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PRE-ASSIGNMENT WORKSHEETS

Student’s Name: Brittney Copeland Date: 10/9/2020 Time: 9 AM

Client’s Initials: RJ Admission Date: Day 1 0600 Allergies: None

Age: 52 Sex: Male Race: Caucasian DOB: March 3 Religion: Not available

Admitting Diagnosis(es): Elective total right knee replacement

Present Surgical Procedures (include dates): Elective total right knee replacement

Client’s Understanding of Illness: Details of the surgery was discussed, and he has no further questions

History of Present Illness: Chronic Osteoarthritis

What medication are you currently taking at home? Medications Time Why?

1 Calcium carbonate 600 mg PO q AM Bones and muscle

2 Meloxicam 15 mg PO q AM reducing pain, swelling, and stiffness in joints

Are your medications causing any discomfort? Pain increases and has not been alleviated regardless of medication.

Medication(s) Works…et (Topical, PO, IM, SQ, IV)

Classification Name Dose/ Route/

Frequen cy Safe Range

Mechanis m of

Action

Indications Side Effects

Nursing Consideratio

ns

Client Teaching

Calcium carbonate – mineral and electrolyte replacements/supplem ents

1 2 g/day in 2 -4 divided doses

Essential for bone formation and blood coagulatio

Adjunct in the prevention of postmenopau sal osteoporosis

Constipat ion Arrhythm ias

Observe patient closely for symptoms of hypocalcemia.

Take exactly as directed. Do not take more or less

Patient: 600 mg PO q AM

n Monitor patient on digitalis glycosides for signs pf toxicity.

of it or take it more often than prescribed. Take it with food or following meals.

Docusate sodium – Laxative/stool softeners

50 – 400 mg in 1-4 divided doses PO

Patient: 100 mg PO BID

Promotes incorporati on of water into the stool, may also promote electrolyte and secretion into the colon

Prevention of constipation

Mild cramps Diarrhea Abdomin al pain

Administer with a full glass of water or juice. May be administered on empty stomach for more rapid results. Oral solution may be diluted in milk or fruit juice to decrease bitter taste.

Norman bowel movements do not always occur daily. Do not administer withing 2 hours of other laxatives.

Enoxaparin – Anticoagulants/Antithro mbotic

Subcutan eous 30 mg – 40 mg

Patient:40 mg subcutane ous q AM

Potentiates the inhibitory effect of antithromb in on factor Xa and thrombin

Prevention of venous thromboemb olism in surgical or medical patients

Bleeding, bruising, site hematom a, hematuri a

Anticoagulatio n during acute coronary syndromes, prophylaxis, and treatment of venous thromboembo lism. Use with caution in patients with impaired

Contact healthcare provider if you notice prolonged bleeding, bruising, and/or tarry stools.

renal function or morbid obesity.

Normal Saline – Crystalloid fluid

Doses can be dependen t on weight and severity 50 mL to 100 mL

Patient: 75ml/hr.

5ml IV q8 hours

Sodium is the major cation of extracellul ar fluids and functions principally in the control of water distribution , fluid and electrolyte balance and osmotic pressure of body fluids.

Hypovolemia as a result of fluid loss due to trauma. As a replacement for fluid loss in chronic renal failure in small animals. May be used as an irrigating solution in wounds.

Fever, injection site swelling, redness, and/or infection.

Always assess level of dehydration before giving by IV, SQ, OR IP. Auscultate breath sounds. Use with caution as it may results in electrolyte imbalance. A one-liter bag of solution has a 6-month expiration date.

Report any signs of fever, swelling, and/or redness.

Oxycodone – opioid analgesics/opioid agonists

5 – 10 mg q 3-4 hr. initially as needed

Patient:10 mg PO BID, 5mg every 4 hours PRN pain, 10 mg every 4 hours

Binds to opiate receptors in the CNS

Used to treat moderate to severe pain.

Confusio n Sedation Constipat ion Respirato ry depressio n

Assess BP, pulse, and respirations before and periodically during administration . If respiratory rate is <10/min, assess the level of sedation. Physical

Take medication exactly as prescribed by your doctor. Never share the medicine with another person. Instruct patient to

stimulation may be sufficient to prevent significant hypoventilatio n.

report symptoms such as drowsiness and lightheaded ness.

Ondansetron - Antiemetic

0.15 mg/kg Max dose: 16 mg

Patient: 4 mg IV q4 hrs. PRN N/V

Blocks the effects of serotonin at 5-HT3 – receptor sites located in the vagal nerve terminals and the chemorece ptor trigger zone in the CNS

Prevention and treatment of postoperative nausea and vomiting.

Headach e Constipat ion Diarrhea

Assess patient for nausea, vomiting, abdominal distention, and bowel prior to and following administration . Assess patient for extrapyramid al effects periodically during therapy.

Report any signs of fever, swelling, and/or redness.

Senna – Laxative/stimulant laxative

2 tablets once daily at bedtime, maximum 4 tablets BID

Patient: 8.6 mg 1 tablet PO daily PRN constipati

Acts as a local irritant on the colon stimulation peristalsis

Prevention of constipation

Electrolyt e imbalanc es, dehydrati on, abdomin al cramps, nausea, vomiting, and diarrhea

Assess for abdominal distention, the presence of bowel sounds, and the usual pattern of bowel function. Assess color, consistency, and amount of stool

Take as prescribed. Should only be used for short-term therapy. Encourage patients to use other forms of bowel regulation, such as increasing

on produced. bulk in the diet, increasing fluid intake, and increasing mobility.

Pathophysiology Brief Textbook Picture with Client Comparison Definition, Etiology, Incidence, Pathophysiology, Diagnostic Test, Signs & Symptoms, Medical treatment, Priority, Nursing Dx.

(3), Reference

The pathogenesis of OA involves a degradation of cartilage and remodeling of bone due to an active response of chondrocytes

in the articular cartilage and the inflammatory cells in the surrounding tissues.

Patient has been admitted to hospital complaining of increase leg pain regardless of medication administration. Pain so severe

it wakes him out of his sleep. He has been diagnosed with Osteoarthritis and has agreed to a total right knee replacement.

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of your bones wears down over time. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips, and spine. There are many test that be used to detect osteoarthritis such

as joint aspiration, X-ray, and MRI. Pain or aching in the joint during activity, after long activity or

at the end of the day. Joint stiffness usually occurs first thing in the morning or after

resting. Limited range of motion that may go away after movement.

Clicking or cracking sound when a joint bends. Swelling around a joint.

Muscle weakness around the joint. Joint instability or buckling (knee gives out).

There is no cure for OA, but medication, nondrug methods and assistive devices can help to ease pain. As a last resort, a

damaged joint can be surgically replaced with a metal, plastic or ceramic one.

Impaired physical mobility related to pain evidenced by reluctance to move.

Assessment/

Subjective and Objective

Nursing diagnosis/ NANDA

Plan/goals Interventions Evaluation

Throbbing calf pain 24 respirations

8/10 pain

Ineffective tissue perfusion related to

increased coagulability of blood evidence by

pain during palpitation of calf muscle.

Client will not experience pulmonary

embolism, as evidenced by normal breathing,

normal heart rate, and absence of dyspnea and

chest pain.

Assess for the signs and symptoms of deep vein thrombosis (DVT). Apply below-knee compression stockings as prescribed.

Ensure that the stockings are the correct size and are applied correctly.

Client will maintain optimal peripheral tissue perfusion in

the affected extremity, as

evidenced by strong palpable pulses,

reduction in and/or absence of pain, warm, and dry

extremities, and adequate capillary

refill. Throbbing calf pain

24 respirations 8/10 pain

Acute pain related to inflammatory response

in affected vein evidenced by reports of

pain, tenderness, aching or burning

Client will report that pain or discomfort is

alleviated or controlled.

Assess degree and characteristics of

discomfort and pain. Encourage client to

change position frequently. Elevate affected extremity.

Client will verbalize methods that provide relief.

Client will display relaxed manner; be able to sleep or rest

and engage in desired activity.

CHEMISTRY PROFILE

NORMAL VALUES CLIENT’S VALUES HEMATOLOG

Y

NORMAL VALUES CLIENT’S VALUES

DATE Day 1

DATE DATE DATE Day 1

DATE DATE

SODIUM 135- 145mmol/L

138 RBC 4.5-5.90 M/mcL

POTASSIUM 3.5-5.2 mmol/L

4.8 HGB 13.0-18.0 g/dL

CHLORIDE 95-110 mmol/L

97 HCT 40.0-52.0%

CO2 19-34 mmol/L 23 MCV 81-97 fL CALCIUM 8.4-10.2

mg/dL 9.5 MCH 26.0-34.0 pg

GLUCOSE 70-110 mg/dL 70 MCHC 31.0-37.0% PHOSPHORUS 2.3-5.0 mg/dL LEUKOCYTES CHOLESTEROL NEUTROPHILS ALBUMIN 3.2-5.0 g/dL SEGMENTS T. PROTEIN 5.5-8.7 g/dL BANDS BUN 6-22 mg/dL 18 LYMPHOCYTES CREATININE 0.6-1.3 mg/dL 0.8 EOSINOPHILS MAGNESIUM BASOPHILS URIC ACID MONOCYTES BILIRUBIN PLATELETS AMYLASE COAGULATIONS STUDIES LIPASE PTT 25 – 40 sec 34 sec LDH PT 11 – 15 sec 12 sec HDL INR 0.8 – 1.1 0.8 LDL BLEEDING TIME

URINALYSIS COLOR TURBIDITY S.G. MISCELLANEOUS TEST

PH TEST NORMAL

VALUES CLIENT’S VALUES

DATE Day 1

DATE DATE

GLUCOSE Anion Gap 10 - 20 18 KETONE BLOOD PROTEIN BILIRUBIN

UROBILINOGEN NITRATE LEUCOCYTE CAST RBC CRYSTALS WBC EPITHELIAL CELLS

DIAGNOSTIC TEST

X-RAYS SCANS / ULTRASOUNDS OTHER

Before the procedure: Large osteophytes, marked joint space narrowing, sclerosis, and definitely bony deformity of the right knee

After the procedure: Right Knee X-ray – Knee implant in proper placement

12 led ECG – normal sinus rhythm