A 74-year-old male was admitted to the hospital after suffering an acute cerebral vascular accident (stroke). He has a history of depression, prior strokes, and his daughter is in hospice care. Upon admission, diagnostic testing revealed evidence of old strokes and significant intracranial atherosclerotic disease. The patient's nursing care plan focuses on improving mobility to prevent complications, addressing feelings of hopelessness through communication and support, and helping with communication challenges due to his stroke through slow, clear speech and allowing time to respond.
An assignment to write a case study for medical terminology as if I were responsible for writing the patient\'s medical record. An assignment at Colorado Technical University online.
Medillectual juniors 2017 (Prelims and Mains)Quitzkrieg
Medical Quiz; A part of Quitzkrieg 2017, the annual AIIMS Delhi Quiz fest under Pulse 2017. QMs: Sneha Mohan, Srividya, Lajja, Dev (and also, Satwik and Utkarsh)
Instructions After reading the clinical description, assign word.docxnormanibarber20063
Instructions: After reading the clinical description, assign words or phrases from the paragraph to the term that best describes that concept. Note: Not all terms will have a match. IMPORTANT: As you review and identify items, please note you are not coding the scenario; coding has many rules associated with how an encounter is coded. This exercise is purely about your ability to recognize the pathophysiology and pharmacology concepts that are found within the excerpts.
Contents
Excerpt 1 2
Excerpt 2 3
Excerpt 3 4
Excerpt 4 5
Excerpt 5 6
Excerpt 6 7
Excerpt 7 8
Excerpt 8 9
Excerpt 9 10
Excerpt 10 11
Excerpt 1
Kimberly is a 37-year-old white female who presented to her family doctor and was referred to radiation oncology department for consultation. While with the oncologist, Kimberly reported that both her mother and sister had breast cancer. She describes feeling heartburn for “a long time” and difficulty swallowing during the past 4 or 5 months. She feels like food occasionally seems to ‘catch’ in her throat, and describes pain immediately below the sternum that feels like a gnawing or burning. Other complaints include weight loss of 30 lbs. in the past 6 or 7 months, weakness and coughing at night. After performing an endoscopy and a biopsy of the esophageal tract, a cancerous tumor was identified and staged, and plans for radiation and an esophagectomy are underway.
Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History
Excerpt 2
Jane is a 12 year old female who presents is being treated today for hypertension related to Congenital Adrenal Hyperplasia (CAH), which was discovered when a biopsy done of Jane’s mother’s placenta for genetic screening showed that both her parents were carriers for the gene. Fetal blood work completed confirmed an enzyme deficiency blocking gluticosteriod and mineralocorticoid hormones. Jane regularly receives hormonal treatment and future genitoplasty is being considered. Normal sexual functioning is anticipated with continued treatment.
Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History
Excerpt 3
James is a 43 y.o. male who complains of chest congestion and dry cough for 30 days. He has had a history of similar problems, but was not exhibiting symptoms when he went to Buffalo to visit brother who has dogs. Patient reports experiencing shortness of breath while sleeping in the guest room bed; reports that brother is a smoker. Unsure if he has seasonal allergies. On ordering a CBC with differential, the higher presence of lymphocytes suggested an allergic reaction. The doctor prescribed oral steroids and an albuterol inhaler and recommended him to return if the cough didn’t decrease.
Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Pr.
Challenges in management of peripartum cardiomyopathy with diuretic resistanc...iosrphr_editor
presentation: In this report we present a 30 years old female patient, Para 1 living 1, who was admitted one month ago with complaints of abdominal distension, lower limb swelling and difficulty in breathing that started worsening two weeks prior.12-lead ECG showed sinus tachycardia (100beats/min), low voltage and non-specific T inversion and flattening.Echocardiography showed dilated left ventricle (5.8cm) and left atrium (4.4cm), global hypokinesia with ejection fraction of 36% by biplane. Grade 1 diastolic dysfunction, no thrombus seenand Mild pericardial effusion.
Challenges in management of peripartum cardiomyopathy with diuretic resistanc...iosrphr_editor
Background: Peri-partum cardiomyopathy is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricle systolic dysfunction towards the end of pregnancy or in the months after delivery, in the absence of any other cause of heart failure.Approximately 75% of cases are diagnosed within the first month peri-partum, and 45% present in the first week. Case
An assignment to write a case study for medical terminology as if I were responsible for writing the patient\'s medical record. An assignment at Colorado Technical University online.
Medillectual juniors 2017 (Prelims and Mains)Quitzkrieg
Medical Quiz; A part of Quitzkrieg 2017, the annual AIIMS Delhi Quiz fest under Pulse 2017. QMs: Sneha Mohan, Srividya, Lajja, Dev (and also, Satwik and Utkarsh)
Instructions After reading the clinical description, assign word.docxnormanibarber20063
Instructions: After reading the clinical description, assign words or phrases from the paragraph to the term that best describes that concept. Note: Not all terms will have a match. IMPORTANT: As you review and identify items, please note you are not coding the scenario; coding has many rules associated with how an encounter is coded. This exercise is purely about your ability to recognize the pathophysiology and pharmacology concepts that are found within the excerpts.
Contents
Excerpt 1 2
Excerpt 2 3
Excerpt 3 4
Excerpt 4 5
Excerpt 5 6
Excerpt 6 7
Excerpt 7 8
Excerpt 8 9
Excerpt 9 10
Excerpt 10 11
Excerpt 1
Kimberly is a 37-year-old white female who presented to her family doctor and was referred to radiation oncology department for consultation. While with the oncologist, Kimberly reported that both her mother and sister had breast cancer. She describes feeling heartburn for “a long time” and difficulty swallowing during the past 4 or 5 months. She feels like food occasionally seems to ‘catch’ in her throat, and describes pain immediately below the sternum that feels like a gnawing or burning. Other complaints include weight loss of 30 lbs. in the past 6 or 7 months, weakness and coughing at night. After performing an endoscopy and a biopsy of the esophageal tract, a cancerous tumor was identified and staged, and plans for radiation and an esophagectomy are underway.
Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History
Excerpt 2
Jane is a 12 year old female who presents is being treated today for hypertension related to Congenital Adrenal Hyperplasia (CAH), which was discovered when a biopsy done of Jane’s mother’s placenta for genetic screening showed that both her parents were carriers for the gene. Fetal blood work completed confirmed an enzyme deficiency blocking gluticosteriod and mineralocorticoid hormones. Jane regularly receives hormonal treatment and future genitoplasty is being considered. Normal sexual functioning is anticipated with continued treatment.
Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Procedure
Examination of living tissue
Medical History
Excerpt 3
James is a 43 y.o. male who complains of chest congestion and dry cough for 30 days. He has had a history of similar problems, but was not exhibiting symptoms when he went to Buffalo to visit brother who has dogs. Patient reports experiencing shortness of breath while sleeping in the guest room bed; reports that brother is a smoker. Unsure if he has seasonal allergies. On ordering a CBC with differential, the higher presence of lymphocytes suggested an allergic reaction. The doctor prescribed oral steroids and an albuterol inhaler and recommended him to return if the cough didn’t decrease.
Diagnos(es)
Prognosis
Etiology
Signs
Symptoms
Complications
Sequelae
Nosocomial
Treatment
Pr.
Challenges in management of peripartum cardiomyopathy with diuretic resistanc...iosrphr_editor
presentation: In this report we present a 30 years old female patient, Para 1 living 1, who was admitted one month ago with complaints of abdominal distension, lower limb swelling and difficulty in breathing that started worsening two weeks prior.12-lead ECG showed sinus tachycardia (100beats/min), low voltage and non-specific T inversion and flattening.Echocardiography showed dilated left ventricle (5.8cm) and left atrium (4.4cm), global hypokinesia with ejection fraction of 36% by biplane. Grade 1 diastolic dysfunction, no thrombus seenand Mild pericardial effusion.
Challenges in management of peripartum cardiomyopathy with diuretic resistanc...iosrphr_editor
Background: Peri-partum cardiomyopathy is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricle systolic dysfunction towards the end of pregnancy or in the months after delivery, in the absence of any other cause of heart failure.Approximately 75% of cases are diagnosed within the first month peri-partum, and 45% present in the first week. Case
A case of chronic diarrhea secondary to Capillaria philippinensis in Occidental, Mindoro Philippines: a newly-diagnosed endemic area?
https://www.actamedicaphilippina.org/article/7208-a-case-of-chronic-diarrhea-secondary-to-capillaria-philippinensis-in-occidental-mindoro-possibly-a-newly-described-endemic-area
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
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The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
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Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
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The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
1. Section Information to Include
Introduction (patient
and problem)
Explain who the patient is (Age, gender, etc.)
Explain what the problem is (What was he/she diagnosed with,
or what happened?)
Introduce your main argument (What should you as a nurse
focus on or do?)
Pathophysiology Explain the disease (What are the symptoms? What causes it?)
History Explain what health problems the patient has (Has she/he been
diagnosed with other diseases?)
Detail any and all previous treatments (Has she/he had any prior
surgeries or is he/she on medication?)
Nursing Physical
Assessment
List all the patient’s health stats in sentences with specific
numbers/levels (Blood pressure, bowel sounds, ambulation, etc.)
Related Treatments Explain what treatments the patient is receiving because of
his/her disease
Nursing Care Plan
Nursing Diagnosis &
Patient Goal
Explain what your nursing diagnosis is (What is the main
problem for this patient? What need to be addressed?)
Explain what your goal is for helping the patient recover (What
do you want to change for the patient?)
Nursing Interventions Explain how you will accomplish your nursing goals, and
support this with citations (Reference the literature)
Evaluation Explain how effective the nursing intervention was (What
happened after your nursing intervention? Did the patient get
better?)
Recommendations Explain what the patient or nurse should do in the future to
continue recovery/improvement
2. Nursing Case Study
I.HealthHistory
The subject of my case study is W. K. W.K. is a 4 year old female who was admitted to National
Kidney and Transplant Institute on June 12, 2011. Prior to being admitted to the hospital, W. K.
had been in excellent health. His troubles apparently began three weeks prior to being admitted.
On November 23, W. K.’s son found him lying on the floor confused, and soaked in urine.
Mr. K. was diagnosed as having an acute cerebral vascular accident. This disorder can also be
described as a “stroke”. It occurs when there is an interruption of normal blood flow in one or
more of the blood vessels that supply the brain. Thrombosis, embolism, and hemorrhage are the
primary causes of a CVA. (Sommers and Johnson 2002) The tissues of the brain become
ischemic, leading to hypoxia or anoxia with destruction or necrosis of the neurons, glia, and
vasculature. Complications of CVA include unstable blood pressure, sensory and motor
impairment, infection, pneumonia, contractures, and pulmonary emboli. CVA is the third leading
cause of death in the United States and affects more than 500,000 Americans annually.
(Sommers and Johnson 2002)
He was widowed in October of 2001, one daughter has coronary artery disease, one son died of
an MI at age 37, and one son died with lung cancer at 57. He had been the primary care giver of
his daughter until she was admitted to the hospital three weeks ago. She is dying with a short
bowel syndrome and cirrhosis and is now being taken care of in hospice. Soon after being left
alone, Mr. K.’s appetite decreased and he had become congested. He was placed on Paxil to treat
symptoms of depression. He had also been taking Cipro for congestion. Also his family noticed
that he was suffering from confusion. As a result, they brought him into the Emergency Room
for evaluation. The Emergency Room doctors performed a CT scan of the brain which revealed
evidence of old strokes. The doctors stopped the Cipro and placed him on Z-pack. This seemed
to improve his state of confusion, as well as reduce his symptoms of congestion.
On the 22nd, he was seen for the congestion. The doctor examined him thoroughly. This exam
included giving him a chest x-ray. The chest x-ray proved to be normal. His white blood count
was elevated and he was found to be mildly dehydrated. He was prescribed Amoxicillin 500
three times a day, and Guaifenesin. His past medical history is short including depression, stroke,
and presbyacusis. He has not had any prior surgery and there are no known allergies.
II. Diagnostic Measures
On November 25, 2002 W. K. under went several diagnostic studies in order to confirm that he
indeed had suffered a stroke on November 23. A MRI scan without contrast, of the brain was
performed; these results were compared to a similar scan performed on November 23. The scan
revealed bilateral acute infracts; the largest was located in the left superior cerebellum. Atrophy
and chronic ischemic change was also evident. The MRA scan, without contrast, of the
intracranial region showed significant intracranial atherosclerotic disease in one or two occluded
branches of the right middle cerebral. On the same day, W. K. had his first DG swallow function
test. Under lateral video fluoroscopic observation, various consistencies of oral barium blouses
were administered to the patient. The video tape recording revealed Frank Tracheal Aspiration
3. with thin liquid, nectar, thick liquid and honey thick consistency barium solutions as well as
vallecular pooling. These findings explain the source of Mr. K.’s congestion. Finally, a DG chest
portable 1V test was performed. The results of this test were compared to a similar test
performed on November 12. There was found to be mild improvement in W. K.’s interstitial
prominence. There was no pneumonia or faxal infiltrates found.
When W. K. was admitted to the hospital, his abnormal laboratory findings included a low
potassium level of 3.1 mEq/Lh, a low lymphocyte count of 3%, a low monocyte count of 0%,
and a low ABS monocyte count of 0% k/uL. His glucose level was high with a reading of 161
mg/dl. There was a high AST/SGOT of 46 U/L. There was a high WBC count of 24.2 K/uL. The
RDW was high at 15.3%; as was the neutrophil count of 97% and a high ADS granulocyte
reading of 23.5 K/uL.
When I met M. K. on the 25th of November, his carbon dioxide level was high at 33 mEq/L and
his WBC count was high at 17.2 K/uL. His RDW was high at 15.0%. His hemoglobin was low at
11.1 g/dL and his hematocrit was low at 33.5%. Finally, his RBC was low at 3.86 MiL/uL.
His vital signs were as followed: blood pressure 143/86, heart rate of 84, respirations were 20,
temperature afebrile at 95 degrees, and his oxygen saturation was 95%. Mr. K. denied any pain.
He had a gaze preference to the left, and a slight left facial droop. He was confused, agitated, and
had slurred speech. W. K.’s heart sounds were a regular rate and rhythm without any murmurs.
Wheezes were present it the left lung lower lobe. Bowel sounds were active in all four quadrants.
No edema present and pedal pulses were not palpable. He had a closed IV in place in his right
had, for quick distribution of IV drugs. This site was free of any signs of irritation. He was
placed on three liters of oxygen by was of a nasal canula. A Foley catheter was in place with out
any discomfort. Mr. K.’s movements proved his anxiety level to be high. His activity was limited
due to weakness in left leg and confusion; he also had a waist belt to restrain him from getting
out of bed. His skin was warm and dry; he had a few abrasions on his left arm. He had
errythematous areas on his iliac, spinal cord, and sacrum.
III. Diet
When W. K. was first admitted to the hospital he was ordered by his doctor to be on a NPO diet.
However, to prevent malnourishment he was allowed to receive a dysphagia meal. This died
consists of pureed foods such as scrambled eggs pureed vegetables, fruits, and custards. He also
has to have all thin liquids thickened with Thick It. Due to the stroke Mr. K. has dysphagia, and
at times aphagia. His foods can be made more appealing if the patient smells the food first. As
the nurse it is important that his head is raised 90 degrees at meal times and 30 minutes after to
decrease aspiration. (Sparks and Taylor 2001) It is also important for this client to receive
adequate fluid intake, because he shows signs of mild dehydration. After meals his bowel sounds
need to be monitored.
IV. Drug Therapy
W. K. is on a total of three drugs that help treat his condition. As always the five rights of drug
administration must be in effect when giving a client medication. The first drug is Asprin also
known as Aspergum, Bayer, Easprin, Ecotrin, Empirin, Entrophen, Genpotin, Norwich,
Novasen, and Zorprin. He is to take 325 mg by mouth everyday at 10:00 am. This drug is
4. classified as an antiplatelet drug. W. K’s immobility makes it easy for blood clots to form.
Asprin was prescribed to thin his blood and protect him from any blood clots or a pulmonary
embolus. This medication needs to be taken with food or after meals if GI upset occurs. Nausea,
GI upset, heartburn, easy bruising, and gum bleeding may occur. (Karch 2000)
The second drug is Paxil or Paroxetine, an antidepressant. Mr. K. takes 12.5 mg of this drug
every day by mouth at 10:00 am. W. K. has a history of depression and after his daughter was
admitted to the hospital his appetite decreased because of reoccurring depression. This
medication may cause drowsiness, dizziness, tremors, GI upset, and alterations in sexual
function. (Karch 2000)
The last drug is Lorazepam, also called Ativan. This drug is used to treat anxiety. W. K. takes
this drug either IV or by mouth .3mg every 8 hours when needed. Mr. K. experiences high
anxiety levels demonstrated by fidgeting, and signs of aggravation associated with being
hospitalized and depression. The nurse needs to make sure that this medication is pushed slow,
infuse at maximum rate of 2mg/min. Drowsiness, dizziness, and GI upset may occur. (Karch
2000)
V. Other Therapy
To maintain W. K.’s oxygen levels between 95% and 100%, he was placed on 3L of oxygen. His
oxygen saturation levels are monitored every four hours. The oxygen saturation levels were best
measured from his ear. His nasal canula must be cleaned and checked to be certain that it is in
the correct position the doctor has ordered that this patient receive physical therapy in order to
prevent problems that occur with immobilization. The patient should try to get out of bed and
move around as much as possible. However, duet to W. K.’s confusion and left sided weakness,
he is very likely to fall. This patient needs to be turned every 2 hours when in bed. He also has to
wear moon shoes to prevent heel damage. W. K. uses a Foley catheter to prevent falls on the way
to the bath room and accidents associated with incontinence. The doctor has ordered a restraint to
be placed across the patients waist in order to prevent him from getting out of bed on his own
and falling. This restraint order must be signed daily by the doctor and the nurse has to verify his
daily signature.
Since this patient can not swallow, mouth care is important in order to prevent debris from
collecting in his mouth. Swabs are used to remove any excess debris from his mouth. W. K.’s
oral membranes need to be kept moist to promote comfort.
VI. Nursing Care Plan
W. K.’s nursing care plan’s physiological mode addresses his physical mobility impairment
related to his neuromuscular impairment. The patient was assessed to have suffered a CVA. Due
to his CVA, W. K. is uncoordinated and has jerky movements. Hi is totally dependent and can
not participate in any activity with out assistance. He has a waist restraint, and a sitter that comes
in from 11pm to 7am. He has some reddened areas on his spine, iliac, and sacrum. Mr. K. also
has moon shoes to prevent heel breakdown.
The nurses plan to prevent complications such as contractures, venous stasis, thrombus
formation, skin break down, or hypostatic pneumonia throughout his hospital stay. Patient or
5. family members will carry out mobility regimen after discharge from the hospital. Patient of
family member will make plans to use resources to help maintain his level of mobility before
discharge from the hospital.
Range of motion exercises are to be performed to joints, unless contraindicated. These exercises
should progress from passive to active as the patient can tolerate.
- These exercises will prevent joint contractures and muscular atrophy.
(Sparks and Taylor 2001)
The patient should be turned and positioned every 2 hours. A turning schedule should be
established because this is a dependent patient.
- This prevents skin breakdown by releaving pressure. (Sparks and Taylor 2001)
The physical therapist will develop the mobility regimen.
- This is to help rehabilitate musculoskeletal deficits. (Sparks and Taylor 2001)
The family members will be instructed in ROM exercises, transfers, skin inspection, and the
mobility regimen.
- In order to help prepare the patient for discharge. (Sparks and Taylor 2001)
The physical therapist will demonstrate the mobility regimen and note the date. The patient and
family members will then demonstrate the mobility regimen to ensure continuity of care and the
use of proper technique. The date of this demonstration will be noted. W. K. has not experienced
any pressure ulcers while being hospitalized.
The self concept mode diagnosis is that the patient exhibits hopelessness related to a failing or
deteriorating physiologic condition. His emotional status is one of a sense of hopelessness. He
stated that “there is no reason left for him to be here”. He exhibits lack of control over self care.
His current situation is a severe state of weight loss. His daughter is in hospice. He has loss his
appetite, his daughter, and his wife. He suffers from depression.
The patient will require rest and an appropriate activity pattern while hospitalized. The patient
will be helped to identify factors that make him feel more hopeful in two days. The patient will
demonstrate more effective communication skills, which include direct verbal responses to
questions and increased eye contact before being discharged.
The medical regimen designed for the patient will be followed.
- This will manage his physiologic condition and increase his potential for recovery. (Sparks and
Taylor 2001)
The family members and patient will be involved in care planning and the patient will be allowed
to choose his degree of self-involvement.
- The cognitive disturbances associated with anxiety or depression prevents the patient form
making healthy decisions. (Sparks and Taylor 2001)
Comfort measures will be used to complement his prescribed medications.
- In order to induce relaxation. (Sparks and Taylor 2001)
The patient will receive help in mobilizing his resources before being discharged. This includes
contacting family members and scheduling follow-up appointments with referral groups such as
hospice. The patient and family members should be left with a sense of future direction. The
patient will be able to discuss feelings of hopelessness openly.
6. Role function mode- the patient suffers from a verbal communication impairment related to
decreased blood circulation to his brain. Therefore, his ability to speak has decreased, and his
ability to understand verbal communication has decreased. He is unable to use words
appropriately. His level of consciousness has decreased and he is disoriented. His major form of
communication is a nod. He has difficulty expressing thoughts, verbally. He has aphagia.
Patient and family will express satisfaction with level of communication skills during W. K.’s
hospital stay. Patient will maintain his state of orientation throughout hospital stay. Patient will
maintain an effective level of communication before discharge from the hospital.
Monitoring and recording changes in speech pattern or level of orientation must be done for this
patient.
- Changes may indicate improvement of deterioration of condition. (Sparks and Taylor 2001)
While communicating with W. K. the nurse needs to speak slowly and distinctly in normal tone
when addressing the patient, and stand where patient can see and hear you.
- These actions promote comprehension. (Sparks and Taylor 2001)
Reorient W. K. to reality by: calling him by name, telling him your name, and giving him
background information.
- These measures develop orientation skills through repetition and recognition of familiar
objects. (Sparks and Taylor 2001)
Use short simple phrases and yes or no questions when patient is very frustrated.
- This is to reduce frustration. (Sparks and Taylor 2001)
Allow ample time for response. Do not answer questions yourself if W. K. has ability to respond.
- This improves patient’s self-concept and reduces frustration. (Sparks and Taylor 2001)
The outcome should conclude that patient and family members are communicating at satisfactory
levels. The patient communicates effectively ten times daily.
Finally, the interdependence mode of the nursing care plan follows the last nursing diagnosis for
this patient. Social interaction impairment related to altered thought process. Because of the
CVA W. K. now has an insufficient quantity of social exchange.
His family reported a change in his style of interaction, W. K. also has a history of presbyacusis
associated with old age.
The plan of care for Mr. K. include, he will remain free of injuries throughout hospital stay.
Patient and family members will report concern about difficulties in social interaction throughout
hospital stay. Patient and family members will participate in care and prescribed therapies
throughout hospital stay. Patient will regain appropriate neurological function to extent possible
before discharge. Lastly, patient and family will identify and mobilize resources for
rehabilitation and discharge planning as necessary.
The nurse needs to take precautions to ensure safe and protected environment providing side
rails, and use of physical restraints as necessary.
- This reduces potential for patient injury. (Sparks and Taylor 2001)
W. K. needs to receive positive reinforcement for appropriate and effective interaction behaviors
(verbal and nonverbal).
- This helps patient recognize progress and enhances feelings of self-worth. (Sparks and Taylor
7. 2001)
W. K. and his family members need to be assisted in progressive participation in care therapies.
- This reduces feelings of helplessness and enhances patient’s feelings of control and
independence. (Sparks and Taylor 2001)
VII. Teaching Plan
Nurses have an ethical responsibility to teach their clients. (Potter 1999) The nurse should
anticipate client’s needs for information that clients and their family members need. W. K. and
his family members need to be educated about the safe and effective use of medication,
according to law and their needs. Mr. K’s family also needed to be educated about proper
positioning of the patient, and rehabilitation techniques to help him function more independently
in his environment. I felt that they also needed to be informed about access to additional
resources in the community, and lastly about when and how to obtain any further treatment W.
K. may need.
I asked Mr. K. questions that could define his motivation to learn, lack of motivation seriously
threatens the success of the teaching plan. (Potter 1999) Because of Mr. K.’s condition he has to
be taught while he is alert and rested. It is also important that there is complete focus on his
wellness and strengths. Also his teaching sessions need to be kept short to maintain complete
alertness.
Knowledge deficit related to psychomotor dysfunction is the best nursing diagnosis that relates
to this patient. The main goals for W. K. is that he takes his medication properly, he is provided
with the proper care for his condition, his skin integrity remains intact, and the family contacts
hospice when necessary so this patient can die peacefully.
I involved the patient by teaching him how to position himself to prevent pressure ulcers, and
having him to demonstrate this back to me. We also performed range of motion exercises that the
patient also demonstrated sufficiently. This is an important measure to prevent contractures.
I implemented my teaching plan through reinforcement. When W. K. seemed to be
understanding, I provided him with positive reinforcement. This can ensure me that after the
teaching he will still perform proper behavior to maintain his health. The effectiveness of my
teaching was based on W. K.’s feed back. From his feed back I would consider my teaching very
effective.
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