Erickson’s Developmental Stage Related to pt. & Cite References (1)
L.D. is in the stage of generativity versus stagnation which is when people reach their 40s which is also known as middle adulthood and extends to the mid 60s. In this stage middle aged adults start contributing to the next generation in caring for others; they also start engaging in meaningful work and contributing to society.
Copstead & Banasik, J. L. (2013). This
is also known as the generativity stage where it involves finding your life’s work by contributing. Those who do not feel like they have mastered this task will feel the stagnation stage. In this stage they feel as though they still haven’t left their meaningful mark on the world or make little interest in self-improvement and connection with others.
Copstead & Banasik, J. L. (2013).
L.D. views her life with generativity because she continuously speaks about her charity work. She also enjoys talking about how much she was able to help people through her yoga classes by helping them relax and leave their daily living stresses behind while in class. She also enjoys socializing with others and helping around. Even in the hospital she is always good with people and being able to cheer others up. I believe now more than ever she will continue to contribute in helping others
.
Patient Education (In Pt.)
L.D. should continue her high protein, low fat diet as well as continue drinking fluids daily. She should completely stop smoking as it only weakens her immunize system and contributes to poor circulation
and slow wound
healing.
L.D.
should clean the area around the wound gently with mild soap and water. Do not rub the incision, allow water to flow gently over it. After your wound is healed, keep it open to the air.
After dressings have been removed
, wash your stump daily with mild soap and water. Do not soak it. Dry it well. Inspect your stump every day. Use a mirror if it is hard for you to see all around it
, inspect
for any red areas or dirt.
Wear your elastic bandage all the time. Rewrap it every 2 to 4 hours. Make sure there are no creases in it. Wear your stump protector whenever you are out of bed. Always notify any changes.
Discharge Planning (home needs
)
Refer L.D. to her dietitian to further provide her with at home details of her dietary plan. This will involve a high protein, low saturated fats, and increased fluids. She will continue her physical and occupational therapy on a daily basis. This will allow her to fully heal as well as learn how to manage her new body part functions. L.D. and her family members will be taught about the adverse effects and medication regimen she must follow at home
with the appropriate parameters to follow.
Patient will be provided with transportation on a daily basis to attend all her therapeutic appointments.
Medical Management/ Orders/ Medications & Allergies (2)
Name
Dose
RT
Freq.
MOA
RN Considerations
Enoxaparin (Lovenox)
30mg
SubQ
Every 12 hours
E ...
Erickson’s Developmental Stage Related to pt. & Cite Refer.docx
1. Erickson’s Developmental Stage Related to pt. & Cite
References (1)
L.D. is in the stage of generativity versus stagnation which is
when people reach their 40s which is also known as middle
adulthood and extends to the mid 60s. In this stage middle aged
adults start contributing to the next generation in caring for
others; they also start engaging in meaningful work and
contributing to society.
Copstead & Banasik, J. L. (2013). This
is also known as the generativity stage where it involves
finding your life’s work by contributing. Those who do not feel
like they have mastered this task will feel the stagnation stage.
In this stage they feel as though they still haven’t left their
meaningful mark on the world or make little interest in self-
improvement and connection with others.
Copstead & Banasik, J. L. (2013).
L.D. views her life with generativity because she continuously
speaks about her charity work. She also enjoys talking about
how much she was able to help people through her yoga classes
by helping them relax and leave their daily living stresses
behind while in class. She also enjoys socializing with others
and helping around. Even in the hospital she is always good
with people and being able to cheer others up. I believe now
more than ever she will continue to contribute in helping others
.
Patient Education (In Pt.)
L.D. should continue her high protein, low fat diet as well as
continue drinking fluids daily. She should completely stop
smoking as it only weakens her immunize system and
2. contributes to poor circulation
and slow wound
healing.
L.D.
should clean the area around the wound gently with mild soap
and water. Do not rub the incision, allow water to flow gently
over it. After your wound is healed, keep it open to the air.
After dressings have been removed
, wash your stump daily with mild soap and water. Do not soak
it. Dry it well. Inspect your stump every day. Use a mirror if it
is hard for you to see all around it
, inspect
for any red areas or dirt.
Wear your elastic bandage all the time. Rewrap it every 2 to 4
hours. Make sure there are no creases in it. Wear your stump
protector whenever you are out of bed. Always notify any
changes.
Discharge Planning (home needs
)
Refer L.D. to her dietitian to further provide her with at home
details of her dietary plan. This will involve a high protein, low
saturated fats, and increased fluids. She will continue her
physical and occupational therapy on a daily basis. This will
allow her to fully heal as well as learn how to manage her new
body part functions. L.D. and her family members will be taught
about the adverse effects and medication regimen she must
follow at home
with the appropriate parameters to follow.
Patient will be provided with transportation on a daily basis to
attend all her therapeutic appointments.
Medical Management/ Orders/ Medications & Allergies (2)
Name
Dose
RT
Freq.
3. MOA
RN Considerations
Enoxaparin (Lovenox)
30mg
SubQ
Every 12 hours
Enoxaparin binds and potentiates antithrombin to form a
complex that irreversibly inactivates clotting factor Xa.
Assess for bleeding signs and teach patient to report any
bleeding, bruising, and pain. Notify if any black stools,
bleeding gums, or bruising occurs.
Oxycodone (Roxicodone)
10mg
PO
Every 4 hours PRN
Act on receptors located on neural cell membranes.
Assess pain level (0-10) before and after administering
. Monitor respirations/vitals and report if any dizziness or slow
breathing occurs. Leave call light near (risk for falls).
Docusate Sodium
(colace)
100mg
PO
Twice daily
Anionic surfactant that allows water and lipids to penetrate
stool.
Monitor for any electrolyte imbalances and assess for abdominal
distention. Notify if any rectal bleeding occurs. Make sure
liquid intake is implemented.
Amoxicillin (Augmentin)
125 mg
PO
Every 12 hours
Acts on bactericidal activity by inhibition of bacterial cell wall
synthesis by binding to penicillin-binding protein 1A.
Monitor bowel function. Diarrhea, abdominal cramping, fever,
4. and bloody stools should be reported. Assess for infection, vital
signs; appearance of wound, sputum, urine, and stool;WBC) at
beginning of and throughout therapy
.
Alprazolam (Xanax)
0.5mg
PO
Twice a day
Benzodiazepines bind to GABA receptors in the brain and
enhance GABA mediated synaptic inhibition.
Assess for any suicidal ideation. Monitor vitals. Assess patient
for drowsiness, light-headedness, and dizziness.
Adams, M., Holland, L. N., & Urban, C. Q. (2019).
Chief Complaint
“
Patient presents for rehabilitation after amputation of left lower
extremity as a result of osteomyelitis complaining of swelling
and pain on amputated stump.”
Admitting Diagnosis
Sw
e
lling and pain
.
Cultural considerations, ethnicity, occupation, religion, family
support, insurance.
(1) (14)
L.D. is a white American female who used to be a yoga
instructor. Her highest level of education is a college level
degree. She enjoys socializing with the nurses as well as petting
the hospitals therapy dog. L.D. is a catholic.
Patient Information
(1)
Name:
L.D.
Age:
5. 4
5
Gender:
Female
Code Status:
Full code
DPOA:
No
Living
Will: No
History of Present Illness (HPI), Pathophysiology of Admitting
Dx (Cite References) Medical, Surgical, Social History (1).
L.D. is a 45-year-old white American female who currently
lives alone.
L.D. was
admitted
to the E.R. after her leg became necrotic due to her previous
medical history of osteomyelitis
and underwent amputation of the lower left extremity
.
L.D. afterwards was omitted for rehabilitation
complaining of swelling and pain on amputated stump.
She is now being carefully treated and undergoes physical
therapies to better assist her in fully healing.
Medical History
Osteomyelitis is inflammation and destruction of bone caused
by bacteria.
Copstead & Banasik, J. L. (2013). Osteomyelitis occludes local
blood vessels, which cause bone necrosis and local spread of
infection which can expand through the bone cortex and spread.
Copstead & Banasik, J. L. (2013).
Certain things such as trauma, surgery, the presence of foreign
bodies, or the placement of prostheses may disrupt bony
integrity and lead to the onset of bone infection. Copstead &
6. Banasik, J. L. (2013).
Osteomyelitis is an infection of the bone; these infections can
reach a bone by traveling through the bloodstream or spreading
from nearby tissue. Infections can also begin in the bone itself
if an injury exposes the bone to germs some of the main known
factors are
s
mokers and people with chronic health conditions, such as
diabetes or kidney failure. Copstead & Banasik, J. L. (2013).
Surgical History
L.D. has a surgical history of left leg amputation about a week
ago as a result of her leg becoming necrotic from her previous
history of osteomyelitis.
Social History
L.D. has a history of chronic alcoholism; it is characterized as
compulsive decision making with impulse behavior and relapse.
She was previously hospitalized a couple times because of her
inability to control alcohol intake.
She has been dealing with chronic alcoholism for about 15
years. She also smokes about 2-3 cigarettes daily, usually after
her meals and occasionally in the afternoons. She has been a
smoker for the past 20 years. L.D. has never used any
recreational drugs. L.D. still refuses to understand her current
condition and why now she has to deal with being in a
wheelchair. She is still not understanding why “out of all
people” how she says she had to have this condition
(osteomyelitis). Although she understands that her lifestyle
choices could have negatively contributed.
She has no evidence of any physical, sexual, or mental abuse.
She does have a history of some depression as a result of her
current situation.
L.D. was a yoga instructor who enjoys helping others. She also
enjoys being able to socialize and not feel alone. Her main
support system is her mother who usually calls her at least three
times a day.
Diagnostic Test/ Lab Results with dates and Normal Ranges
8. 8-28-19
14
Creatinine
0.5-1.1
8-28-19
0.84
Concept Map
Student Name:
Instructor:
PC Outcomes/Goal
Monitoring vitals provides a baseline that allows quick
recognition.
Adequate nutrition will prevent disability that will predispose
infection as well as heal surgical incision better.
Good room temperature reduces microorganism on skin.
Proper ROM exercises promotes tissue perfusion.
Priority nursing diagnosis #2
Body image disturbed related to surgical amputation as evidence
by
verbal preoccupation with changed body part or function.
Respiratory
(7)
Oxygen: Room air
Cough: None
Sputum: none
Secretions: none
Breath sounds: Clear
Lung sounds: Regular
SpO2: 96%
Airway device: none
9. Vital Signs
(4)
BP: 135/30
HR: 92
Respiratory rate: 16
SpO2: 96
%
Temp: 98.2 F (Tympanic)
Left radial pulse: 65bpm
Inte
rventions # 2
Refer patient to available resources such as prosthetic device.
Do not support denial but instead focus reality and adaptation.
Be honest with patient and stay in frequent contact with patient.
Monitor for any suicidal ideation.
Use anxiety reducing techniques as often as needed.
Collaborate with psychiatric nurse regarding care as needed.
Refer patient to occupational and physical therapy
once a day.
Monitor for pain every 2 hours.
Assessment/ Evaluation #1
The patient met the goal of the nursing interventions.
The patient reported feeling less pain and more eager with her
physical exercises. Patient attended physical therapy twice a
day. Patient performed all her range of motion exercises while
in bed and even attempted them on her own with adequate rest
periods. Patient used her wheelchair and took a stroll to the
nursing station for 15 minutes.
She
looked stronger and was enjoying her new diet plan. Patient
only took one dose of her PRN pain dose.
A
ssessment/ Evaluation #2
The patient met the nursing intervention goals.
10. Patient was eager to know more about her prosthetic use and
asked for more information. Patient was told of her limitations
and how she would be able to manage a normal life. Patient
looked at her amputated leg with more of an understanding as
well as attended her psychiatric nurse. Patient attended a social
group and communicated/socialized more outside of her room.
Patient used deep breathing techniques when she felt anxious.
She attended all her physical and occupational therapies. Patient
received her usual dose of alprazolam and was monitored
for any adverse reactions, but none were reported.
PC Evaluation Plan
The patient met the goal of the nursing intervention.
The patient increased her fluid, vitamin C, iron, and nutrition
intake. Patient was turned every 2 hours as well as maintained a
proper room temperature. Patients dressing was changed this
morning and the swelling was reduced and no drainage shown.
The proper sterile technique was implemented while changing
her dressing. Patient reported less swelling on her legs and a
pain level of 4 from her previous 8. She performed her deep
breathing and coughing techniques as well as proper hygiene
amongst the faculty, patient, and visitors.
Patients skin tone and extremities were assessed for proper
circulation.
PC Interventions
Monitor
vitals every 4 hours.
Maintain adequate nutrition and fluid and electrolyte balance
such as increased vitamin C, sufficient iron, and 2400-2600 mL
of fluid daily.
Monitor the administration of antibiotic for any side effects.
Maintain neutral temperature environment.
Turn patient every 2 hours.
Cough and deep breathing exercise every 2 hours.
Use sterile techniques when changing dressings.
Good hand hygiene and teach patient how to care for their own
11. hygiene as well.
Psychosocial
(14)
Language barrier: None
Understands directions: Yes
Level of Education: College
Mood/Affect: Cooperative/low mood
Alcohol use: Yes
Tobacco use: Yes (2 cigarettes/day)
Support: Mother
Stressors: Condition
Cardiovascular
(6)
Devices (pacemaker): No
Capillary refill: <3 secs
Peripheral Edema: Edema: Present on RLE & LUE non-pitting
Peripheral
Heart sounds: S1, S2, normal
Pulses: Present
except on LLE amputation.
Endocrine
(13)
Thyroid Disease: None
Estrogen use: None
Testosterone use: None
Steroid Use: None
Misc. (Ht/Wt)
Weight: 125.27lbs
Height: 5’8
GU (10)
Urinary Symptoms: None
Urine color: Yellow
12. Urinary Catheter: No
Urinary Elimination: voiding w/o difficulty
Urine odor: Normal
Last Void: 8/30/19
1:40pm
GI
(9)
Bowel Sounds: All hypoactive
Abdomen: Distended
Last BM: 8/30/19, 1:30pm
Stool: Semisoft
Color: Brown
Ostomy: No
Incontinence: No
Rest/ Exercise
(11)
Activity:
Mobility Aids: Wheelchair
Functional level: Independent
Sleep patterns: Uninterrupted
ROM: limited on LLE
Fall risk: High risk
Neurological
(5)
Pain: 9 (0-10 scale)
PEERLA: 4mm Brisk
Oriented: Alert & Oriented X4
Glasgow Coma Scale: 15
Senses: normal (all 5)
Behavior/Emotional: Cooperative
Outcome/Goal #1
13. Patient will improve mobility and independence within three
days by assisting physical therapy daily.
Priority nursing diagnosis #1
Impaired physical mobility related to left lower extremity
amputation as evidence by wheelchair assistive device.
Nutrition/Hydration
(8)
Diet: High protein and fiber
Feeding Method: Self
Nausea: No
Vomiting: No
Skin turgor: Normal
Weight: No change
Aspiration Risk: None
Outcome/Goal #2
Patient will verbalize accepting body image of left extremity in
two weeks, by demonstrating a positive attitude.
Integumentary
(12)
14. Skin:
Intact
c
ool and moist
Risk for falls: High risk
Skin Color: Pink no cyanosis
Lesions: None
Skin turgor: Good skin turgor
Potential Complications/ at risk for
At risk
for infection related to surgical procedure on left lower
extremity as evidence by increased red
dened
swelling at surgical site.
Interventions #1
Educate the patient on the proper use of assistive device.
Provide progressive mobilization as much as patient tolerates.
Schedule physical therapy twice a day and increase
mobilization.
Perform Range of motion exercises every two hours.
Maintain a high protein diet/adequate nutrition.
Implement measures to prevent falls such as low position of
bed, call light near, wearing nonskid shoes/socks.
If in pain give pain medication before any physical movement.
15. Chief Complaint
Contractions, rupture of membrane or bleeding.
Admitting Diagnosis
NSVD, or C-Section
Medical Conditions
Patient Information
(1)
Name:
Age:
Height/Weight:
Allergies:
Gestational Age:
Admitting Dx (Cite References) Medical, Surgical, Social
History and OB History
Medical History
Surgical History
16. Social History
Obstetric History
GTPAL
Cultural considerations, ethnicity, occupation, religion, family
support, insurance. (1) (14)
Medical Management/ Orders/ Medications & Allergies (2)
Name
Dose
RT
Freq.
MOA
RN Considerations
Onset/Peak/Duration
(Insulin)
17. Erickson’s Developmental Stage Related to pt. & Cite
References (1)
Patient Education (In Pt.) & Discharge Planning (home needs)
Diagnostic Test/ Lab Results with dates and Normal Ranges (3)
Test
Norms
Date
22. Case Scenario 6
History of Present Problem:
Jennifer Lopez is a 25-year-old female patient G1P0 who is
currently 39 3/7 weeks gestation. She is admitted to the hospital
to be induced for being post-date. She is positive for Group
Beta streptococcus and receiving IV antibiotics per protocol.
She is 65 inches (162.5 cm). Her pre-pregnancy weight was 115
pounds (52.3 kg). She gained 18 pounds (6.8 kg) during this
pregnancy. She just had spontaneous rupture of membranes with
a moderate amount of thick meconium fluid at 9 pm. The nurse
performed a vaginal check, and her cervix is dilated to 4 cm, 8
percent effaced and -1 station. Pitocin is infusing at 8
mU/minute intravenously.
Personal/Social History:
Jennifer lives with a roommate and is no longer involved with
the father of her baby. Her family support is limited to her older
brother, Sal. She smokes one pack of cigarettes a day and has
not had a job for over a year and states money is tight. She
admits to not eating very healthy during the pregnancy because
it is easier to grab hamburger and coke than cook. She missed a
few of her prenatal visits due to transportation issues and did
not attend any prenatal classes. Her sister is present as her
support person during labor and delivery.
Patient Care Begins: Current VS:
P-Q-R-S-T Pain Assessment:
T: 99.9 F/37.7 C (oral)
Provoking/Palliative:
Uterine contractions
P: 92 (regular)
Quality:
Severe cramping; moderate to palpation
23. R: 18 (regular)
Region/Radiation:
Low pelvis
BP: 128/68
Severity:
6/10
O2 sat: 99 % LA
Timing:
With uterine contractions
GENERAL APPEARANCE:
Calm and appears to be resting between contractions. Using
breathing techniques during contractions appropriately
RESP:
Breath sounds clear with equal aeration bilaterally ant/post,
nonlabored respiratory effort
CARDIAC:
Pink, warm & dry, no edema, heart sounds regular with no
abnormal beats, pulses strong, brisk cap refill, 1+ bilateral
pedal edema
NEURO:
Alert and oriented to person, place, time, and situation (x4)
Maternal/Fetal
FHT’s:
140s regular
Variability:
See monitoring strip to address
Accelerations:
See monitoring strip to address
Decelerations:
See monitoring strip to address
Contractions:
Yes
Frequency:
24. Every 3-4 minutes
Duration:
60-70 seconds
Intensity:
Moderate to palpation
Diagnostic Results: Complete Blood Count (CBC)
WBC
HGB WBC
PLTs
% Neuts
Current:
10.2
11.2
240
62
MISC.
Blood Type
Current:
A-
Over the past hour, fetal heart tones (FHT) have remained at
140 with
Minimal variability and no accelerations. She has had three
more variable decelerations lasting 30-40 seconds. You position
Jennifer on her left side, and she receives an IV bolus of 1000
mL LR and O2 is applied via non-rebreather mask at 10 liters.
You are in the room trying to help her breathe through her
contractions when she has a prolonged late deceleration lasting
three minutes with FHTs in the 70s before returning to 120 bpm.
Medical Management
Consent for C-section
Stop Pitocin
Terbutaline 0.25 mg subcutaneous x1
dose
25. 0.9% NS 1000 mL IV bolus
Foley indwelling catheter
O2 at 10 L via mask
