Question

Carl Shapiro is a 54-year-old male who travels frequently. He was seen in the Emergency Department at 1:30 p.m. for complaints of chest pain, diaphoresis, and shortness of breath. He was treated in the Emergency Department with aspirin and two doses of sublingual nitroglycerin. Chest pain improved with nitroglycerin administration. IV infusion of normal saline was started in the Emergency Department and is running at 25 mL/hour. Ordered lab values are pending. Provider wants to be called as soon as the labs are available. Patient is receiving oxygen at 4 L/min with SpO₂ values at 97%. Chest pain was last rated as a "0" following second nitroglycerin dose and nitroglycerine patch 0.4 mg. He has been admitted to the Telemetry Unit.

Pt#2

Skyler Hansen is an 18-year-old male diagnosed with type 1 diabetes 6 months ago. He was brought to the Emergency Department by his friends. The friends report that he started acting "weird" while they were playing basketball. He has not eaten anything for 5 hours. Skyler told them that he felt lightheaded and was going to lie down on the cement. They became nervous and decided to bring him in to the Emergency Department. The patient is drowsy, wakes with stimulus, has slurred speech, is diaphoretic, and is acting irrationally

Pt#3

Doris Bowman is a 39-year-old female patient who underwent a total abdominal hysterectomy with bilateral salpingo-oopherectomy with general anesthesia. Patient tolerated the procedure without complications. She has an abdominal incision covered with a 4 × 4 gauze dressing with no drainage noted. IV of potassium chloride in 5% dextrose and normal saline is infusing at 125 mL/hr. Estimated blood loss was 400 mL. She was extubated in the operating room and is breathing spontaneously at 21 breaths per minute. Blood pressure is stable at 154/92. She has a Foley catheter placed with 200 mL urine output and compression stockings have been applied.

1.Create a plan of care for each patient ranking at lease 2 problems in order of priorty(include goals, interventions and evaluation methods),

2. List 5 (or more) education topics related to each patient’s current status.

Include how the topics shall be taught (I.e. give patient literature or demonstration by nurse).

Include statements about how each of the education topics should be evaluated for patient comprehension?

Answer 1

1. Carl Shapiro : Plan of care

Patient's problems:

a) Shortness of breath / Ineffective breathing pattern:

Goal: Patient maintains an effective breathing pattern at normal rate and depth in a relaxed manner.

Interventions:

* Monitor the respiratory rate,  depth and auscultate for  abnormal breath sounds ,

to know the baseline data

* Provide a comfortable position for the patient by elevating the head end of the bed or sitting position.

sitting position or Fowler's position helps to expand the chest volume by relaxing the abdominal muscles, makes the breathing easy.

* Demonstrate the deep breathing techniques and encourage the patient to do deep breathing.

* Administer oxygenation and medications as per Doctor's order.

Evaluation:  

Patient maintains effective breathing pattern as evidenced by relaxed breathing and normal rate and depth of respiration.

b)Acute chest pain :

Goal : Patient verbalize relief or control of chest pain within appropriate time frame.

Interventions:

* Assess the characteristics ( location, frequency) and severity of pain by using pain scale.

* Monitor the vital signs of the patient; temperature, pulse, respiration and Blood pressure to know the deviations from normality.

* Administer Medication to relieve chest pain as per physician's order.

Evaluation:

* Patient's verbalization of relief of pain or by pain scale measurement.

Patient teaching:

* Have healthy date that is safe for heart, low carb and low fat diet with less salt .

* Regular exercises according to the instructions of physician.

* Avoid exertional activities.

* Avoid smoking and drinking

* Pracice Deep breathing exercises.

Patient's understanding about education topics should be checked by the nurse by asking various questions related to each topic.

2. Skyler Hansen:

Hypoglycemia is a too low level of blood glucose, characterised by light headedness, fatigue, fainting, shakiness, mental confusion, slurred speech, blurred vision, irritability etc.

Patient problems:

1. drowsy, slurred speech, weakness are the symptoms hypoglycemia.

Risk for Altered Cerebral perfusion related to inadequate glucose supply to the brain.  

Goal: After a 4 hrs of nursing care , Patient's blood glucose level become normal and he will be free from insufficient tissue perfusion.

Interventions:

* Check blood sugar level

* Administer fast acting sugar containing food / drink. Example: fruit juice ( easily digested and absorbed to blood and can increase blood sugar level.

* After the fast acting sugar ingestion, provide the patient a small meal or snack.

Evaluation: After 4 hrs of nursing care, Patient's blood - glucose level became normal as evidenced by blood- glucose level and absence of slurred speech , snarkiness and fatigue.

2. Acute confusion

Goal: Patient regains normal level of Consciousness and reality orientation.

Interventions:

* Assess the level of Consciousness and orientation

* treat the underlying problem; correction of hypoglycemia.

* Orient the patient to surroundings and staff

Evaluation: Patient verbalized appropriate orientation; place , person and time.

3. Hysterectomy: The surgical procedure to remove all of or part of the Uterus

Bilateral Salpingoopherectomy: Surgical removal of both uterus and fallopian tubes.

Patient problems:

1. Acute pain in the surgical site

Goal: Patient verbalize a reduction in pain

Interventions:

* Assess characteristics of pain and its severity

* Provide diversional therapy to divert the mind from pain  

* Teach relaxation techniques to the patient

* Administer analgesics as per Doctor's order

Evaluation:

Patient verbalized a reduction in pain.

2. Risk for infection related to surgical incision

Goal: Patient remains free of infection as evidenced by absence of signs of infection.

Interventions :

* Assess the surgical site for any signs of infection such as swelling, redness, infection, abnormal discharge etc.

* Strict aseptic techniques should be maintained while dressing and cleaning the site.

* Provide a diet with Vitamin C and protein rich diet for fast healing.

* Administer prophylactic antibiotics as per physician's order.

Evaluation:

Patient remained free of infection as evidenced by absence of signs of infection.