Nursing Diagnosis Assessment - Assignment Example

Running Head: NURSING DIAGNOSIS OF EMPHYSEMA, OSTEOPOROSIS AND HYPETENSION of Submission Case Plan Patients Initials: B.N Patients Age: 61 years Vital signs T: 102 F BP: 168/94 RR: 32 P: 112 Sp02 85% Pain Pathophysiology of Nursing Diagnosis Erickson's Stage of Development For a normal healthy person, the air-sacs are surrounded by blood capillaries where oxygen is absorbed into the blood. Toxicants like cigarette smoke getting into the lungs are trapped and cause localized inflammation that can eventually result in alveolar septum disintegrating (septal rapture) and deformation of structure of the lungs. These deformations greatly reduce surface area for gaseous exchange (Green 2007). The chest expands to compensate because of reduced ventilation, the capacity to give out carbon dioxide in damaged. Hyperventilation cannot compensate for this and hence vasoconstriction ensues leading to hypertension. Emphysema happens mostly in patients with reduced alpha 1- anti-trypsin (A1AT) levels. Alpha 1 anti-trypsin deficiency (A1AD) destroys alveolar tissues. Smoking reduces A1AT to greater extend and cause emphysema The patient is in her late adulthood: the age range is 55 to 65 years. This is basically the ego development result stage. People at this stage of life are recovering from middle adulthood and experience Despair versus Integrity. The basic strength at this age is wisdom. Those who lived up to their dreams in life usually enjoy good memories and this is what is identified as integrity. Having failed to achieve better life and bearing in mind the situation of the patient's aliments, the patient is not able to find her true self to develop her personal ego as expected of her age. She may not develop wisdom She may start getting scared of death while tying to find self esteem in life. She is likely to despair Risk Diagnosis Interventions with Rationale The patient presents risk of pain and disturbed sleeping patterns: This is evidenced by the patient's ailments which appear like co morbidity of several disease conditions or a cascade of ailments. she had suffered osteoporosis for 8 years, emphysema for 12 years, hyperlipidemia for 5 years and hypertension for 15 years Treatment Open (bronchial ventilation) by suction or giving medication that reduce secretions, acid base management techniques and use of medication. keeping pain diary to assist in identification of irritating and ease factors on pain, assisted the patient in selecting best management strategy and acknowledge and recognize patients past experience (Green 2007) Medication Aggrenox one (200mg) tablet twice a day, Coreg 3.125 mg per oral administration twice a day and Cozaar 50mg per oral administration everyday to reduce high blood pressure. Administer Acetaminophen 650mg six hours interval to relive mild pain and reduce fever. Ipratropium Bromide two puffs twice a day to reduce allergic reactions and secretions as well as for brocho-dilatation Diet 3. The patient to be put on a steady diet with more calcium and vitamin D and also carry out exercises to strengthen the back. Referred the patient to osteoporosis support. Pr Assessment Functional Health Patterns Nursing Diagnosis 1 The patient has intermittent sleep patterns only able to tolerate with HOB up in high fowler position. The patient has suffered osteoporosis for the past 8 years, multiple admission for pneumonia. Osteoporosis causes a lot of skeleton-muscular pain because the bones gradually weaken and any slight strain on the body structure is very painful(Green 2007) The functional health patterns are identified as; 1. Sleep-Rest Patterns 2. Sensory Perception Patterns Psychological Nursing diagnosis the patient experienced stress and anxiety Physiological Nursing Diagnosis The patient experienced disturbed sleeping patterns and Ineffective airway clearance In relation to being deprived of sleep obstruction by secretions in airways evidenced by abnormal breath sounds (wheezes and fine crackles), tachypnea and changes in RR and chronic pain as well due to long term/chronic illnesses 2 The patient was diagnosed with osteoporosis eight years ago. This could have resulted from to poor metabolism of calcium leading to bone resorption to compensate for the poor absorption of calcium or poor utilization of the absorbed calcium as a mineral. 3. Nutritional- Metabolic Patterns 4. Self perception/self concept patterns Psychological Nursing Diagnosis The patient experienced boring lifestyle and depression Physiological Nursing Diagnosis The patient had imbalanced nutrition, malnutrition and poor physical health. In relation to Inadequate nutritional uptake: The body received less than what it demands Evidenced by Manifested by the process of osteoporosis, emaciation and low body weight Pr Planning Implementation Rationale Evaluation 1 1. To alleviate the symptoms of breathlessness, reduce tracheal secretions, reduce anxiety and ease the pain (Green 2007) To ensure no perception of pain and the patient has good undisturbed sleep neither by pain nor the feeling of obstruction in the lungs 2. Ensure that the patient gets enough rest; ensure the patient's sleep is enough in terms of quality and quantity, normal sleeping pattern are achieved and uninterrupted sleep. 1. the nurse will Assess and open the air passages by use of jaw thrust or chin lift, position the patient in a way to enhance ventilation, carry out chest physical therapy, allow slow but deep breaths, teach patients on the use of inhalers, supply humid oxygen, teach effective coughing style, posture the patient to reduce dyspnea, remove bronchial secretions by suction, management of high blood pressure using drugs and controlled exercise 2. provide better sleeping position, help the patient to relax as stress interferes with sleep, establish a better sleeping routine, monitoring bedtime foodstuff and beverages that may interfere with sleep, identify factors affecting sleep and change lifestyle and pre-bedtime activities, diet that contain milk and proteins help to induce sleep as it contains amino acid tryptophan (a precursor for serotonin) which induces sleep and maintains it and introduce routines that comfort relax and cause sleep (Green 2007) 1. Enhanced gaseous exchange and to reduced the feeling of breathlessness makes the patient comfortable. When the air passages are open, breathing is easier and the patient is relieved of dyspnea, there is enough flow of oxygen to the vital body organs via the lungs. Allowing or ensuring removal of bronchial secretions reduces the blockade and also the surface for oxygen diffusion to the blood stream is opened up, thus enhancing gas exchange. 2. enough sleep gained by the patient attaining consistent sleep especially throughout the night, and being able to falling and remaining asleep cantankerously, reduces the feeling of fatigue after sleep and assists the patient not to rely on sleeping aids like sleep inducing drugs (Green 2007) 1. The patient experienced Easiness in breathing, alleviated dyspnea, feeling of restlessness was alleviated, oxygen saturation was achieved, reduced blood pressure to normal (less than 150/90). There was also reduced stress, reduced anxiety and no pain perception at the back(Green 2007) 2. the patient was also able to achieve undisturbed sleep throughout the night, no sleep deprivation was indicated in the morning, feeling of rejuvenated after sleep was observed, the patient did not rely on sleep aids 2 3. To decrease pain perception, stop smoking to prevent further progress of the condition; to understand safety precaution to help prevent possible fracturing of bones (Green 2007). 4. To alleviate the symptoms of dyspnea, reduce tracheal secretions, reduce anxiety and ease the pain 3. The nurse instructed the use of (drugs) pharmacological interventions like acetaminophen which is a painkiller in this case (Green 2007). A smoke cessation program was initiated 4. The nurse assisted the patient carry out exercises to strengthen the back, referred the patient to osteoporosis support, carry out a review of safety precaution for falling, direct on dietary intake that should have more calcium supplements to prevent complications, seek consultancy for better exercises, medication and quit smoking completely. 3. analgesics and antipyretic drugs reduces the feeling of pain, fever and enhances comfort of the patient so that she can be able to perform her daily chores without any pain 4. This will ensure that the patient experiences no more feeling of back pain or even at the joints. (Green 2007) Osteoporosis can cause very painful back aches and joints aches too but this can be reduced by enhancing bone strength 3. The patient felt alleviated pain perception in the whole body. The patient was also able to stop smoking 4. the patient reduced and eventually quit smoking, the patient also got involved in simple exercises like taking a walk for about 30 to 45 minutes as part of exercises, there was no more back pains and no more mood swings Medication & Dose Class & Safe Range Mechanism of Action Nursing Consideration Cefotetan- 1gram given intravenously after every 12 hours. The normal dose range is 1-2 grams given intravenously or intramuscularly. However, correct dose and mode of administration should be established by the patient's situation and severity I illness, and vulnerability of causative agent An antibiotic for prophylaxis. Classified together with cephalosporins. It is a broad spectrum antibacterial agent. Safe range; should not exceed 3grams Inhibits the formation of the cell wall on microorganisms Hypersensitivity has been reported Avoid alcohol as it may cause toxicity Coreg 3.125 mg per oral administration twice a day. The dosage of Coreg depends on bodyweight. 187 pounds or less should take only 25mg two times a day. Body weight more than 187 pounds can have 50mg two times a day Antihypertensive (treats hypertension). The safe range is about 50mg and should not exceed 100mg. It's an alpha- adrenergic receptor antagonist and may also block beta receptors (Green 2007). The drug blocks the neurotransmitter from binding alpha and beta receptors and this way controls the effects of noradrenalin on the heart and hypertension is thus managed (Green 2007). May exacerbate shortness of breath, insomnia, depression and nausea (Green 2007) Cozaar 50mg per oral administration everyday. The dosage regime starts by giving 50 mg once per day. However, the drug can be administered twice a day, a dosage totaling up to 25-100 mg. If no response in blood pressure in 3 to 6 weeks. The dose can be increased or a low efficacy diuretic introduced. Angiotensin II receptor blocker. For the administration to remain beneficial and safe, it should not go beyond 50mg in a day. It's an angiotensin II inhibitor causing dilatation of blood vessels and reduces blood pressure. Basically, angiotensin II stimulates the production of aldosterone, and also causes vasoconstriction on peripheral blood vessels. Blocking it means that more urine and sodium will be lost and vasodilatation will occur and eventually a drop in blood pressure. May cause serious heart problems, persistent cough, diarrhea and insomnia Crestor 10mg per oral administration at bedtime Adjunct for diet for hyperlipidemia. The dosage can be given ranging from 10mg to 40 mg per day. Blocks the function of HMG Co-A reductase (Green 2007). This enzyme is a rate limiting enzyme in formation of cholesterol. This means on administration cholesterol will be decreased. LDLs and VLDL will not be produced. It encourages formation of HDLs which are safer Hypersensitivity, skeletal muscle effects- myopathy Aggrenox one (200mg) tablet twice a day. The normal dosage is about 75mg 4 times per day and can increase to 400 mg incase of complications Anti-inflammatory, vasodilator and anticoagulant; reduces risk of developing stroke (Green 2007). Blocks action of adenosine deaminase and phosphodiesterase to prevent Camp from breaking down, inhibits function of platelets and reduces the effects of thromboxane A2 The drug can cause Pneumonia, renal failure, Diarrhea, cardiac arrest could result, sensory disorder, sepsis Ipratropium Bromide two puffs twice a day Broncho-dilator, anti-allergy. The safety range is established to be 12 puffs per day and this should not be exceeded since inhalation that goes beyond this has not clearly been established scientifically (Green 2007). Anti-cholinergic receptor blocker. This means the drug blocks action of neurotransmitter acetylcholine at parasympathetic junction and through this way, bronchial secretions are reduced(Green 2007) No contraindicative effects have been recorded in older adults hence very safe (Green 2007) Solu Medrol 25mg IV once a day. Dosage for adults is usually 10-250 mg and can be given 6 times per day. In extreme cases, it could be administered at 1-2mg per kg body wieight. Corticosteroid- Anti-inflammatory. The recommended dosage range is 10 mg to 1.50 g per day, but higher IV doses can be used if the condition is life-threatening. Modifies transcription and protein synthesis; then interferes with inflammatory mediators' response, and suppress humeral immune responses. The anti-inflammatory function of corticosteroids involves phospholipase A2 and leukotrienes. The drug could cause euphoria, depression, hirsutism and may exacerbate osteoporosis Acetaminophen 650mg six hours interval as required for T>101.3. The normal dose is 650mg to 1000 mg per day at intervals of 4 to 6 hours is recommended for children above 12 years and adults. Analgesic and antipyretic. Safe range indicates that 4000 mg should not be exceeded in a day (24 hours). Reversible inhibition of cyclooxygenase, an enzyme that catalyses prostaglandin (PG) synthesis (Green 2007) Overdose is very dangerous as it is toxic and possibly fatal References Barrett D.W & Woollands. A. (2009). Care Planning. A Guide for Nurses. Harlow- Pearson Education Doenges M. et al (1999). Nursing Care Plans. Guidelines for Individualizing Patient Care F.A. Davis Green J.R (2007). Natural Therapies for Emphysema and COPD. Relief and Healing For Chronic Pulmonary Disorders. Inner Traditions/Bear & Company Word Count: 2,135 Note: Pathophysiology is a brief description of the disease and how the client's normal physiological process can be altered by the disease. Identifying essential signs and symptoms associated with the disease References Barrett D.W & Woollands. A. (2009). Care Planning. A Guide for Nurses. Harlow- Pearson Education Doenges M. et al (1999). Nursing Care Plans. Guidelines for Individualizing Patient Care F.A. Davis Green J.R (2007). Natural Therapies for Emphysema and COPD. Relief and Healing For Chronic Pulmonary Disorders. Inner Traditions/Bear & Company Read More