Fundamental
A08
CASESTUDYwrk.docxCOURSE PROJECT (SELECTION OF CLIENT AND BACKGROUND INFORMATION)
NUR2115 (FUNDAMENTALS OF PROFESSIONAL NURSING)
PROFESSOR
NOVEMBER 6TH, 2022
Introduction
The five key skills for enhancing healthcare delivery are essential for ensuring positive outcomes for patients. These skills include effective communication, empathy, teamwork, problem-solving, and critical thinking. There are many ways to administer drugs, and the most appropriate method depends on the drug itself and the condition being treated. Common methods of drug administration include oral, nasal, topical, and injectable. Each has its own advantages and disadvantages, and certain drugs are more suited to certain methods than others. The route of administration chosen must also be considered; considering the patient's condition and ability to take the drug in the chosen manner. This paper will also discuss medications that have been used in the management of the patient so far.
This project basically focuses on Ms. Sato, a 75-year-old female Japanese American who recently moved to a long-term care facility. She is proficient in reading and writing in English, and her primary language is Japanese. Ms. Sato formally lived in her home before moving to the long-term-care facility. She is divorced and was a housewife who cared for her family, especially her son, who was diagnosed with cystic fibrosis and Type 1 diabetes at a young age. Two of her daughters lived close to her home; they would visit her every week and serve as her support system.
Ms. Sato is dependent and needs help with her activities of daily living, help to change her ostomy bag, and ambulation with a gait belt and a one-person standby assist.
Her medical history includes colon CA, colostomy, helicobacter pylori infection, depression, Hypertension, and Osteoporosis. Her orders include full resuscitation, regular diet, daily physical therapy, daily occupational therapy, and psychiatry consult, and she also wears glasses for reading. For this project work, we shall focus more on her diagnosis of Hypertension. According to the world health organization (2017), Hypertension mainly causes cardiovascular disease and deaths worldwide, especially in low- and middle-income countries. This is a condition where the blood pressure is higher than usual.
Medication used and nursing education
Ms. Sato vital signs on admission: T = 97.8 P = 98b/m R = 18c/m BP =148/90mmHg
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Drug Name Trade & generic name, dose, route & frequency |
Pharmacological & therapeutic drug class & Expected action in the body |
What medical diagnosis is your patient taking this drug for? How will it help them? |
Side Effects & Adverse Reactions/ Complications/Top drug interactions |
Nursing Administration Special Instructions and Assessments |
Client Education Evaluation of Medication Effectiveness (e.g., Pain Scale) |
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- Drug name: Clonidine - Trade name: Catapres - Dosage: 0.1 mg - Route: Oral - Frequency: TID |
- Drug Class: α₂-adrenergic agonist - Expected action: Acts by stimulating α₂ receptors in the brain, thus decreasing peripheral vascular resistance, leading to lowering of blood pressure.
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- Medical diagnosis: Hypertension Help: It helps in lowering blood pressure.
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Common side effects: - Headaches - Dizziness - Hypotension - Xerostomia - Sleepiness
Severe side effects: - Confusion - Hallucination - Heart arrhythmias
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Nursing Administration Special Instructions:
- Make sure patients swallow drugs and not chew.
Assessments: - Monitor patient closely during test dose.
- Measure blood pressure before and after medication
- Measure pulse rate
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- Drink a lot of water to avoid dehydration.
- Do not skip the dosage.
- Do not double dose. If a dose is missed, the patient should take it as soon as possible, only if it is close to the next dosage period. They should then skip the next dosage.
- The patient should inform the nurse of any new side effects and developing conditions as a result of the medication. |
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- Drug name: Alendronate - Trade name: Fosamax - Dosage: 10 mg - Route: Oral - Frequency: Daily |
- - Drug Class: Bone resorption inhibitor - Expected action: Inhibits bone resorption, increases bone density |
- Medical diagnosis: Osteoporosis - Help: Reduces the risk of fractures by increasing bone density |
Common side effects: - Nausea - vomiting - diarrhea - constipation - abdominal pain - heartburn
Severe side effects: - Esophageal ulceration - esophageal perforation
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Nursing Administration Special Instructions: - Take plenty of water on an empty stomach at least 30 minutes before breakfast. - Do not lie down for 30 minutes after taking it.
Assessments: - Assess for GI side effects such as nausea - vomiting - diarrhea - constipation - Monitor calcium and phosphorus levels. |
- Take as prescribed, with plenty of water on an empty stomach, at least 30 minutes before breakfast. - Do not lie down for 30 minutes after taking it. |
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- Drug name: Cholecalciferol - Trade name: Drisdol - Dosage: 1 capsule (5,000 IU) - Route: Oral - Frequency: Daily |
- - Drug Class: Vitamin D supplement - Expected action: Increases calcium absorption from the gut, helps maintain serum calcium levels |
- Medical diagnosis: Osteoporosis - Help: Helps to maintain serum calcium levels, which is important for bone health |
Common side effects: - Nausea - vomiting - diarrhea - constipation - abdominal pain
Severe side effects: - Excessive calcium in the blood |
Nursing Administration Special Instructions: - Take with a full glass of water. Assessments: - Assess for GI side effects such as nausea - vomiting - diarrhea - constipation - Monitor calcium and phosphorus levels. |
- Take as prescribed, with a full glass of water. |
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- Drug name: Sertraline - Trade name: Zoloft - Dosage: 50 mg - Route: Oral - Frequency: Daily |
- - Drug Class: Selective serotonin reuptake inhibitor (SSRI) - Expected action: Increases serotonin levels in the brain, helps to relieve depression |
- Medical diagnosis: - Depression - Help: Helps to relieve symptoms of depression |
Common side effects: - Nausea - vomiting - diarrhea - constipation - abdominal pain - headache - dizziness - insomnia - drowsiness - sexual dysfunction
Severe side effects: - serotonin syndrome - mania - seizure
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Nursing Administration Special Instructions: - Take with a full glass of water.
Assessments: -Assess for psychiatric side effects such as mania, depression, and anxiety - Monitor serum sodium levels. |
- Take as prescribed, with a full glass of water. |
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- Drug name: Metoprolol ER - Trade name: Lopressor. - Dosage: 100 mg - Route: Oral - Frequency: Daily |
- - Drug Class: Beta-blocker - Expected action: Blocks beta receptors, slows heart rate, and decreases blood pressure |
- Medical diagnosis: Hypertension - Help: Helps to lower blood pressure by slowing the heart rate and decreasing the force of heart contractions |
Common side effects: - Nausea - vomiting - diarrhea - constipation - abdominal pain - headache - dizziness - insomnia - drowsiness - sexual dysfunction
Severe side effects: - bradycardia - hypotension - heart block |
Nursing Administration Special Instructions: - Take with a full glass of water.
Assessment: -Assess for cardiovascular side effects such as bradycardia and hypotension. - Monitor heart rate and blood pressure. |
- Take as prescribed, with a full glass of water. |
LABS AND DIAGNOSTIC TESTS.
A complete blood count is also known as a full blood count; it helps provide information about cells in a patient body and a medical assessment in diagnosing diseases. It measures white blood cells, red blood cells, hemoglobin, hematocrit, and platelet counts. A normal CBC range is 5,000 - 10,000 /mm3. Since taking her hypertensive medication, Ms. Sato's CBC is expected to be above 10,000 /mm3.
Urinalysis is a urine test that checks for kidney diseases by measuring urine creatine ratio and protein level. A normal urine result should be no change in urine color once the strip is dipped in urine for testing, while for an abnormal result, there would be a color change.
ECG (Electrocardiogram) test records the heart's electrical activities. It helps determine the condition of the heart and evaluates heart-related problems such as shortness of breath, tiredness, and chest pain. Electrocardiogram result shows normal when the heart is beating at 60 to 100 beats per minute at an even rate. Abnormal ECG results could be a slow or fast heart rate, abnormal heart rhythm, enlarged heart, or signs of heart disease. A client with a diagnosis of Hypertension's ECG result should be normal if taking their medication as prescribed and regularly.
Cardiac ultrasound uses electrodes to check heart rhythm called Echocardiogram. It shows a big picture of heart health, strength, and functions. Heart walls thicker than 1.5cm is abnormal, while a typical heart wall would be less than 1.5cm thick.
A comprehensive metabolic panel (CMP) measures body fluid balance, electrolytes such as sodium, potassium, chloride, total protein, alanine transaminase, aspartate aminotransferase, bilirubin, blood urea nitrogen (BUN), creatinine, alkaline phosphatase, glucose, calcium, carbon dioxide, chloride, and albumin. A patient with a diagnosis of Hypertension should have a standard range of sodium level of 135-145 milliequivalents per liter (mEq/L). Hypertensive patients should lower salt consumption for lower blood pressure.
Conclusion
Clonidine is a very effective drug for the treatment of high blood pressure. It works by decreasing the amount of noradrenaline in the brain, which in turn lowers blood pressure. It is generally well tolerated, with the most common side effects being dry mouth and drowsiness.
References
Tsiomidou, S., Pamporaki, C., Geroula, A., Van Baal, L., Weber, F., Dralle, H., ... & Unger, N. (2022). Clonidine suppression test for a reliable diagnosis of pheochromocytoma: When to use. Clinical Endocrinology. Centers for diseases and prevention control (2021). Heart disease resources for health professionals. https://www.cdc.gov/heartdisease/sodium.htm
Johnell O, Kanis J. (2006). A review of worldwide prevalence and disability associated with osteoporotic fractures. International 2006; 17: 1726–1733.
Morris, J. & Dunham, A. (2022). Metoprolol. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK532923/
Varacallo, M. & Fox, E. (2014). Osteoporosis and its complications. Medical Clinic North America Jul;98(4):817-31, xii-xiii. https://pubmed.ncbi.nlm.nih.gov/24994054/
World Health Organization (2017). Cardiovascular diseases (CVDs). Retrieved from (https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(CVD).
Yasaei, R. & Saadabadi, A. (2022). Clonidine. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Retrieved from: https://www.ncbi.nlm.nih.gov/book/NBK459124.
COURSE PROJECT PART 2 (Health Assessment, Health History, and Nursing Diagnoses)
RASMUSSEN UNIVERSITY
NUR2115 (FUNDAMENTALS OF PROFESSIONAL NURSING)
PROFESSOR
NOVEMBER 15, 2022
Health Assessment, Health History, and Nursing Diagnoses Outline
1. Medical History
· Describes the medical diagnosis of the client.
· Identifies hypertension’s pathophysiology.
1. Medical Diagnoses
· Identifies four medical diagnoses for hypertension.
· Discusses how each diagnosis is carried out.
Head-to-Toe Assessment
· Determines how the client interview will be carried out.
· Determines how a head-to-toe will be carried out and what physicians will look out for in different parts of the body.
Priority NANDA nursing diagnoses
· Identifies five NANDA nursing diagnoses.
· Identifies priority with which the diagnoses will be followed.
References
Introduction
Hypertension is a common condition that affects many people in the United States. It is defined as having elevated blood pressure, which can cause damage to the arteries and increase the risk of heart disease and stroke (Wajngarten & Silva, 2019). If one has high blood pressure, it is important to work with a doctor to get it under control.
Medical History
Pathophysiology of the admitting Ms. Sato for hypertension
Ms. Sato has several risk factors that increase her chances of developing high blood pressure. First is age; as one age, the body loses its ability to regulate blood pressure naturally and may need more medication to keep it at normal levels. The second is a family history: Since Ms. Sato has a sibling with high blood pressure increases the risk of developing the condition in later life. The last factor is race/ethnicity: minorities are more likely than whites or Hispanics to develop high blood pressure.
A) Hypertension Pathophysiology
The admitting diagnosis determined that the patient, Ms. Sato, exhibited the signs and symptoms of hypertension, also known as high blood pressure. The condition’s pathogenesis is multifactorial as it involves different mechanisms working within the cardiovascular system. One of the key determinants of the condition’s development is excess sodium intakes (Rositto et al., 2021). Excess intakes of sodium lead to increased fluid volume which in turn lead to increased contractility and increased preload. Secondly, obesity is closely associated with the development of hypertension. Obesity leads to hyperinsulinemia where the body has abnormal high levels of insulin. Hyperinsulinemia causes blood pressure to elevate leading to structural hypertrophy and ultimately leads to increased peripheral vascular resistance (Koliaki, Liatis & Kokkinos, 2019). Ultimately, genetic alteration is also associated with the development of hypertension. Alteration of the cell membrane results in functional construction which leads to an increased peripheral vascular resistance (Brown et al., 2018). Risk factors associated with the condition include obesity, inactivity, drug and alcohol abuse/intake, age, increased salt intake, and pre-existing medical condition such as diabetes.
B) Medical Diagnoses for Hypertension / The Four secondary medical diagnoses
i) Electrocardiogram (EKG or ECG)
Electrocardiogram is considered as the quickest diagnosis for hypertension. The diagnosis measures the heart’s electrical activity, rhythm, and rate. ECG/EKG is conducted using electrodes which are attached to a patient’s chest, arms, or legs. The results are recorded in a chart which provides readings to determine the presence of hypertension. Signals measure systolic (SBP) and diastolic (DBP) blood pressure. The measurements are then categorized in three categories which include normal (120/80 mm Hg), prehypertension (120/80 mm Hg), and hypertension (140/90 mm Hg and above)
ii) Ambulatory Monitoring
Ambulatory monitoring involves monitoring a patient through an in-patient approach. The patient’s blood pressure is monitored for a period of 24 hours where blood pressure is measured systematically, preferably every 6 hours. The measurements are done continuously throughout the period to determine the patient’s blood pressure. The measurements are taken when the patient is both active or inactive (e.g., awake, or asleep). Hypertension is determined if the patient’s systolic blood pressure (SBP) is above 130 and their diastolic blood pressure (DBP) is equal or more than 80- or 130/80-mm Hg. Physicians use a sphygmomanometer for readings to determine whether the patient has hypertension.
iii) Lab Tests
Thirdly, lab tests are essential in measuring elements or components whose presence signifies the development of hypertension. The most common tests include blood and urine samples to determine the presence of conditions that may cause or lead to the worsening of hypertension. One of the most common tests is cholesterol which causes plaque in arteries narrowing or hardening them. High blood sugar tests may also determine the existence of hypertension as it damages blood vessels forcing their walls to harden. Both tests are necessary in determining the presence and level of hypertension.
iv) Echocardiogram
Ultimately, an echocardiogram is utilized to monitor the heart’s rhythm and rate. The diagnosis creates soundwaves which create an image of a beating/functioning heart (Qi et al., 2018). The images to determine the flow of blood within the organ and its valves. Moreover, the test can help determine cardiac morphologic changes which are caused by high blood pressure in the arteries. The test is used on individuals of all ages and is one of the most effective approaches in monitoring the heart and determining its health.
Head to Toe Assessment and client’s interview
First, we need to determine what her goals are for her treatment plan. Ms. Sato wants the best care possible and wants to continue living independently in the long-term care facility. She is not interested in being discharged from the facility and moving back home because she would not be able to take care of herself since her two daughters cannot manage to be with her all the time.
In addition, she does not want to return to her former lifestyle; she told us that the only thing she misses about her home is having someone else around who can help with cleaning and cooking since she was divorced. I learned through our interview with Ms. Sato that she has some mobility issues due to osteoporosis. However, she still can get around well when necessary, such as when she needs help getting into or out of bed or changing her ostomy bag. She has regular headaches, which might be caused by high blood pressure.
· The head-to-toe assessment will be determined by the level of blood pressure and any other risk factors. Moreover, a client interview is carried to obtain objective and subjective data which are central to diagnosing the patient. The interview will be carried out when collecting data on medical history. The assessment and interview follow a logical sequence which includes addition, she does not want to return to her former lifestyle; she told us that the only thing she misses about her home is having someone else around who can help with cleaning and cooking since she was divorced. I learned through our interview with Ms. Sato that she has some mobility issues due to osteoporosis. However, she still can get around well when necessary, such as when she needs help getting into or out of bed or changing her ostomy bag. She has regular headaches, which might be caused by high blood pressure.
· Medical history- Identification or risk factors including family history of hypertension and destructive behaviors such as smoking. Patient will be asked to provide necessary information regarding these risk factors. during the process, the physician will; showcase active listening, utilize nonverbal communication, utilize adaptive questioning, be empathetic, show the need to create a professional relationship, and educate the patient as necessary.
· Blood pressure measurements – the measurements are taken on different parts of the body including both arms and legs. Multiple measurements are taken from different positions including patient standing, patient sitting, and patient lying down.
· Eyes – an exam on the patient’s retina is carried out. Physician determines whether there is damage on the retina which occurs due to the development of hypertension.
v) Heart Exam – secondary medical diagnoses are carried out to determine blood flow the health of the heart and its components. An Echocardiogram is recommended.
· Legs – an exam is carried out to determine the build of fluid (edema).
· Abdomen – a stethoscope is used to listen to blood vessels to determine if there are any abnormal sounds in the abdomen. Abnormal sounds may be caused by narrowed arteries or abdominal bruits.
· Neck – the physician determines whether the patient has an enlarged thyroid. The presence of bruits in carotid arteries are an indicator of hypertension.
Identify five (5) Priority NANDA nursing diagnoses
The section identifies diagnosis as described by the North American Nursing Diagnosis Association (NANDA) and discusses; definition of terms, evidence to carry out diagnosis, desired outcomes, and interventions.
i. Decreased cardiac output risk
NANDA defined decreased cardiac output as in the inability of the heart to pump adequate blood that could meet a patient’s metabolic demands (Ackley et al., 2021). The intervention is carried out to ensure that there is no risk of decreased cardiac output. The desired outcomes from the intervention include blood pressure remains at an acceptable range, cardiac rhythm remains stable, and patient can carry out activities that will decrease their blood pressure. Interventions that can be carried out under the diagnosis include administration of medication, monitoring of blood pressure, auscultation, and a reduction in sodium intake if necessary.
ii. Acute Pain
The most typical acute pain experienced by patients includes headaches. Pain is defined by the patient and occurs when a patient reports it, when a patient reports it and involves a sensory experience resulting from potential damage in body tissues (Ackley et al., 2021). The risk is evidenced by; a patient reporting a headache or a change in appetite. The desire outcomes for the diagnosis are patient reports that they are comfortable, patient reports that they are no longer experiencing headaches, and patient reports that they are pain free. Interventions carried out under the diagnosis include determining specifications of the pain, rest when experiencing pain, limitation of unnecessary movement, utilization of relief methods, and provision of medication when necessary.
iii. Activity Intolerance
NANDA describes activity intolerance as inability to carry out daily activities due to insufficient psychological or physiological energy (Ackley et al., 2021). The condition is evidenced by; changes occurring in electrocardiogram measurements, patient experiencing discomfort, patient reports that they are weak or tired, and patient exhibits abnormal levels of heart rate. The diagnosis’ desired outcomes include patient’s ability to carry out daily activities, patient reports that they are carrying out more activities, patient has no signs of intolerance, and patient utilizes recommended approaches to improve tolerance. Interventions that can be carried out include determining factors that lead to weakness, determining the patient’s intolerance, monitoring the patient’s activities, and encouraging an activity up-take to increase tolerance.
iv. Ineffective coping
NANDA defines ineffective coping as the inability to manage stressful conditions (Ackley et al., 2021). The condition is evidenced by; patient asks for help to cope, patient exhibits anxiety, and patient engages in destructive behaviors such as drug abuse or overeating. The diagnosis’ desired outcomes include patient’s ability to cope, patient can identify ineffective approaches to coping, patient takes initiative to avoid stressful conditions, and patient uses coping skills to deal with stressful conditions. Interventions that can be carried out during the diagnosis include determining areas where the patient is unable to cope, identification of stressors, lifestyle changes, and development of a care plan with participation from the patient.
v. Imbalanced nutrition
NANDA defines imbalanced nutrition as behaviors exhibited by a patient where their intake of nutrients is above required levels (Ackley et al., 2021). Possible evidence to identify the risk include an increase in weight and observable dietary behaviors. Desired outcomes from the intervention include patient understands the link between obesity and hypertension, patient consumes a balanced diet, and patient shows a change in dietary behaviors. Interventions that may be carried out include determining the patient’s understanding on risks of obesity, educating patient on the link between hypertension and weight, recommending dietary habits, initiating physical activity, and creating a nutrition plan.
Conclusion
Hypertension is a condition that results in high levels of pressure in the blood vessels. It can be caused by several factors, including physical factors like genetics and obesity and emotional or psychological factors (Burnier & Egan, 2019). There are many ways to treat hypertension; some methods involve lifestyle changes and adjustments, while others involve medications.
References
Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. (2021). Nursing Diagnosis Handbook, Revised Reprint with 2021-2023 NANDA-I® Updates-E-Book. Elsevier Health Sciences.
Brown, I. A., Diederich, L., Good, M. E., DeLalio, L. J., Murphy, S. A., Cortese-Krott, M. M., ... & Isakson, B. E. (2018). Vascular smooth muscle remodeling in conductive and resistance arteries in hypertension. Arteriosclerosis, thrombosis, and vascular biology, 38(9), 1969-1985.
Koliaki, C., Liatis, S., & Kokkinos, A. (2019). Obesity and cardiovascular disease: revisiting an old relationship. Metabolism, 92, 98-107.
Qi, X., Berzigotti, A., Cardenas, A., & Sarin, S. K. (2018). Emerging non-invasive approaches for diagnosis and monitoring of portal hypertension. The Lancet Gastroenterology & Hepatology, 3(10), 708-719.
Rossitto, G., Maiolino, G., Lerco, S., Ceolotto, G., Blackburn, G., Mary, S., ... & Delles, C. (2021). High sodium intake, glomerular hyperfiltration, and protein catabolism in patients with essential hypertension. Cardiovascular research, 117(5), 1372-1381.
