case pre.docx
TRANSCRIPT
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CENTRAL LUZONS DOCTORS HOSPITAL E-I
SAN PABLO, TARLAC CITY
IN PARTIAL FULFILLMENT IN NCM 102
CASE STUDY IN SURGICAL WARD
PRESENTED BY:
Cherry Tabucol
Nova Ibarra
Tina Caryl Corpuz
Everlasting Silverio
Jerami Carreon
Mark Chris Garbin
Irish Antonio
PRESENTED TO:
Angelina Sibug RN, MSN
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TABLE OF CONTENTS
I. INTRODUCTION Significance/ relevance to the concept
II. OBJECTIVEIII. NURSING HEALTH HISTORY
Biographical Information Reasons for Seeking Health Care Clients Expectations Present Illness Past Health History Spiritual Health
IV. ASSESSMENT Cephalocaudal
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V. ANATOMY AND PHYSIOLOGY Pathopysiology Labaratory Findings Doctors Orders
VI. MEDICAL MANAGEMENT Drug Study
VII. NURSING MANAGEMENT Nursing Care Plan
VIII. DISCHARGE SUMMARY Methods Approach
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I. Introduction
After three weeks of exposure at CLDH hospital, we came up to study the case congestive heart failure.
To be more specific, what are those illnesses?
Congestive Heart Failure - often called congestive heart failure (CHF) or congestive cardiac failure (CCF), occurs when the heart is unable to provide sufficient
pump action to maintain blood flow to meet the needs of the body.
For the confidentiality and privacy of the patient, we named her as Patient A. Patient A is 51 years old, married, with 4 kids (2 girls and 2 boys), and from
Tarlac City.
Significance/Relevance to the Concept
This case shows us student what we have read from books. It proves that complications or abnormalities can occur at any moment. This also taught us to
deal with patient with problems competitively and the proper way of treating them.
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II. Objectives
To establish rapport between nurse and the patient To be able to know the proper care for patient with Congestive Heart Failure To be able to provide information and health teaching to the patient To be able to describe the development, pathophysiology and nursing care of a client who have undergone To be able to carry out hospital routines and the treatment prescribed to the patient To be able to perform nursing procedures and nursing considerations for a client in the preoperative and postoperative stages
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III. Nursing Health History
For the confidentiality and privacy of the patient, we named her:
a. Biographical Information
Surname: B
First Name: AMiddle Name: C
Age: 51Weight: 55.2 kg
Birthdate: Dec. 15, 1961Birth Place: Balungao, Pangasinan
Nationality: FilipinoAddress: Landig, Cuyapo, Nueva Ecija
b. Reasons for seeking Health Care
Mrs. A seeks for health care because of the chief complaint is difficulty of breathing.
c. Client Expectations
Mrs. A expectations in the following areas:>Information needed about her disease process and involvement in decision making.
>Caring and compassion expressed by care providers>Timeliness of caregivers response to client requests
>Relief of pain and symptoms
d. Present Illness
Mrs. A admitted to the Intensive Care Unit, last July 29, 2013(Monday) subsequently complaining of difficulty of breathing t. With an admitting impressionin Congestive Heart Failure class IV-E with RVR.
e. Past Health HistoryThere is no past confinement of the client.
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f. Spiritual Health
Mrs. A is a Roman Catholic and makes it a point to visit and attend a mass every Sunday with her husband and children. Their beliefs about life, their
source for guidance in acting their beliefs, and the relationship they have in exercising their faith is truly on a God-centered manner.
IV. Assessment bbn
Area/region Findings Normal
Findings
Abnormal
findings
Interpretation/analysis
Skin in general
Temperature
Patients skin
color is dark
brown
Skin feels is
warm to touch
Light tones in
lightskinned
persons
Normal
Abnormal
Abnormal
Due to deficient supply
of blood to the system
Due to heat intolerance
Areas to assess Findings Normal/abnormal Interpretation
SKIN
Hair: characteristics Resilient, silky
hair
Normal Normal
Scalp: Characteristics
Deformities
Shiny and
smooth w/o
lesions, masses
or mumps
No trauma
Normal
Normal
Normal
Normal
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Redness orscaliness
findings
No redness or
scaliness
Normal Normal
Skull Characteristics
Symmetry offacial features and
movement
Rounded andsmooth skull
contour w/o any
signs of
enlargement
Symmetrical in
facial features
and movement
Normal
Normal
Normal
Normal
Eyes Characteristics
Symmetry of eyefeatures and
movement
Pink
conjunctiva,
anicteric sclera
Bilateral
exopthalmus
Abnormal The sclera
should be
white
Presence of
edema
Neck Symmetry
Thyroid gland
Enlarged and
palpable mass
on anterior
portion of the
neck
Presence of mass
during
palpitation
Abnormal Due to lack of
iodine
Nails Capillary refill (-)slow capillary
refill, (-)
Normal Normal
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crushing pain
Lungs Characteristics rales, (+), cough
(+)
Abnormal Excessive
accumulation
of mucous
membrane
Musculoskeletal Characteristics Fine tremors Abnormal Due to bodyweakness
Neurologic Characteristics Irritable and
restless
Abnormal Due to body
weakness
Abdomen Characteristics (+) symmetrical
(-) bruit sound (-
) pain
Normal Paracentesis
done
After Physical assessment there was no abnormalities expect for resilient and silky hair, bilateral exopthalmus of her eyes, excessive sweating of his skin
enlarged and palpable mass on the anterior portion of the neck, fine tremors, irritable and restless.
ASSESSMENTName: MilwidaDela CruzAge: 46
Temperature: 36Blood Pressure: 110/80
Respiratory rate: 20Pulse rate: 75
Date Performed: July 16, 2013
AREA TECHNIQUE NORMALFINDINGS
ACTUALFINDINGS
INTERPRETATIONANALYSIS
GENERAL
APPEARANCE
INSPECTION Relaxed,erect
posture;
Irritable Posture is erect
and properly
Abnormal dueto illness
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coordinated
movement
Clean, neat;no bodyodor
aligned
Clean,Neat, nobody odor Normal
SKIN INSPECTIONPALPATION
Skin texturemust besoft. Hair is
evenlydistributed
and variesthe color
from therace.
Free fromany lesion,
wounds,
scars andscabies.
Skin has darkcomplexion ,the hair is
evenlydistributed
Skin is dry Pale, Grayish
color .
No signs oflesion,wounds, scars,
and scabies.
Normal Abnormal due
to illness
Normal
HAIR INSPECTION
PALPATION
Evenlydistributedhair and
uniform incolor.
Thick, silkyand resilient
hair. Black shiny
The hair isblack shinny,well
distributedand it is thin
and coarse.
Normal
Normal
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hair, it may
be thicksmooth.
Neitherbrittle nor
dry.
Normal
HEAD INSPECTIONPALPATION
The skull isrounded and
smooth
Absence ofnodules andmasses.
Head isrounded and
smooth.
Absence ofnodules andmasses.
Normal Normal
EYES INSPECTION
PALPATION
PERRLA
Eyebrows areevenlydistributed
and skin isintact.
Eyelashes areequally
distributed. Pupil
constrictwhen expose
to sunlight. Cornea is
cleartransparent.
The color ofthe iris
depends onthe persons
Eyebrows areevenlydistributed.
Eyelashesturn outward.
Pupilsconstrict
when exposeto sunlight
Cornea istransparent.
The sclera iswhite in
color.
Pupils areequal andreactive to
light
Normal
Normal Normal
Normal Normal
Normal
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NAILS INSPECTIONPALPATION
Convexcurvature,
angle ofnail plate is
160 Smooth
texture,highly
vascular,clean and
pink incolor.
Prompt toreturn of
pink orusual color
in capillaryrefill(1-2
sec) incolor
No clubbingand spoon
nail
Nails areshort andclean
Capillaryrefill is
about 2 sec.in color
Normal
Normal
Normal
EAR INSPECTIONPALPATION
Ear lobesare bean
Ears areparallel and
Normal
race.
The sclerashould be
white incolor.
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no lesion and
air moves freelyas client breathe
through thenares.
Patient is withO2 inhalationand on and off
difficulty ofbreathing
obstruction.
Normal Normal
MOUTH INSPECTION
PALPATION
Normal lipscolor variesfrom the race.
Teeth arewhitish in color.
Tongue is incentral position,
pink in color,moist and
moves freely.
The lips arepinkish in color.
Teeth arewhitish in color.
Tongue is incentral position,
pink in colorand movesfreely.
Normal
Normal
Normal
NECK INSPECTIONPALPATION
Muscle equal insize; head
centered, goodrange of
motion,(hyperextension
, flexion androtation),
necked color isproportion to
Muscles equalin size; head
centered, goodrange of motion
is present andneck color is
proportioned toskin color.
Normal
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the skin.
Jugular neckvein is not
visible Lymph nodes
are notpalpable.
Trachea is incentral
placement in the
neck. Thyroid gland is
not visible in
inspection,
moves up whenswallowing.
Distendedjugular neck
veins No palpable
lymph nodes. Trachea is in
central
placement in theneck.
Thyroid gland isnot visible.
Abnormal
Abnormal
Normal
normal
CHEST andTHORAX
INSPECTIONPALAPATION
AUSCULTAION
Chest issymmetrical
, spine isvertically
aligned andspinal
column isstraight.
Quit,rhythmic
andeffortless
Chest issymmetrical,
spine isvertically
aligned andspinal column
is straight.
Rapid chestmovement
Normal
Due todyspnea
.
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respiration.
Nopresence of
lumps andtenderness
No presenceof lumps and
tendernessduring
palpation.
Normal
HEART INSPECTIONPALPATION
AUSCULTAION
Nomurmurs
must beheard.
Notenderness,
masses andlumps in
palpation.
Rales soundsis heard upon
ascultation
No tenderness,masses and
lumps inpalpation.
Due toventricular
obstruction
Normal
ABDOMEN INSPECTIONAUSCULTATION
PERCUSSIONPALPATION
Uniform incolor, flat
rounded noevidence of
enlargementof liver and
spleen. No
abdominaldistention
Audiblebowelsounds
No
NoOrganomegaly
Presence ofabdominal
distention
Audible bowelsounds
Abdominal
Normal
Due toaccumulation of fluid
in theabdomen
Due to
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tenderness;
relaxedabdomen
withsmooth,
consistenttension. It must be
regularpattern not
deep.
tenderness fluid
accumulation
EXTREMITIES INSPECTIONPALPATION
AUSCULTAIONPERCUSSION
Muscles areequal size
on bothsides of the
body.
Bones andjoints, no
deformities,tenderness
andswelling,
joints movesmoothly.
Presence ofedema in
bothextremities
( + 1)
AbnormalInadequate
blood supply
\
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Coronary Arteries
The coronary arteries supply oxygen to the heart muscle.
The heart has three main coronary arteries:
Right coronary artery: supplies the right ventricle Left coronary artery: supplies the left ventricle Posterior circumflex artery: supplies the posterior aspect of both ventricles
Anatomy examples:
Coronary angiogram Front view of the heart and coronary arteries Back view of the heart and coronary arteries
http://www.freemd.com/congestive-heart-failure/anatomy.htm#/et/coronary-angiogram.htmhttp://www.freemd.com/congestive-heart-failure/anatomy.htm#/et/coronary-angiogram.htm -
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Cardiac Conduction System
An electrical impulse stimulates the muscle fibers in the heart to contract. The impulse spreads through the heart in a very organized manner, so that the atria
contract first, followed by the ventricles.
The electrical impulse proceeds in the following manner:
The electrical impulse originates at the sinoatrial (SA) node, which is located in the wall of the right atrium. The SA node is the heart's naturalpacemaker:it regulates the heart rate.
The impulse proceeds through the atria, stimulating them to contract. After the atria are stimulated to contract, the atrioventricular (AV) node slows the electrical impulse before it proceeds to the ventricles. This pause allows
the ventricles to fill with blood before they contract.
The AV node is located between the atria and the ventricles.
After the pause, the impulse then proceeds through the ventricles, stimulating them to contract.Anatomy examples:
The cardiac conduction system ECG showing electrical activity of heart
http://www.freemd.com/arrhythmia/treatment-pacemaker.htmhttp://www.freemd.com/congestive-heart-failure/anatomy.htm#/et/ekg.htmhttp://www.freemd.com/congestive-heart-failure/anatomy.htm#/et/ekg.htmhttp://www.freemd.com/arrhythmia/treatment-pacemaker.htm -
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VI. Pathophysiology
CONGESTIVE HEART FAILURE
NON MODIFIABLE RISK MODIFIABLE RISK
Age StressGender Diet
Heredity Lifestyle
|_________________________________________________________|
Clogging of the coronary blood vessels
(coronary athesclerosis)
Persistent increase of BP
Increase myocardial demand
Heart compensate to double pump___________________________________
Blood backs up in the left side is unable to eject blood to systemic circulation
Systemic circulation
lungs swollen with blood
Peripheral congestion,
Distended neck vein, fluid leaks
Edema (feet, ankles and finger ),
Hepatomegaly
Cortal hypertension Pulmonary edema/ congestionDyspnea
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PATHOPHYSIOLOGY
Congestive Heart Failure
The pumping action of the healthy heart maintains a balance between cardiac output and venous return. But when the pumping efficiency of the
heart is depressed so that circulation is in adequate to meet tissue needs, congestive heart failure occurs.
Congestive Heart Failure is usually a progressive condition that reflects weakening of the heart by coronary atherosclerosis (clogging of the
coronary vessels with fatty build up ), persistent high blood pressure, or multiple myocardial infarctions ( leading to repair with non-contracting scar
tissue ).
Because the heart is a double pump, each side can fail independently of the other. If the left heart fails, pulmonary congestion occurs. The right side
of the heart continues to propel blood to the lungs, but the left is unable to eject the returning blood into the systemic circulation. As blood vessels swollen
with blood, the pressure within them increases, and fluid leaks from the circulation into the lung tissue, causing pulmonary edema. If untreated the person
suffocates.
If the right side of the heart fails, peripheral congestion occurs as bloods back up in the systemic systemic circulation. Edema is the most noticeable in the
distal parts of the body. The feet the ankles,and fingers become swollen and puffy. Failure of one side of the heart puts a greater strain on the opposite side,
and eventually the whole heart fails.
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VII. Medical Management
a. Drug Studyb. Laboratory Findings and Interpretationc. Doctors order
Drugs name Action Route
and
dosage
Classification Indication Contraindication Adverse effect Nursing responsibilities
Aldactone
(spironolactone)
Cause loss of
sodium
bicarboante
and calcium
while saving
potassium
and hydrogen
ions
25mg
tab
(BID)
Diuretics
*potassium
sparing
diuretics
Counteract
potassium loss
caused by other
diuretics.
Hypersensitivity,
hyperkalemia
*use cautiously in:
hepatic
dysfunction,
geriatric or
debilitated patients
or patients with
D.M
CNS:
dizziness,
clumsiness,
headache
CV:
arrhythmias
GI:
constipation
Monitor I and o ratiosand daily weight during
therapy
Monitor Blood Pressure Monitor BUN, serumcreatinine and electrolytes
before and periodically during
therapy
Metoprolol Blocks
stimulation
of
beta1(myoca
rdial)
adrenergicreceptors
50mg
Tab
(BID)
Anti angina
Antihyperten
sives
Hypertension
Angina pectoris
Prevention of M.I
Management of
stable,
symptomaticheartfailure due to
Uncompensated
CHF, pulmonary
edema,
cardiogenic shock
bradycardia or
heartblock
Cns: Fatigue,
weakness,
anxiety,
depression
dizziness,
drowsiness,insomnia
-Monitor bp and pulse
frequency during dose
adjustments and periodically
during therapy
-Monitor vital signs every 5-15
min during and for several hrsafter parenteral administration
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Lasix (furosemide)
does not
usually affect
beta2
adrenergic
receptor sites
Inhibits the
re absorption
of sodium
and chloride
from the loop
of henle and
distal renal
tubule
Increasesrenal
excretion of
water,
sodium,
chloride,
magnesium,
hydrogen,
and calcium.
May have
renal and
peripheral
vasodilatoryeffect
20g
IV
Every 8
hours
Diuretics
Loop
diuretics
ischemic
hypertensive
origin
Edema due to
CHF, hepatic or
renal disease,
hypertension
Hypersensitivity
cross sensitivity
with thiazides and
sulfonamides may
occur.
Pre- existing
electrolyte
imbalance hepatic
coma or anuria.Some liquid
products may
contain alcohol,
avoid patients
with alcohol
intolerance
EENT:
Blurred
vision
Stuffy nose
CV:
bradycardia
Hypotension
CNS:
dizziness
Encepalopath
y
Headache
Insomnia
Nervousness
EENT:
hearing lossTinnitus
CV:
hypotension
GI:
constipation
Diarrhea
Dry mouth
Dyspepsia
Nausea and
vomiting
CNS: fatigue,
headache,weakness
- asses fluid status during
therapy
Monitor daily weight, I and o
ratios
-Amount and location of
edema, lung sounds, skin
turgor, and mucous
membranes
- monitor BP, and pulse beforeand during administration
- monitor apical pulse for 1 full
min before administering.
With hold dose and notify
physician if pulse rate is less
than 60beats per minute
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Lanoxin Increases the
force of
myocardial
contraction.
Prolongs
refractory
period of the
AV node.
Decreases
conduction
through the
SA and AV
nodes
0.25
mg
TAB
once a
day
anti
arrythmics,
inotropics
Treatment of
CHF.
Tachyarrythmias:
atrial fibrillation
and atrial flutter
(slows ventricular
rate), paroxysmal
atrial tachycardia
Hypersensitivity.
Uncontrolled
ventricular
arrhythmias. AV
block, idiopathic
hypertropic
subaortic stenosis.
Constrictive
pericarditis.
Known alcohol
intolerance
EENT:
blurred
vision, yellow
or green
vision
CV:
arryhtmias
Bradycardia
Ecg changes
AV- block
SA-block
GI: anorexia
Nausea
Vomiting
DiarrheaENDO:
gynecomasta
HEMAT:
thrombocytop
enia
METAB:
Hyperkalemia
with acute
toxicity
EENT:
hearing loss
Tinnitus
-monitor apical pulse for 1 full
minute before administering.
With hold dose and notify
physician if pulse rate is
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Clinical
laboratory
Result Reference Method Interpretation
Creatinine Increase108umol/L 62-106umol/L Vitros 350
Blood urea
nitrogen
Increase
6.3mmol/L
2.5-6.1mmol/L Vitros 350
Albumin 30g/L 35-50g/L Vitros 350
Interpretations:
1. Creatinine-Raised creatinine levels will be developing when the filtration mechanism becomes gradually damaged by long-term raised blood pressure or diabetes.
As the kidneys become increasingly unable to cope, so the creatinine level rises
2. BUN
-A disease condition is often present. One of the most common causes of RBC's in the urine, is infection or inflammation of the urinary tract itself
3. Albumin-Decreased blood albumin levels may occur when your body does not get or absorb enough nutrients and may be a sign of kidney diseases and liver
diseases.
RADIOLOGIC FINDINGS
Chest x-ray (CXR)
There is a hazed capacity in the right lower lung field Heart is enlarge Diaphragm is intact. Costophrenic sulci are intact The rest is visualized chest structure are unremarkable
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IMPRESSION
Consider pneumonia, right lower lobe Cardiomegaly
Clinical correlation is recommended
DIAGNOSIS
Community Acquired Pneumonia High risk (with hypoxemia) Rheumatic Heart Disease
PROCEDURES: S/P Paracentesis
1st- july 29 (First Session)
2nd- july 30 ( Second Session)
3rd
- july 31, 2013 ( Third Session)
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VIII. Nursing Management
a. NCP
Assessment Diagnosis Analysis Planning NursingInterventions Rationale Evaluation
Subjective:
Objectives
>with productive
cough yellowish
in color
>(+) Difficulty of
Breathing
>with pale
conjunctiva, nail
beds and buccal
mucosa
>30
Ineffective
airway clearance
related to
retained
secretions as
evidence by
presence of rales
on both lung
feilds
Inability to clear
secretions or
obstructions
from the
respiratory tract
to maintain a
clean airway
Short Term:
> After 3-4 hours
of nursing
interventions,
the patient will
be able to
establish and
maintain airway
AEB absence of
signs of
respiratory
distress.
Long Term:
>After 2-3 days
of nursing
interventions,
the patient will
be able to
demonstrate
>Monitor and
record vital
signs.
>Monitor
respirations and
breath sounds,
noting rate and
sounds.
>Position
appropriately
and discourage
use of oil-based
products around
nose.
>Auscultate
breath sounds
and assess air
>To obtain
baseline data
>To determine
respiratory
distress and
accumulation of
secretions.
>To prevent
vomiting with
aspiration into
lungs
>To ascertain
status and note
progress
Short Term:
>The patient
shall have been
able to and
maintain airway
patency AEB
absence of
respiratory
distress.
Long Term:
>The patient
shall have been
able to
demonstrate
improve airway
clearance AEB
reduction of
congestion with
breath sounds
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improve airway
clearance AEB
reduction of
congestion with
breath sounds
clear andimprove RR.
movement.
>Encourage
deep breathing
and coughing
exercises.
>Keep back dry
and loosen
clothing.
>Instruct patient
have adequaterest periods and
limit activities to
level of activity
intolerance.
>Give
expectorants and
bronchodilators
as ordered.
>To maximize
effort
>To promote
comfort and
adequate
ventilation
>Rest will
prevent fatigue
and decrease
oxygen demands
for metabolic
demands
>To further
mobilizesecretions
>To clear airway
when secretions
are blocking the
airway
clear and
improved RR.
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>Suction
secretions PRN.
>Administer
oxygen therapyand other
medications as
ordered.
>Indicated to
increase oxygen
saturation
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and use of
accessory
muscles
>Measure tidal
volume and vitalcapacity
>Assess
emotional
response
>Position patientin optimal body
alignment in
semi-fowlers
for breathing
>indicates
volume of airmoving in and
out of lungs
>detects use of
hyperventilation
as a causative
factor
>optimizesdiaphragmatic
contraction
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Assessment Diagnosis Analysis Planning NursingInterventions
Rationale Evaluation
Subjective:
None
Objective:
>generalized
weakness
>limited range of
motion as
observed
Activity
intolerance
related to
imbalance
oxygen supply
and demand as
evidence by
ROM,
generalizedweakness and
DOB
Insufficient
physiological or
psychological
energy to endure
or complete
required or
desired daily
activities
Short Term:
>After 3-4 hours
of nursing
interventions,
the patient will
use identified
techniques to
improve activity
intolerance.
Long Term:
>After 2-3 days
of nursing
interventions,
the patient will
report
measurable
increase in
activity
>Establish
rapport
>Monitor and
record V/S
>Assess patients
general condition
>Adjust clients
daily activities
and reduce
intensity of level.
>to gain clients
participation and
cooperation in
the nurse patient
interaction
>to obtain
baseline data
>to note for any
abnormalities
and deformities
present within
the body
>to prevent
strain and
overexertion
Short Term:
> The patient
shall have used
identified
techniques to
improve activity
intolerance.
Long Term:> The patient
shall have
reported
measurable
increase in
activity
intolerance.
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intolerance. Discontinue
activities that
cause undesired
psychological
changes.
>Instruct client
in unfamiliar
activities and in
alternate ways of
conserve energy.
>Encourage
patient to have
adequate bed
rest and sleep.
>Provide the
patient with a
calm and quiet
environment.
>Assist client in
ambulation
>to conserve
energy and
promote safety
>to relax the
body
>to provide
relaxation
>to prevent risk
for falls that
could lead to
injury
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>Assist the client
in a semi-
fowlers position
>Elevate the
head of the bed
>Instruct the SO
not to leave the
client unattended
>Encourage the
client to
maintain a
positive attitude.
>Give client
information that
provides
evidence of daily
or weekly
progress
>Provide client
with a positive
atmosphere.
>to promote easy
breathing
>to maintain an
open airway
>to avoid risk
for falls
>to enhance
sense of well
being
>to sustain
motivation of
client
>to help
minimize
frustration and
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rechannel energy
Assessment Diagnosis Analysis Planning Interventions Rationale Evaluation
S=O=
>bulging of eyes
>irritable
>decrease
appetite
>weight loss
>poor muscle
tone
>lack of
available food
Nutritionalimbalance, risk
for less than
body
requirements
Intake ofnutrients
insufficient to
meet metabolic
needs
After nursingintervention the
patient
demonstrate
stable weight
with normal
laboratory
values and be
free of signs and
malnutrition
Monitordaily food intake.
Weight daily and
report losses.
Encourage
patient to eat
and increase andsnacks using
high calorie
foods that are
easily digested
Consult
with dietitian to
provide diet high
Continuedweight loss of
adequate caloric
intake may
indicate failure
of anti-thyroid
therapy
Aids in
keeping caloric
intake highenough to keep
up with rapid
expenditure of
calories caused
by hyper
metabolic state
May need
assistance to
ensure adequate
After nursingintervention the
patient
demonstrate
stable weight
with normal
laboratory
values and be
free of signs and
malnutrition
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in calories,
protein,
carbohydrate
and vitamins
intake of
nutrients identify
appropriate
supplements
IX. METHODS
M- Lasix- 40mg 1 tab ODAldactone- 25mg ODLanoxin- 0.25mg tab OD
Metropolol- 50mg 1 tab BIDSafdicure- 300mg 1 cap for 5 days
E- Bed rest, restrain from any strenuous activities.
T- oral care, Proper personal hygiene
H- Advice pt. to consume and take meds as prescribed.- Advice pt. to avoid strenuous activity to conserve energy.- Advice pt. to remain at rest to prevent fatigue
O- OPD- follow up check up on august 12, 2013 at 12 nn
D- low salt include tomato soup, salted crackers, bakon, canned meats, and fish. low fat, try lemon and herbs as a subtition. Provide potassium supplements,dercrease fluid intake.
S-Not applicable
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