08/18/2019

Weekly Concept Focus

• Mobility or Safety
• Elimination
• Oxygenation: Gas Exchange
• Thermoregulation or fluid and electrolytes
• Inflammation/infection
• Tissue Integrity
• Pain

Date:

8/02/2019

Student name:

Edward Nuarpah

Clinical Site/Unit:

LTC

Clinical Site Instructor:

Joylyn Anderson

Clinical Site Mentor:

Ibrahim

Overweight/underweight:

Normal 152lbs

Allergies:

Acetazolamide

Marital Status:

Divorced

Religion:

Christianity

Cultural Background:

German

Primary Language:

English

Code status:

2

Diet/Nutrition:

Recommended and monitored

Activity:

Physical therapy,

Treatments:

Medication and Psychotherapy

IV/Tubes/Ostomies:

None

Interdisciplinary Cares(OT/PT/RT):

Occupational therapy, physical therapy, range of motions

Dressings/Wounds: (type & location)

None

Oxygen: (delivery method & amount)

Room air

Dialysis:

0

Admitting Medical Diagnosis(s):	Parkinson disease	Reports experiencing light-headedness, sometimes motion intolerance, unstableness, weakness in both limbs and feeling drowsy and somehow sluggishness. He reports the symptoms for about ten days.
Primary (if different than Admitting)	Hearing Loss	B. K reports a history of hearing loss for about six years
Secondary (Do not include History Of):
	Stroke
	Hypertension

Medication Data Sheet

Scheduled Medications that your patient is currently taking.

Drug Name and Classification	Expected action & indication for use	Side Effects/ Adverse Reactions	Medication/Food Interactions	Nursing Administration Special Instructions & Assessments	Client Education & Evaluation of Medication Effectiveness e.g. Pain Scale
lisinopril	Inhibit action of angiotensin converting enzyme thus preventing conversion of angiotensin I to angiotensin II	Lightheadedness, nausea, headache, dizziness	Aliskiren, lithium, losartam	Get slowly from any position to reduce side effects such as lightheadedness. The drug rarely cause serious problems but in case you feel serious effects such as fainting call for help immediately	Three consecutive blood pressure reading using a blood pressure cuff of width of 40% arm circumference and length of 80% arm circumference show normal range of BP reading: 121/79, 126/84, 124/89
Atenolol	Inhibit the action of certain natural chemical such as the epinephrine on the heart thus lowering blood pressure	Lightheadedness, nausea, headache, dizziness	Dosaletron	Get slowly from any position to reduce side effects such as lightheadedness. You may feel cold, put on warm clothes to avoid feeling cold. Call for help when feeling unwell any time after administration of the drug. Take the drug regularly as prescribed. Should not be taken with orange or apple juice. Be taken with or without food by mouth	Three consecutive blood pressure reading using a blood pressure cuff of width of 40% arm circumference and length of 80% arm circumference show normal range of BP reading: 121/79, 126/84, 124/89
Aspirin	Inhibit the action cyclooxygenase enzyme thus preventing production of prostaglandins		Heartburn and stomach upset	Never chew or crush the enteric coated tablet as this may worsening stomach upset. Swallow the tablet. Seek immediate attention in case of vision loss, weakness on one body part, slurred speech	Patient report no pain after one hour of administration

Daily “Brains”, to be completed during clinical day.Begin your day with a plan and change/make notes as needed.You may print and use this template or create your own.

Room #:

Diet: DASH Diet

Ambulation:

IV fluids: 1000mls normal saline

Allergies: No known food or drug allergy

	Medications	Treatments	Nursing care/interventions	Vital Signs
0700	lisinopril	Lowers higher blood pressure through inhibiting of angiotensin converting enzyme preventing conversion of angiotensin I to angiotensin II	Teach on the significance of slow movement when changing position to reduce effects such as lightheadedness. Educate on drug adherence and consistency in taking medication to increase drug effects. Advice and ensuring that the patient wear heavy clothes and made aware that cold is a normal side effect of lisinopril	Temp 28 degree Celsius, RR 23 beat/min Oxygen saturation 93% blood pressure 121/89 mmHg PR 60 beat/min
0800	Atenolol	Lowers high blood pressure and treats left ventricular hypertrophy. It inhibits the action of natural chemicals such as epinephrine on the blood vessels and heart thus lowering blood pressure	Ensuring and teaching on the significance of slow movement during changing of position in reducing the adverse effects such as nausea, dizziness and lightheadedness Make aware of the need to seek medical attention in case the effects become unbearable	Temp 30 degree Celsius, RR 23 beat/min Oxygen saturation 93% blood pressure 121/89 mmHg PR 60 beat/min
0900	Aspirin	Relieves pain. It inhibits the action of cyclooxygenase enzyme thus cutting the production of prostaglandins.	Teach and in all cases ensuring the patient swallow the capsule. Make the patient aware that chewing and crushing increases sides effects of the drug such stomach upset. Again, ensure the patient is aware that aspirin should not be used for more than ten days.	Temp 28 degree Celsius, RR 23 beat/min Oxygen saturation 93% blood pressure 121/89 mmHg PR 60 beat/min Pain chest pain
1000
1100
1200
1300

ASSESSMENT SUMMARY: Complete in narrative form based on the form filled out during clinical day.

Body System
Vital Signs and Pain Level:	Weight 152 lbs. Height 5’7 BMI 25 PR 105 HR 105 RR 22 TEMP 96.6FOXYGEN SATURATION 93% PAIN-Reports chest pain
Sensory:	maureen is very sensitive. Assessment of all the senses shows that all his senses are active.
Neurological:	B. K is well oriented X2 and alert. He is quite cooperative and welcoming but seems depressed. He present with abnormal gait speaks normally and the reflexes are normal.
Respiratory:	On measurement, maureen’s respiratory rate is 22 beats per minute; his oxygen saturation is at 93%. On inspection, no intercostal retraction. The respiratory rhythm is irregular. On palpation, there is tenderness and chest movement is regular. Rales are present on auscultation and pulmonary edema is revealed
Cardiac:	Palpation of the heart reveals the location of PMI. Auscultation shows irregularity in heart sounds and murmurs are noted. Maureen has unequal pressure in both arms.On examination, there are carotid bruits and abnormality in abdominal aorta is noted. The veins as well as distended.
Integument:	Maureen has no rashes, lesions or ulcers. There are not subcutaneous nodules or tightening on palpation
Gastrointestinal:	Inspection reveals masses, the abdominal wall seem normal. On palpation and percussion of the liver, spleen and abdomen, no ascites or irregularities are noted. However, the kidney is swollen. Examination reveals no hernia. There are no rectal masses or hemorrhoids. There are bowel sounds in all the four quadrants.
Musculoskeletal:	Maureen has no deformity or pain. His muscle strength is up to +5
Renal:	There are no symptoms of hematuria, urgency, retention, nocturia, polyuria, dysuria, stones. External genitalia are clean.
Endocrine:	Maureen reports rapidly weight loss and attribute it to loss of appetite. The patient reports no any other symptom.
Immune and Hematologic:	There are no symptoms of cyanosis, bruises or enlargement of any lymph node. Maureen reports no incidence of bleeding
Psychosocial/ Sociocultural / Spiritual:	Maureen seems so depressed because of her condition. However, she denies stress, any symptom of anxiety, memory loss or earlier psychiatric illness. However, she’s not oriented to place and. she also appears confused.

Patient education: (e.g. medication, possible complications associated with the patient, nutrition, activity)Complete in a narrative format exactly how you would educate the patient.Include 7 narrated sentences.

Hello Maureen, I am happy on the way you have shown commitment towards our desire to better your health. Thus, I want to take this chance to give you the necessary guidance that will improve your life. Firstly, it is important that you include fruits and vegetable in your diet; preferably every meal of the day. A good diet will ensure your body defenses itself against some diseases. Secondly, ensure that you engage in daily exercise. Exercising ensures that your body remains active (Lee et al., 2018). Sometimes if you cannot exercise, engage in long distance walks. Thirdly, ensure that you take your drugs as prescribed. Taking drugs requires a lot of discipline on your side for there will be no one watching you or bringing the drugs to you. Another vital factor you should consider is ensuring you see a doctor regularly. Doctors know better while you the patient know the pain that you experience with the disease. It is upon you to constantly see the doctor and open up about your condition. Lastly, as I told you earlier, every drug has its side effect (Clinical Service of Rhode Island, 2019). Therefore, in case of dizziness, you can sleep to cool off. However, if the feelings persist, you can call your doctor or visit your nearest hospital or clinic for check-up. Furthermore, before you decide on seeing any new doctors concerning your condition, I am happy to inform you that I will be available to help. Let me be the first person to call in case of any emergencies. I will send you a person or I will personally come in case you cannot drive to the facility. Thank you for your cooperation.

Outcome: Critical Thinking: Self assessment:

Self reflect on how your clinical experience correlates with what you learned in this week’s module.Objectives are located in the course under each module and are helpful in completing this section.

Clinical field is a very interesting area of nursing. For all the period that I have worked in this facility, I have come to realize that whatever I learned theoretically in class is significant in the nursing home as much as it was in the exams. Patient’s with your kind of disease face a lot of pain from the body aches that they face. It is one of the diseases that I have encountered in this facility and through my understanding of patient management; I was able to handle the patients. Moreover, the knowledge I acquired from the week’s lessons emerged significant in relieving patients’ pain, prevent infections, and many more. I have clear understanding of pain that patients experience. I know when a client is in severe pain and when to offer help. My understanding on the amounts of drugs to administer for a patient is also helpful in the field. Thus, I can confess that all the theoretical knowledge that I acquired during the week’s module has been vital to me in administering quality care to the patients. My patients have never been disappointed when it comes to handling their feelings. I am happy to work in this field and I am looking forward to do better for my next patients like Maureen.

Outcome: Caring

Identify one example from your clinical day in which you observed, participated in, or provided some aspect of caring for the provision of psychosocial and/or cultural diversity needs. How did you inspire or make a difference in your patient’s life today?

Patient’s cooperation is usually earned rather than being forced (Stratil, Rieger, & Völter-Mahlknecht, 2017). Mohamed Abiud was my patient in the clinic. He was infected with HIV and wanted to take his life. I took it upon myself, sat him down, and talked to him about the quality of life. I was there when he needed me, availed all that he wanted, listened to him, and offered pieces of advice until he finally changed his mind. He agreed to take his drugs and we all went home happy after his discharge from the hospital. I am sure that if any similar case arises with any patient of mine, I can handle them. I have a connection ability with people who require help. My skills in engaging people will help me substantially in assisting patients who have a similar case like the Abiud’s issue.

References (at least 3 in APA format)

Hypertension retrieved from https://emedicine.medscape.com/article/241381-workup#c8

Johnston, S. C., Amarenco, P., Albers, G. W., Denison, H., Easton, J. D., Evans, S. R., … & Wang, Y. (2016). Ticagrelor versus aspirin in acute stroke or transient ischemic attack. New England Journal of Medicine, 375(1), 35-43.

Leung, A. A., Nerenberg, K., Daskalopoulou, S. S., McBrien, K., Zarnke, K. B., Dasgupta, K., … & Bolli, P. (2016). Hypertension Canada’s 2016 Canadian hypertension education program guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Canadian Journal of Cardiology, 32(5), 569-588.

Nerenberg, K. A., Zarnke, K. B., Leung, A. A., Dasgupta, K., Butalia, S., McBrien, K., … & Lamarre-Cliche, M. (2018). Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Canadian Journal of Cardiology, 34(5), 506-525.

Lee, C. J., Kim, J. Y., Shim, E., Hong, S. H., Lee, M., Jeon, J. Y., & Park, S. (2018). The Effects of Diet Alone or in Combination with Exercise in Patients with Prehypertension and Hypertension: a Randomized Controlled Trial. Korean circulation journal, 48(7), 637–651. doi:10.4070/kcj.2017.0349, Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031728/ [Accessed on: 19 August 2019]

Clinical Service of Rhode Island, (2019), Side Effects of Drugs and the Cost to the Body, Available at: https://clinicalservicesri.com/side-effects-of-drugs/ [Accessed on: 19 August 2019]

Stratil, J. M., Rieger, M. A., & Völter-Mahlknecht, S. (2017). Cooperation between general practitioners, occupational health physicians, and rehabilitation physicians in Germany: what are problems and barriers to cooperation? A qualitative study. International archives of occupational and environmental health, Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500677/ [Accessed on: 19 August 2019]

General information about the client and family

Maureen is an eighty-eight years old and Caucasian American and a Christian. She was diagnosed with Parkinson’s diseases and currently being treated with medication and disease management at the Shayne crossing Eventide. According Maureen, She’s the third born in a family of four. Her mother died from diabetes at the age of sixty, and their father died five years later due to hypertension. The firstborn in the family died in a road accident, which was attributed to drug abuse. The other two siblings are alive and healthy. Maureen was married to one man fifty years ago and blessed with three children, two daughters and one son. All three children and the wife are alive and healthy.

Past medical History

Maureen is primarily diagnosed with Parkinson disease and currently residing at the Shayne crossing eventide.On 20th December 2016, Maureen was admitted due to four different conditions. Firstly, she was diagnosed with vascular dementia with behavioral disturbance though this was not taken as the primary diagnosis. Secondly, Maureen was diagnosed with primary hypertension, which was again not accepted as the primary diagnosis. Thirdly, she was diagnosed with acute post hemorrhagic anemia and successfully underwent medical management. Lastly, Maureen was diagnosed with a fracture of the unspecified part of neck of femur, a subsequent encounter with a closed fracture with routine healing. She received medical attention and became well afterwards.

On 3rd August 2017, she was admitted and diagnosed with unspecified glaucoma, though this was not accepted as the primary diagnosis. On 28th March the same year, she was diagnosed with dysphagia, oropharyngeal phase, which was not accepted as the primary diagnosis. On 5th August 2018, Maureen was diagnosed with age-related osteoporosis with pathological fracture. However, this diagnosis was not accepted as the primary diagnosis. On the same date, she was diagnosed with iron deficiency anemia and successfully received medical management. On 3rd October 2018, she successfully underwent major joint replacement surgery after she was diagnosed with periprosthetic fracture around the internal prosthetic hip joint, subsequent encounter.

Present Medical History

Maureen presents with stiff limbs, slow and unstable movement. She cannot maintain an upright posture and has a rigid facial expression. Additionally, she has tremors, especially in the extremities and her voices changes. Moreover, Maureen cannot think properly and seems disoriented. She is weak and reports extreme fatigue.

Additionally, Maureen appears pale, has brittle nails and cold extremities. She also reports lightheadedness, dizziness and headache as well as chest pain. The caretaker says that some symptoms have been mild for the past one week and became worse the morning of her admission.

Maureen is allergic to acetazolamide. She, however, report no known food allergy. She has never smoked tobacco, abuse any drug or consumed alcohol in her life.

General examination reveals that the blinking rate of Maureen is lower. Again, Maureen displays a less varied and less frequent facial expression. On examination, Maureen shows resistance against the passive movement. There is resting tremor with is more pronounced in one arm than the other when she is asked to talk while relaxing her arms. Maureen cannot maintain balance on her own and maintains a stooped posture. On further examination, she is slow in movement. Lastly, she finds it hard to identify odors. She reports sleep disturbance.

Current medications and side effects

Latanoprost solution 0.005 drops

It causes a blurred vision. It may result in changes in the color of the eyelashes, their thickness and number. Additionally, it drives to redness of the eye after its application and sometimes may make an individual feel like there is a foreign body in the eye. The drug causes browning of the iris, watery eye and makes the eye to be dry.

Acetaminophen 500mg PO bid

The drug has no side effect. However, some side effects may be experienced due to allergy but are rarely severe. They include rash, difficulty in breathing, itching.

Donepezil tablet 10mg PO od

Side effects include feeling generally unwell, loss of appetite, tremor, dizziness, fatigue, muscle cramps, weight loss, insomnia

Carbidopa-levodopa tablet 25-100mg 2 tablet PO tid

Its side effects include nausea, vomiting, dizziness, lightheadedness, unusual dreams, sleeping problems and sometimes headaches

Vitamin D-3 tablet 3000 units PO od

The drug’s side effects include bone loss, elevated blood levels, stomach upset, constipation, poor appetite, nausea, vomiting, elevated blood calcium levels

Droxidopa capsule 600mg PO od

Lightheadedness, confusion, severe dizziness, burning pain during urination, shortness of breath, seizures, dangerously high blood pressure

Flonase suspension 50

Side effects include nasal septal perforation, epistaxis, Candida albican infection, nasal ulceration, immunosuppression, adrenal suppression, impaired wound healing and glaucoma

VitaminA capsule 800 PO od

Side effects are rare but are apparent when taken in high doses. They include risk of osteoporosis and hip fractures, particularly in old age.

Milk of Magnesia 300ml PO prn

The most common side effect is diarrhoea. Some patients report symptoms of a high level of magnesium such as muscle weakness, symptoms of dehydration, stomach pain, rectal bleeding among others

Tums tablet chewable 1000mg PO prn

Side effects include constipation, excessive gas and in some instances burping may be present. Also, nausea, vomiting, bone pain, unusual weight loss, headache, unusual weakness, excessive urination may be evident

Loperamide HCI 2mg capsule 2mg PO prn

Side effects include stomach pain, fatigue, discomfort, constipation, dry mouth, dizziness and drowsiness

References

Vallerand, A.H., Sanoski, C.A, (2016). Davis’s drug guide for nurses (15th ed.). Philadelphia, PA: F.A. Davis Company

 

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