ࡱ> { V+bjbjBrBr 4  #Q8:lKJJ``` K"K"K"K"K"K"K$M5PVFKFK``4[K`` K KDElI`7/.^F* KqK0KFPXPTIPIFKFK*KP : Clinical Prep Sheet Student Name: Nurse Nancy SVN Unit: 3-East Date: 01/01/2012 Clinical Wk#_1 Patient Initials: JDS Age: 86 Allergies: NKDA_________________________________ Medical Diagnosis for Admission to the Hospital Pathophysiology /Etiology/Cause for Medical Diagnosis Primary Diagnosis and additional diagnosis Chest Pain Hypertension DM  Short patho about primary diagnosis if needed attached additional page  Findings to be reported to HCPHCP OrdersBased on medical diagnosis and nursing diagnoses, what complications could occur and what you would report to the primary nurse and /or HCP Worsening skin integrity Purulent drainage from wound Elevated temperature Abnormal lab values Abnormal VS Increase pain/discomfort Place physician orders here that pertain to your patient Wound Care Nurse Consult Foley Catheter Physical Therapy consult Diet: Treatments: Activity Level Restrictions:Collaborative Care: Lab DataXrays / Procedures (Results)Test/Exams that relate to your patients diagnosis and the normal and results of the exams. Glucose- 280 CBC (H/H; WBC;RBC) BUN 26 Creatinine- 2.0 Electrolytes Urinalysis Chest Xray (CXR) Bilateral lower lobe infiltratesNursing Assessment Findings Textbook (Source)Patient SpecificAccording to your textbook what is the signs and symptoms of the medical diagnosis and nursing diagnosis Pressure or aching in chest Constrictive, squeezing, heavy choking or suffocating sensation Location sub sternal with radiating into neck, jaw and down arms. Pain lasts for only a few minutes (5 to 15 min) Pain occurs during activity or has a precipitating factor Pain at rest is unusual Diaphoresis Shortness of breath Lewis, (p.772) C/O of sharp pain Denies any squeezing or suffocating sensation Location right upper chest with no radiation, no redness, bruising or injury noted in right upper chest. No masses or tenderness noted upon palpation. Pain last several hours, denies and nausea or vomiting Pain occurs after eating Pain during activity and rest, no restriction in activity or ADLS Skin warm and dry, color pink Denies any shortness of breath, lungs clear to auscultation bilaterally. Respiration regular and unlabored at 18 What is the assessment data, signs and symptoms that your patient exhibits. This is objective and subjective data. It also can be retrieved from the MDs admission notes, History and Physical, Emergency Room record; admission nurses notes, patient, family and your assessment.Clinical Prep Sheet Student Name: Nurse Nancy SVN Unit: 3-East Date: 01/01/2012 Clinical Wk#_1 Patient Initials: JDS Age: 86 Allergies: NKDA_________________________________ Nursing Diagnosis: Problem r/t etiology Refers to specific patient problem and need. NOT A MEDICAL DIAGNOSIS Short Term Goal Patient oriented, Realistic, Timed, and Measurable Patient will have improved skin integrity BEOS (by end of stay) AEB decreased redness and improved healing of stage 4 ulcer.Met, Partial Met, Not Met and Analysis Goal met patient wound healing without difficulty. If goal partial met or not met put why it was not met and what you plan to do. Example goal not met wound healing not improving, review and revise plan of care with patient and team members.Assessment Interventions What you would assess and monitor with rationale: Asses extremities for normal range of motion (limited movement can cause contractures) Assess VS and LOC (changes in memory, orientation, etc could indicate neurological deficits: and change in VS could indicate infection, resp./cardiac distress) Nursing Interventions: (Specific to Patient) Intervention with rationale Linen wrinkle free/dry (moisture and wrinkles increase breakdown of the skin) Evaluation of Interventions (Patients Response) Evaluations are patient oriented, not nurse oriented. There should be a patient response to the intervention performed. Skin remained free from further breakdown Avoid friction when moving patient (to prevent skin breakdown)  Used draw sheet-not friction or shearing of skin Reposition every 1-2 hours; get patient out of bed. (prolonged pressure on bony prominences decreases circulation and increases skin breakdown)  Turned and reposition q2, no increased reddened areas. Encourage ADLs ( to increase perfusion and circulation)  Patient assisted with ADLs ROM (passive and active) (increases circulation to prevent DVTS; maintains joint mobility and decreases development of contractures)  FROM in bilateral arms decreased range of motion in both legs.Patient Education and Health Maintenance: Teaching Referral Instruct active ROM exercises (see NI 5 above) Evaluation: Patient demonstrated active ROM exercises  Physical Therapy (assists with physical needs, RIM, ambulating, equipment) Home Health (assists with needs at home, bathing, medications, dressing change)  Interventions should be problem specific and performed interventions are to be highlighted and an evaluation done. Clinical Prep Sheet Student Name: Nurse Nancy SVN Unit: 3-East Date: 01/01/2012 Clinical Wk#_1 Patient Initials: JDS Age: 86 Allergies: NKDA_________________________________ Therapeutic Communication (Must submit at least one (1) conversation per week two exchanges) Non Verbal Behavior Verbal Behavior Communication Technique Interpretation Evaluation Nurse Pulled up chair along side of bed and leaned forward. You seem upset about something. Making Observation Therapeutic I think the client appears upset. I thought I could get the client to talk.Ineffective There were no feelings of anger expressed. I could have said, You seem angry.Patient Makes contact with nurse. Shakes head yes. I amNurse Facing the patient. Tell me more about your feelings.Open ended question TherapeuticI think the client is angry. I thought I had made her angry.Effective The client voices that she is scared and angry.Patient Dries tears, looks angry. Im scared and angry. Must submit one (1) communication interview per week. If you need more room you can continue on another CPS sheet. Reflection of Clinical Week (What did you expect, what really happened? How do you think you are progressing? ) Reflect over your clinical week. Put you thoughts, experiences, and feelings. If you found a specific strength or weakness you discovered about yourself you document here. State one thing you would have changed or done differently.  Clinical Prep Sheet Student Name: Nurse Nancy SVN Unit: 3-East Date: 01/01/2012 Clinical Wk#_1 Patient Initials: JDS Age: 86 Allergies: NKDA_________________________________ CPS Medication Sheet Medication Generic & Trade Dosage & RouteClassificationWhy is your client taking this drug?Nursing ImplicationsAdverse Effects Most Serious implications and what information you need as a nurse to perform or assess before giving medication. Minimum of 3 implications.Minimum of 3 adverse effects.digoxin Lanoxin 0.125 mg 1xday PO Cardiac GlycosideCHF1. Do not give if apical pulse less than 60. 2. Monitor digoxin level; electrolytes. 3. Monitor for violent vomiting.1. Nausea/Vomiting 2. Yellow Hazes 3. Dysrhythmiasfurosemide Lasix 40mg 1xday PO Loop DiureticCHF1. I&O every shift, daily weight. 2. Monitor B/P, S/S overload/deficit. 3. Monitor potassium level.1. Hypokalemia 2. Muscle cramps 3. Decreased BPcaptopril Capoten 12.5mg every 8 hours PO ACE InhibitorHypertension1. Monitor B/P-do not give if less than 90/60. 2. Monitor for orthostatic hypotension. 3. Teach to take when BP is within a normal range.1. Dry cough 2. Angioedema 3. Bronchospasmpotassium Cl K-Dur 10 mEq 2xday POElectrolytesElectrolyte Replacement1. Monitor K level (>5.8). 2. Monitor high potassium foods. 3. Store at room temperature.1. Muscle cramps 2. Bradycardia 3. Confusionibuprofen Motrin 600mg every 6 hours PO NSAIDMuscle Pains1. 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