Nursing Discharge Project Ischemic Stroke Power Point
Component 1: Objectives, clinical picture and concept map
Situation
Diagnosis
Name: B.C.R
Age: 78-year-old male
Physician/Surgeon: Mohammed I.G
Reason for Admission/Transfer: diverticulitis of the large intestine, with perforation and without bleeding
ED Admits-Did patient meet Sepsis Criteria: No
Component 1: Objectives, clinical picture and concept map
Pertinent History: Chronic obstructive pulmonary disease(COPD), depression, anxiety, obstructive sleep apnea, former smoker (0.5 packs/day, quit 03/01/19) and current alcohol user.
Pertinent assessments
Vital Signs: Temperature – 98-degree Fahrenheit, pulse -85, MAP -97 mmHg, BP – 150/71, Resp. 18.
GI: Soft, right abdominal tenderness, non-distended, bowel sound sluggish
GU: Urine is amber/yellow no odour and voiding without trouble
PAIN: 8.5/10, abdominal pain on a pain scale 1 to 10.
Component 1: Objectives, clinical picture and concept map
Pertinent assessments
Neuro: alert oriented, no gross motor deficits
Cardio/Vasc: Normal S1, S2, no murmurs
Skin: No rash, skin warm, intact and dry.
Respiratory: clear to auscultation bilaterally, no crackles or wheezes
I/O: Intake= 2493 mL, Output= 4145 mL
Drains/Tubes/Foley: Colostomy LLQ and NG tube
Dressings: Negative Pressure wound therapy
O2: 97 %
IV’s: 0.9% NaCl, Dextrose 10%, Fentanyl PCA, Piperacillin, Thiamine
Component 1: Objectives, clinical picture and concept map
REQUIREMENTS
Isolation: None
Fall Risk: YES
Restraints: NONE
Other: NPO
EVALUATE
Labs: Glucose, chlorine, sodium, calcium, blood urea nitrogen (BUN) test, hemoglobin, hematocrit and MCV blood test.
CORE MEASURES
Surgery/ Procedure took place on 10.4.2020
Component 1: Objectives, clinical picture and concept map
The objective is to develop a comprehensive discharge care plan for the patient as a cardinal part of the nursing care and to aid the care transition in a pertinent manner(Schieffer et al. 2018). The objective is also to develop a quality and safe plan that is important to note.
Component 2: Pathophysiology
Diverticulitis involves small abscesses or infection in one or more of the diverticula, or perforation of the bowel. The disorder pathogenesis that involves three major areas which is the colonic wall structural abnormalities, absence of fibers in the diet and lack of proper motility of the small intestine. There are various etiological factors that are involved in the development of the clinical condition and as for a matter of fact, inflammation is a major process causing issues (Nalamati & Munie, 2018, p. 210). Hyperplasia and hypertrophy due to the elastin deposition is a major critical process. The myoelectric patterns along with the very chemical messengers with different hormones also a major role in the development of the diverticular disease(Ellison, 2018, p. 68).
Component 2: Pathophysiology-statistical information
The prevalence of diverticulitis in the U.S. has increased dramatically over the past several decades and is estimated to be 180/100,000 persons per year. Most patients with diverticulitis are older than 50 years of age. However, diverticulitis is seen increasingly in younger individuals. Diverticulitis is more common in women than in men, particularly after the sixth decade of life, and in whites than in other racial groups(Swanson & Strate, 2018, p. ITC65-ITC80).
Component 2: Pathophysiology-Key Diagnostics and Lab Studies
Colonoscopy, to detect diverticulosis
CT scan will be done to confirm diagnosis, grade severity, detect abscess of fistula, and guide treatment.
A liver enzyme test, to rule out liver-related causes of abdominal pain.
Laboratory tests include Hemoccult or guaiac testing of stool to identify the presence of occult blood and a WBC count.
The abnormal lab values are indicated below: GLU 194(high), CA 7.9(low), NA 146(high), CL 112(high), BUN 30(high), HGB 11.0(low), HCT 35.1(low), MCV 101.2(high).
Component 3: Medications & Treatments
Medications
Thiamine (B-1) 100mg, folic acid 1mg in sodium chloride 0.9% 100 mL IVPB – for treatment of vitamin deficiencies and electrolyte imbalance
Piperacillin – tazobactam(ZOSYN) 3.375 g in sodium chloride 0.9% 100 mL IVPB – is a combination penicillin antibiotic for treatment of stomach infections.
Budesonide –anti-inflammatories (steroidal), 1 mg total daily dose
buffered lidocaine – anesthetics (topical/local); antiarrhythmics – used to reduce pain, 20-30 mL of 1% solution
Diphenhydramine – to treat allergy and fever, 25 to 50 mg orally 3 to 4 times a day
fentanyl citrate –opioid analgesics – for analgesia, 50 micrograms per ml per injection
fentanyl PCA 20mcg/ml – for reducing pain
fluticasone NASAL – to treat nasal problems, total daily dose, 200 mcg
formoterol nebulizer – acts as bronchodilator, 12 mcg (1 inhalation) orally
heparin – anticoagulants – for prevention of blood clots. IV bolus of 60 units/kg
Hydralazine – antihypertensives – this is to treat high blood pressure, 300 mg/day
Labetalol – beta blockers, antianginals, antihypertensives – to treat hypertension and cardiovascular problems. 100 mg PO q12hr
Lorazepam –analgesic adjuncts, antianxiety agents, sedative/hypnotics; as a sedative effect for sleeping and anxiety issues. 2 to 3 mg orally per day
Metoclopramide – antiemetics; to treat nausea and gastrointestinal issues. Oral Sol: 5mg
Treatment
The Doctors recommended surgery- Sigmoid colectomy, colostomy with Hartmann pouch and abdominal washout for the treatment of the “Diverticulitis of the Large Intestine with perforation without bleeding” with intravenous antibiotics and some other medications as indicated in the previous slide.
Component 4: Sources of Support & Services Offered
Financial Support Sources – government funded aged people health coverages, pension scheme and hospital coverages with Medicare services
Component 4: Sources of Support & Services Offered
Inpatient Sources of Support –
Nursing
Nutritionist
Surgeon and other doctors
Primary care providers
Bedside alarms and monitors
Physiotherapist
Respiratory therapist
Clinical psychologist
Specific services and needs –
Gastrointestinal bleeding check
Cardiovascular monitoring
Respiratory monitoring
Component 4: Sources of Support & Services Offered
Daughter
Family Support Sources
Family members
Community Support Sources
Social workers
Self help groups
Nutritional surveillance programs
Community nurses
Mental health services
Community general practitioners
Component 5: Patient Teaching: Comprehensive Overview of Teaching Needs
Information on medication, importance, side effects, timings, doses and the adverse effects
Information on the post surgical healing and the usage of effective dressing procedures
Information on the mindfulness and psychological management skills to address the anxiety issues.
Information on cardiovascular management and the red flags
Need to verbalize, demonstrate and understand about how to check vital signs and the fluid balance; demonstrate stress reduction techniques
Information on self care and resilience skills to fight depression and aid personal recovery
Discharge planning and teaching should be initiated early, as the patient has a new colostomy. Reinforcement of self-care teaching may need to be instituted over several sessions to ensure the patient and/or caregiver can manage the colostomy.
Dietary considerations should be included in the discharge plan. Consult with a dietitian for instructions and menu planning; reinforce teaching.
Teach about potential postoperative complications such as abdominal abscess or bowel obstruction, their signs and symptoms, and preventive measures(Bauldoff, Gubrud, & Carno, 2019, p. 789).
Patient Teaching Guide
Take care of your stoma as directed by your ostomy nurse.
Always refer to the patient education sheet about colostomy care given to you your significant other by your ostomy nurse. It will help remind you how to care for yourself.
Don’t lift anything heavier than 5 pounds until your healthcare provider says it is OK.
Don’t drive until after your first healthcare provider’s appointment after your surgery.
Ask your healthcare provider when you can expect to resume normal daily activities.
Increase your activity gradually. Take short walks on a level surface.
Wash your incision site with soap and water and pat it dry.
Check your incision every day for redness, drainage, swelling, or separation of the skin.
Take your medicines exactly as directed. Don’t skip doses. Don’t take any over-the-counter medicine unless your healthcare provider tells you to do so.
Call your healthcare provider immediately if you have any of the following: Excessive bleeding from your stoma; Blood in your stool; very hard Stool; No gas or stool; Change in the colour of your stoma; Bulging skin around your stoma; A stoma that looks like it’s getting longer; Fever of 100.4°F (38°C) or higher, or chills; Redness, swelling, bleeding, or drainage from your incision; Constipation; Diarrhea; Nausea or vomiting; Increased pain in the belly or around the stoma(“Discharge instructions for colostomy,” n.d.).
Component 6: Conclusion
Potential for Complete Recovery
Client will have better recovery if he will adhere with the treatment procedures and the recommendation made during discharge. This will reduce the risks of post surgical complication.
The procedure notes reports no complication during or immediately after the surgery and in post operative nursing care
shows adherence to medications and shows the intention and skill for maintain holistic wellbeing with respect to physical and mental health.
Client demonstrates literacy about the clinical risks, adverse effects of condition, factors promoting and limiting recovery form the condition.
Discharge Readiness Checklist
Patient ability to perform a return demonstration on the care of ostomy
Diet and Elimination
Client agrees with discharge plan
Activity in past 24 hours: Independent at bedside
Vita Signs (HR 90 bpm, RR <20, BB <135/95)
Respiratory Status: SpO2 > 94 per cent
Pain score: <3 (on a 0-10 Pain Scale)
Lessons Learned
Ability to deliver holistic nursing care.
Developing comprehensive nursing care plan from healthcare recipient’s history (past, present)
Conducting assessment to collect relevant data based on client’s health status.
Identifying cues for accurate nursing diagnosis while reviewing medical diagnosis and previous medical record.
Interprofessional Collaboration to deliver safe, quality, effective and efficient healthcare.
Maintaining optimal health to prevent exacerbation of condition.
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