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

• asprin
• 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.CVA stands for cerebrovascular accident or "stroke" .It is a sudden death of brain cells due to lack of oxygen and blood flow
- circulation to the brain is impaired by blockage or rupture of the artery to the brain
The blockage may be due to a clot or piece of atherosclerotic plaque.'sudden death of brain cells due to lack of oxygen and blood flow
left sided brain damage ---> symptoms on the right side of the body.

Suppose if CVA is on the left side of the brain results in:
- right-sided hemiplegia or contralateral hemiparesis

1.CVA stands for cerebrovascular accident or "stroke".It is a sudden death of brain cells due to lack of oxygen and blood flow
- circulation to the brain is impaired by blockage or rupture of the artery to the brain
The blockage may be due to a clot or piece of atherosclerotic plaque.'sudden death of brain cells due to lack of oxygen and blood flow
left sided brain damage ---> symptoms on the right side of the body.

Suppose if CVA is on the left side of the brain results in:
- right-sided hemiplegia or contralateral hemiparesis
- language & verbal skill problems: aphasia (know what's happening but can't express), agraphia (writing), Alexia (reading)
- right visual field deficit
- apraxia (can't do skilled movements
- difficult w/ problem solving
- aware of neuro deficits (frustrating)
- intellectual impairment
- slow, cautious
- anxious, depressed, worries
- feels worthless; a sense of guilt
- body disorientation (can't identify the body parts)
*profits from non-verbal instruction

-show them how to do things ex. demonstrate how to eat.

Aspirin:

Aspirin is known as a salicylate and is a nonsteroidal anti-inflammatory drug (NSAID).

Contraindications:

- allergic to aspirin or any other pain reliever/fever reducer(salicylate)

• systemic mastocytosis
• Inadequate Vitamin K
• Gout
• Anemia
• Hemophilia
• The decrease in the Blood-Clotting Protein Prothrombin
• Blood Clotting Disorder - Von Willebrand's Disease
• Decreased Blood Platelets
• alcoholism
• Reye's Syndrome
• Thrombotic Thrombocytopenic Purpura
• Presence of Polyps in the Nose
• Ulcer from Stomach Acid
• Stomach or Intestinal Ulcer
• Damage to Stomach Lining
• liver problems
• Bleeding of the Stomach or Intestines
• kidney disease with a reduction in kidney function
• pregnancy
• a mother who is producing milk and breastfeeding
• Anemia from Pyruvate Kinase and G6PD Deficiencies
• aspirin-exacerbated respiratory disease
• Active peptic ulcer
• Hypoprothrombinemia or other coagulation disorders.

• Action:

  Aspirin's effects and respective mechanisms of action vary with dose:

  - decreases inflammation
  - blocks pain impulses in the central nervous system
  - dilates peripheral vessels
  - decreases platelet aggregation

Side effects:

• heartburn or indigestion
• mild-to-moderate abdominal or stomach cramps, pain, or discomfort
• nausea
• buzzing or ringing in ears
• severe or continuing abdominal or stomach pain, cramping, or burning
• signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• vomiting
• hearing loss
• signs of bleeding in the stomach (e.g., bloody, black, or tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Nursing implications or management:

higher risk of hypersensitivity in patients with asthma, allergies, nasal polyps or who are allergic to tartrazine
- assess pain, fever
- monitor hepatic function: AST, ALT, D/C when severe abnormalities or active liver disease and use with caution in the future
- signs of toxicity or overdose: tinnitus, headache, hyperventilation, agitation, mental confusion, lethargy, diarrhea, and sweating => withhold medication and notify it to the physician.

Patient education:

• Do not use more than directed.
• Do not stop taking this medicine unless told by the doctor.
•   It is best to take this medicine with food or milk.
• Capsule, tablet, or coated tablet: Swallow whole. Do not crush, break or chew it. • Swallow the extended-release capsule whole. Do not crush, break or chew it.
• Take the capsule with a full glass of water at the same time each day.
• Missed dose: If you miss a dose of, skip the missed dose and go back to your regular dosing schedule. Do not take extra medicine to make up for a missed dose.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

2.Lab orders:

CT is the primary diagnostic test used after a stroke, without contrast can determine if it is a stroke and what kind of stoke and will let you know how to treat them
- CT should be obtained within 25 minutes and read within 45 minutes of arrival at ER
- CT will Indicate the size and location of the lesion and differentiate between ischemic and hemorrhagic stroke
Other studies
- Cerebral angiography
- Digital subtraction angiography
- Transcranial Doppler ultrasonography
- Lumbar puncture
- LICOX system
- Cardiac imaging

To confirm the site and type of stroke

3.Nursing diagnosis(after removal of Foley's catheter)

*impaired urinary elimination related removal of foleys catheter(retention)

*Urinary retention related to fear

* self-care deficit related to weakness

*knowledge deficit related to self -toileting

Interventions:

*Encourage or enhance the patient for self void

*Encourage her to take adequate amount of fluid to prevent urinary retention

*Encourage her activity or self-mobility

*Educate her regarding the importance of self-voiding and effects of foleys for a long time

4.Nursing diagnosis based on objective and subjective data:

*Impaired physical mobility due to weakness

*Impaired verbal communication related to aphasia

*Risk for impaired swallowing related to dysphagia

5.The data shows that the patient is having urinary tract infection:

• Assess for the discomfort of the patient
• Immediately notify it to the physician
• Administer antibiotics as prescribed
• Encourage her to take an adequate amount of fluids

6.

• Assess for the signs and symptoms of sepsis
• Monitor the vital signs frequently
• .Assess for the type and color and amount of blood in urine
• Assess whether the patient is stable or not

7. One of the main cause for his hematuria is her Urinary tract infection

it may be due to the inflammation of the bladder wall during the removal of the catheter

It may be from a wound that results from itching or scratching at the urethral orifice related to urinary tract infection

8 S: 2 days onwards after her foleys removal when 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.

B: 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.

A: I am suspecting she is having UTI induced hematuria, but I am not sure

R: Is there anything I need to do in the meantime such as administration of fluids or starting of some medications

9.Educate the family members regarding the practice of good personal hygiene to prevent the occurrence of infection

Encourage them to drink plenty of fluids to prevent the recurrence of infection

Encourage to empty the bladder completely as soon as she feels the urge, or at least every three hours to avoid bacterial occlusion in the bladder.

10. Certain foods and beverages might irritate your bladder, including:

• Alcohol.
• Red meat.
• Dairy products.
• Caffeine, which decreases the blood flow to the bladder, making it more difficult for your immune system to shut down infections.
• Corn, and corn-fed animals (including fish)
• Potatoes, wheat, and rice, which break down to sugar in your body.
• Certain acidic fruits — oranges, grapefruits, lemons and limes — and fruit juices.