the loop of henele

ADVERSE EFFECTS

Dehydration, electrolyte imbalance can cause dystythmias. Dizziness & syncope due to hypertension. May cause metabolic alkalosis.

CONTRAINDICATIONS

Hypotension

Hypovolemia

Anuresis

Hepatic coma

Hypersensitivity

NURSING IMPLEMENTATION :

Assess the vitals of the patient

Monitor intake and output

Monitor potassium loss and assess ECG changes

Monitor for weight loss and hearing problems

Teach patient to report hearing loss or gout symptoms

Teach patient to take medication early in day to reduce chances of nocturia

PATIENT TEACHING :

Teach patient to get up out the bed slowly to avoid fall due to hypotension

Teach patient to report dizziness

Teach patient to monitor weight regularly

Teach patient the side effects of the drug and when to reach the physician .

Advice patient to take plenty of fluids

2. Digoxin is LANOXIN

ACTION

increases the force of myocardial contraction

prolongs refractory period of the AV node

decreases conduction through SA & AV nodes

THERAPEUTIC EFFECT :

increased cardiac output ( positive inotropic effect) & slowing of the heart rate ( negative chronotropic effect)

CONTRAINDICATION :

hypersensitivity

uncontrolled ventricular arrhythmias

av block ( in absence of pacemaker)

idiopathic hypertrophic subaortic stenosis

constructive pericarditis

known ETOH intolerance (elixir only)

SIDE EFFECTS:

Fatigue

Arrhythmias

Bradycardia

Anorexia

Nausea

Vomiting

Yellow or green vision

Blurred vision

Electrolyte imbalance with acute digoxin toxicity

Nursing consideration:

MONITOR APICAL PULSE FOR 1 FULL MINUTE BEFORE ADMINISTERING.

WITHHOLD DOSE & NOTIFY HCP IF PULSE < 60.

ALSO NOTIFY HCP PROMPTLY OF ANY SIGNIFICATION CHANGES IN RATE, RHYTHM , OR QUALITY OF PULSE

Patient and family teaching

instruct pt to take medication as directed, at the same time each day.

teach pt how to accurately measure medication .

take missed dose within 12 hrs of scheduled dose or omit. do not double doses.

consult HCP if doses for 2 or more days are missed. do not d/c med w/o consulting HCP

Teach pt to take pulse & to contact HCP before taking med if pulse < 60 or > 100.

Review signs and symptoms of digoxin toxicity with patient. Advise patient to call HCP immediately if theses symptoms or symptoms of CHF occur.

Inform pt that these symptoms may be mistaken for cold or flu

Instruct pt to keep in original container and not to mix with other pills

caution pt avoid concurrent use of RX, OTC & herbal products w/o consulting HCP

advise pt to avoid taking antacids or antidiarrheals within 2 hours of digoxin

pt should carry ID describing disease process & medication regimen at all times

3. Warfarin is COUMADIN

CLASS :

Anticoagulant

ACTION:

Inhibits clotting of the blood

SIDE EFFECTS :

Bleeding

Cramps

Dermal necrosis

Fever

Nausea

NURSING IMPLICATIONS:

- assess for signs of bleeding and hemorrhage

- assess for evidence of additional or increased thrombosis

- monitor pt, inr during therapy

Monitor still and urine for occult blood

PATIENT TEACHING :

Limit vitamin k intake

Soft toothbrush

Electric shaver

Take med as directed take missed doses ASAP

Report unusual bleeding and bruising

CONTRINDICATIONS :

Uncontrolled bleeding;

Open wounds;

Active ulcer disease;

Recent brain, eye, or spinal cord injury or surgery;

Severe liver or kidney disease;

Uncontrolled hypertension;

OB: Crosses placenta and may cause fatal hemorrhage in the fetus. May also cause congenital malformation.

4. Acetaminophen is PARACETAMOL( Tylenol)

CLASS :

Central analgesic, non-narcotic analgesic, antypyretic

ACTION :

Appears to inhibit prostaglandin synthesis in the CNS and, to a lesser extent, block pain impulses through peripheral action. acts centrally on hypothalmic heat-regulating center, producing peripheral vasodilation.

CONTRAINDICATIONS :

Active alcoholism, hepatic disease, viral hepatitis, all of which increase the risk of hepatoxicity.

SIDE EFFECTS:

Hypersensitivity reaction

NURSING IMPLICATIONS:

If given for analgesia, assess onset, type, location, duration of pain. Effect of medication is reduced if full pain response recurs prior to next dose

Assess for fever, alcohol usage.

Assess for clinical improvement and relief of pain, fever. severe pain or fever may indicate serious illness. advise not to take more than 4 g/24h period.

PATIENT TEACHING :

Advice patient not to take alcohol

Advice patient not to take more than 4 doses a day

Teach patients side effects of the drug and when to reach the physician in case of emergency