The document provides a nursing care plan for a 62-year-old female patient, Mrs. Kulsum, who is being treated for Pott's Spine at L3 and L4 levels. It includes her medical history, physical examination findings, lab results, medications and nursing assessments. The nursing diagnoses identified are acute pain, impaired mobility, altered nutrition, impaired skin integrity, self-care deficit, ineffective coping and risks for infection and aspiration due to her condition and restricted activity.
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For the following Case Study, as follow is Discussion Question shantayjewison
For the following Case Study, as follow is Discussion Question: As an NP student, needs to determine the medications for constipation.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed for constipation? Write her complete prescriptions using the prescription writing format.
Support with 1 journal no older than 5 years.
Week 7: DISCUSSION QUESTION IN DISCUSSION BOARD
Gastroenterology-Motility Case Study
ACC/AHA Guidelines
PLEASE USE THIS MEDICATION FOR THE CASE STUDY: LUBIPRISTONE 24 MCG TWO TIMES A DAY.
Case study sample:
Chief complaint:
“ I have chronic constipation, incomplete defecation and abdominal bloating” for past 2 years.
HPI:
M.C. a 46-year-old hispanic female presents to the GI-Motility clinic for complaint of chronic constipation, incomplete defecation and abdominal bloating. She has pmhx of DM-type 2, IBS-Constipation, Tubular Adenoma.
She also indicates that she has noticed that her symptoms are worsening for past 3 months. She has associated her symptoms with abdominal bloating, straining and incomplete defecation.
She has tried Miralax one packet po daily for at least 8 weeks and it has not relieved her symptoms.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
Diabetes Mellitus, type 2
Constipation, chronic-IBS
Surgeries: None
Allergies
:
Penicillin
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: + 1 pitting leg edema. + Varicose veins.
Skin: + rash crusted white in feet and inter-digit in feet.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN: +Dryness, No open lesions. +Dry crusts in sole of feet. + moist crust in between toes.
PSYCH
: Normal affect. ...
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The transmitted distance can be anywhere between a few meters (for example, a television's remote control) and thousands of kilometers (for example, radio communication).
Wireless communication can be used for cellular telephony, wireless access to the internet, wireless home networking, and so on.
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# Internet Security: Safeguarding Your Digital World
In the contemporary digital age, the internet is a cornerstone of our daily lives. It connects us to vast amounts of information, provides platforms for communication, enables commerce, and offers endless entertainment. However, with these conveniences come significant security challenges. Internet security is essential to protect our digital identities, sensitive data, and overall online experience. This comprehensive guide explores the multifaceted world of internet security, providing insights into its importance, common threats, and effective strategies to safeguard your digital world.
## Understanding Internet Security
Internet security encompasses the measures and protocols used to protect information, devices, and networks from unauthorized access, attacks, and damage. It involves a wide range of practices designed to safeguard data confidentiality, integrity, and availability. Effective internet security is crucial for individuals, businesses, and governments alike, as cyber threats continue to evolve in complexity and scale.
### Key Components of Internet Security
1. **Confidentiality**: Ensuring that information is accessible only to those authorized to access it.
2. **Integrity**: Protecting information from being altered or tampered with by unauthorized parties.
3. **Availability**: Ensuring that authorized users have reliable access to information and resources when needed.
## Common Internet Security Threats
Cyber threats are numerous and constantly evolving. Understanding these threats is the first step in protecting against them. Some of the most common internet security threats include:
### Malware
Malware, or malicious software, is designed to harm, exploit, or otherwise compromise a device, network, or service. Common types of malware include:
- **Viruses**: Programs that attach themselves to legitimate software and replicate, spreading to other programs and files.
- **Worms**: Standalone malware that replicates itself to spread to other computers.
- **Trojan Horses**: Malicious software disguised as legitimate software.
- **Ransomware**: Malware that encrypts a user's files and demands a ransom for the decryption key.
- **Spyware**: Software that secretly monitors and collects user information.
### Phishing
Phishing is a social engineering attack that aims to steal sensitive information such as usernames, passwords, and credit card details. Attackers often masquerade as trusted entities in email or other communication channels, tricking victims into providing their information.
### Man-in-the-Middle (MitM) Attacks
MitM attacks occur when an attacker intercepts and potentially alters communication between two parties without their knowledge. This can lead to the unauthorized acquisition of sensitive information.
### Denial-of-Service (DoS) and Distributed Denial-of-Service (DDoS) Attacks
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1. BDM COLLEGE OF NURSING
NURSING CARE PLAN
ON
POTT S SPINE
SUBMITTED TO: SUBMITTED BY:
MRS. KAVITA MAM MS. AANCHAL SINGHAL
LECTURER M.SC NURSING 1st
YEAR
(BDMCON)
SUBMITTED ON: 22/08/2019
2. INTRODUCTION ABOUT THE CLIENT:
Mrs. Kulsum is a resident of Uttar Pradesh. She is suffering fromPott’s Spine L3, L4 .She was
presented with complaint of lower backache since 2 months, history of fever, weight loss and
decrease appetite was also present but no motor and sensory loss was present.
REASON FOR SELECTING THIS TOPIC FOR CARE NOTE:
I found his case interesting and out of my curiosity .I selected Pott’s Spine L3, L4 as my topic
for Nursing care plan. As a part of nursing process, I wanted to learn the comprehensive care
which is required by such patients so that, this learning could help me develop and refine my
nursing care providing abilities for future purpose as well.
IDENTIFICATION DATA
1. CLIENT PROFILE
1. Name : Mrs. Kulsum
2. Age: 62years
3. Sex: Female
4. Marital status: Married
5. Ethnic orientation: Indian
6. Date of admission – 22/01/2019
7. Religious orientation: Muslim
8. Educational level: Illiterate
9. Language: Hindi
10. Occupational history: Housewife
11. Interest, hobbies. Recreational activities:Cooking
12. Diagnosis : Pott’s Spine L3 , L4
2. CHIEF COMPLAINTS AT THE TIME OF ADMISSION
Patient came with complaints of lower backache since 2 months, history of fever, weight
loss, spinal tenderness and decrease appetite was also present but no motor and sensory loss
was present .
3. HISTORY OF PRESENT ILLNESS
3. Patient was apparently well 2 months back whenshe developedlower backache since 2 months,
history of fever, weight loss and decrease appetite was also present but no motor and sensory
loss was present. Patient was treated symptomatically and diagnosed to Pott’s Spine, L3 , L4 for
which patient had been advised for bed rest and put on ATT drugs and on high protein diet.
4. PAST MEDICAL HISTORY
There is ano significant past medical history of abdominal TB ,DM and hypertension.
5. PAST SURGICAL HISTORY
Not significant.
6. FAMILY MEDICAL HISTORY
No history of DM/HTN/ hypothyroidism in family. No one from family member have any
communicable diseases like TB and non communicable diseases Like DM/HTN .
FAMILY TREE
7. PERSONAL AND SOCIAL HISTORY
Patient is non alcoholic and non smoker.
PHYSICAL EXAMINATION
4. GENERAL APPEARANCE
Body built - Mesomorphic
Nourishment - Moderately nourished
Level of consciousness - Conscious
Hygiene - Not maintained
Activity - Restricted due to disease condition but
Active and passive range of motion exercises
Performed on her
Posture & gait - Cannot determined
GENERAL PHYSICAL EXAMINATION
Level of consciousness :-Patient is conscious and oriented
Psychomotor patterns:- Intact
G.K, Memory and concentration :- Intact
VITAL SIGNS (28-01-2019)
Temperature - 98.4 degree Fahrenheit
Pulse - 82/ min
Respiration - 20/min
Blood pressure –110/70mmHg
VITAL SIGNS (29-01-2019)
Temperature -97.5 degree Fahrenheit
Pulse - 98/min
Respiration - 20/min
Blood pressure - 120/76 mm Hg
ANTHROPOMETRIC MEASUREMENT
Height - 5’6”
Weight - 64kg
BMI - 22.9 (Normal)
ABG VALUES (10-01-2019)
Parameters Patient value Normal values Interpretation
PH 7.37 7.35-7.45 Normal
PaCo2 36.9 35-45 mm Hg Normal
HCO3 22 22-28 meq/l Normal
PaO2 89.7 75-100 mm Hg Normal
5. Interpretation :- Normal ABG
HEAD TO TOE EXAMINATION
SKIN
Colour - Skin is wheatish in color
Texture - Skin is dry
Temperature98.6 degree Fahrenheit
Lesions No macules, papules, vesicles present
Clubbing :- Not present
Edema : No edema present
HEAD
Colour of hair - Black
Shape of skull - Normal
Scalp - Scalp is clean, no swelling or dandruff is present
Pediculosis - No pediculosis
Texture - Texture is soft.
Hair distribution – Less
FACE
Shape - Symmetrical
Oedema - Absent
Hydration - Face is hydrated
Any abnormality - No any abnormality
EYE
Vision - Normal
Eye brows - Eye brows are normal
Eye lashes - There is no evidence of any infection
Eye lid - Normal
Eye ball - Eye ball are normal
Conjunctiva - Pale in colour
Sclera- Whitish
Cornea & iris - Normal
Pupil - Pupil is reactive to light B/L equal 2mm and normal
Lens - Lens are normal
EAR
Hearing - Patient is able to hear properly
6. External ear -Clear ear
Tympanic membrane - There is no perforation
Discharge - No discharge from ear
NOSE and SINUS
Nostrils - Nostrils are normal
Nasal septal deviation - There is no septal deviation
Discharge - No discharge is present from nose
Any bleeding from nose – No bleeding is present from nose
Sinus - Sinuses were normal ( Frontal, Ethmoid, Sphenoid, and
Maxillary)
MOUTH
Lips - Symmetrical, dehydrated, Slight black in colour
Odour of mouth - Foul smell present
Teeth - There is no dental caries & yellowish discoloration of teeth
Mucous membrane & gums - There is no swelling present on gums
Tongue - Pale, dry
Tonsils - No inflammation or ulceration of tonsils
NECK
Nuchal rigidity - Not present
Lymph nodes - No lymphadenopathy
Thyroid gland - Not palpable
Trachea - Midline
Carotid pulse - Present
CHEST
Symmetry - Symmetrical
Colour - Normal skin colour
Lesions - No lesions
Chest - Symmetrical in shape & no gynaecomestia present
AXILLA
Redness - not present
Lumps - absent
Rash - absent
Lymph nodes - not enlarged
7. SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM
Inspection- symmetrical
Barrel chest - absent
Kyphoscoliosis- absent
Breathing pattern- 20breaths per minute on room air
Palpation- no tenderness
Tactile fremitus- absent
Percussion- no free fluid present
Air entry – B/L equal
Auscultation :- no abnormal lung sounds present
CARDIOVASCULAR SYSTEM
Inspection and palpation-Normal, no abnormality detected
Auscultation-S1 and S2 normal, no murmur,
Heart rate- 88 beats/min
Pain – no chest pain
ABDOMEN
Inspection -Not distended, tensed ,and Cullen and grey turner signs were absent
Auscultation -Hypoactive bowel sounds
Percussion - Dull, free fluid present
Palpation -Tenderness not present
GENITALIA & RECTUM
STDs - Absent
Any enlargement - Absent
Haemorrhoids - Absent
Pelvic masses - Absent
Rectal polyps - Absent
Foleys catheter present 16 French (22-01-2019)
EXTRIMITIES
Movements - Pain felt duringFlexion and extension of the extremities
Tremors - Absent
Edema - Absent
Reflexes - Normal
8. Varicose vein - Absent
IV cannula present on Left hand (26-01-2019)
SPINE
Spina bifida - Absent
Scoliosis/kyphosis/lordosis - Absent
Curvature - normal
Sacral region - no oedema present
Spinal movements :- Restricted and painful
Pain in back due to disease condition and tenderness present
NEUROLOGICAL TEST
Coordination test- Cannot determined as patient is on complete bed rest
Reflexes - Normal (patellar reflex, Babinski reflex)
Test for sensation - Normal
GCS - 15 (E4V5M6)
No sensory deficit , no cerebellar sign and no sign of meningeal irritation present.
DIET :- High protein diet
LABORATORY INVESTIGATION:
S.No NAME OF THE
INVESTIGATION
CLIENT
VALUES
28/01/19
29/01/19 NORMAL
VALUES(WITH
UNIT)
REMARKS
1 Hb 9.6 9.8 13-17gm/dl Low
2 Lymphocyte 24 26 20-45% Low
3 Monocyte 07 06 2-10% Normal
4 Eosinophil 1 1.2 1-6% Normal
5 Platelet 1.57 1.68 150000-450000
per micro litre of
blood
Normal
6 TLC 37,00 3500 4500-11000
WBC
per microlitre
Low
7 Blood urea 51 48 15-40mg/dl High
8 Sr. Creatinine 1.2 1.5 0.2-1.0mg/dl High
9. 9 Sr.Sodium 134 136 136-145mmol/L Normal
10 Sr.Potassium 4.3 3.9 3.5-5mmol/L Normal
11. SGOT 118 166 5 to 40 units per
litre of serum
High
12 SGPT 328 566 7 to 56 units per
litre of serum
High
Tridot (20-01-2019)= Negative
Interpretation :-Low Hb indicates Anemia,LFT is deranged,High TLC indicates infection
REPORTS :-
USG abdomen:-25-01-2019
Liver 14cm, No SOL/IHBRD, partially Gall bladder distended, spleen –normal and pancreas -
normal
MEDICATION :-
MEDICATION ACTION
1. Inj Streptomycin 0.5 mg IM OD Antibiotic
2. Tab Levofloxacin 500 mg OD Antibiotic
3. Tab Ethambutol 800 mg OD Anti tubercular drug
4. Tab Rantac 150 mg OD Antacid
5. Tab Diclofenac 50 mg SOS Analgesic
6. Tab Multivitamin 1 OD Multivitamin
NURSING ASSESSMENT
10. Assessment of the patient done on regular bases for continuous two days .
Assess the patient respiratory status, need for advance support or oxygenation for any
distress.
Assess the vitals and other parameter like BP, intake and output and SPO2
Assess level of activity tolerance and degree of fatigue, lethargy, and malaise when
performing routine ADLs
The goals for the patient may include increased participation in activities, improvement
of nutritional status, improvement of skin integrity, decreased potential for injury,
improvement of overall health status, and absence of complications.
Weight and fluid intake and output are measured and recorded daily.
Patient is having stress and anxiety due to lack of financial support and loss of job.
NURSING DIAGNOSIS
1. Acute pain related to inflammatory process as evidenced by facial expression
2. Impaired physical mobility related to therapeutic restriction to movement as evidenced
by inability to move purposefully within physical environment, including bed mobility
3. Altered nutritional status less than the body requirement related to fatigue as evidenced
by weight loss
4. Impaired skin integrity related to decreased tissue perfusion as evidenced by dryness on
hands and feet
5. Self care deficit related to pain in back as evidenced by asking for help
6. Ineffective coping pattern related to fear of changes in body image and life expectancy
as evidenced by destructive behaviour towards self or others
7. Risk for infection related to presence of IV lines, Foleys catheter
8. Risk for aspiration related to bed rest.
NURSING CARE PLAN
NURSING
ASSESSMENT
NURSING
DIAGNOSIS
NURSING
INTERVENTION
NURSING
IMPLEMENTATION
EVALUATION
SUBJECTIVE
DATA- Pt. says
that he has pain
at the site of
surgery.
OBJECTIVE
Acute pain
related to
inflammatory
process as
evidenced by
facial
expression
To assess the
level of pain.
To provide the
comfortable
position and rest
Pain level was
assessed by pain scale
and pain score was
610.
Comfortable position
was given.
Pain level is
reduced.
11. DATA- I
observe the
facial
expression of
the patient.
to patient.
To provide the
diversional
therapy.
To provide the
medicine as per
physician
prescription.
Diversional therapy
was given.
Medication was given
i.e.brufen
SUBJECTIVE
DATA –
Patient says
that he is not
able to do his
activity of life
as well as he is
not able to
move.
OBJECTIVE
DATA- I
observe the
general
condition of the
patient.
Impaired
physical
mobility
related to
therapeutic
restriction to
movement as
evidenced by
inability to
move
purposefully
within
physical
environment,
including bed
mobility
To assess the
general condition
of the patient as
well as impaired
mobility pattern.
To provide the
psychological
support to the
patient
To provide the
help in doing
ADL.
To consult with
the
physiotherapist.
General condition
was assessed.
Psychological support
was given.
Help was provided
for maintaining ADL.
Consult was taken
from physiotherapist.
Activity pattern
is improved a
little bit.
SUBJECTIVE
DATA- Patient
says that he
feels warmth
OBJECTIVE
DATA
I observe the
vital sign of the
patient
Risk for
infection
related to
presence of
IV lines,
Foleys
catheter
To assess thelevel
of infection.
To maintain the
hygiene of the
patient.
To maintain the
environmental
hygiene.
To maintain the
aseptic condition.
To provide
medicine as per
doctor
Level of the infection
was assessed.
Hygiene of patient
was maintained.
Environmental
hygiene was
maintained.
Asespsis was
maintained.
Medication was given
as per doctors
order.i.e antibiotic
Risk of
infection is
reduced.
12. priscription
HEALTH EDUCATION
Home care
Patient require complete bed rest
Patient should take high protein diet
Free range of motion exercises to be done
Patient should take anti tubercular drugs on time
Awareness to be given to people about relationship of TB and malnutrition
Tell the patient that physical therapies for pain relieving modalities , postural education
for strength and flexibility should be followed.
If any side effects from medications occur such as itching, change in colour of skin,
tiredness, visual changes or excessive fatigue , then call the doctor immediately
Patient can use braces for back support.
Multivitamins and high protein diet should be taken properly
Tell the patient to maintain the hygiene to prevent from infection.
Prevention of bed sore should be taken care of.
Treat other co morbid conditions
Gradual mobilization is encouraged in absence of neural deficits with spinal braces and
back extension exercises at 3-9 weeks.
Patient should come for the follow up
13. BDM COLLEGE OF NURSING
NURSING CARE PLAN
ON
POTT S SPINE
SUBMITTED TO: SUBMITTED BY:
MRS. KAVITA MAM MS. JYOTI
LECTURER M.SC NURSING 1st
YEAR
(BDMCON)
SUBMITTED ON: 22/08/2019