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Original Question
Case study: This patient is a 73-year-old male Caucasian with admitting diagnosis of hypoxic respiratory failure and COVID 19 pneumonia. secondary diagnoses of Type 2 diabetes mellitus, liver cirrhosis and chronic kidney disease (CKD) stage 3. After hospitalization he developed signs of stroke and MRI then showed extensive Ischemic changes in the left medial temporal lobe, left occipital love, left basal ganglia, and corpus callosum and right periventricular region, no hemorrhage, no brain herniation. EKG showed sinus rhythm. PROVIDE DETAILED ANSWERS PLEASE ADDITIONAL DATA/INFORMATION What is the Explanation of Additional Data & Nursing Implications (Provide a credible reference within the box) Physical deconditioning with impaired mobility and ADLs Activity level: Weak-Use of ambulatory aid(walker) Morse fall risk: High risk (No history of falls and no heparin or iv lock however patient has secondary diagnoses, ambulatory gait, impaired gait and forgets limitations). Heart rate= 80 beats per minute, regular EKG= sinus rhythm Warm extremities bilaterally -hands and feet had mild pallor, posterior tibial, and dorsalis pedis pulses were present bilaterally, normal volume and rhythm. Capillary refill was slow- about 3 seconds No pedal edema Patient was on Lovenox for prophylaxis against DVT Patient was on oxygen therapy at 2 liters per minute through nasal cannula. No spirometry or chest tube 3 Bowel movements – brown, formed but soft. Oral feeding, On modified soft diet and thin liquids due to dysphagia No urinary catheter Skin:Intact skin, no breakdown. Braden Score Sensory Perception 3 (slightly limited) Moisture 3 (Occasionally) Activity 2 (Chairfast) Mobility 2 (very limited) Nutrition 2(Probably Inadequate) Friction and Shear 2(Potential Problem) Braden Score 3 – 14 Moderate Risk Musculoskeletal & Extremities (Cast) No cast Evidence-Based GeriRN or other appropriate screening tool (Report name of instrument, score, & Interpretation) LABORATORY & DIAGNOSTIC TESTS Explain 5 significant abnormal laboratory &/or diagnostic test results (Bloodwork, cultures, EKG, X-Rays, etc.) Include nursing implications and how you would explain the results to the patient. IF there are no abnormal results, please discuss the laboratory and diagnostic tests most relevant to the patient’s admitting diagnosis or health conditions that directly impacted the patient’s care. Test Name/ Result & Normal Range Discuss abnormal results (provide a reference) GlucosePoint-of-care testing (POCT)= 190 mg/dL(High) Explain the abnormal result: Nursing Implications for abnormal result: In three sentences or less, discuss how you would explain this to your patient. Hemoglobin A1c (results are pending) Explain the abnormal result: Nursing Implications for abnormal result: In three sentences or less, discuss how you would explain this to your patient. 3.Platelets= 105× 109 /L (patient has liver cirrhosis) Explain the abnormal result: Nursing Implications for abnormal result: In three sentences or less, discuss how you would explain this to your patient. 4. Hemoglobin = 7.6g/dL (Anemia) Explain the abnormal result: Nursing Implications for abnormal result: In three sentences or less, discuss how you would explain this to your patient. 5. stool for occult blood(Rule out GI bleeding) =No occult blood Explain the abnormal result: Nursing Implications for abnormal result: In three sentences or less, discuss how you would explain this to your patient. CLINICAL JUDGMENT Use your textbooks, and other evidence-based resources for this section. Nursing Diagnoses (10 points) Patient Outcomes/Goals (10 points) Progress Note in PIEP Format (20 points) Evidence-Based Rationales for Actual & Planned Interventions (20 points) For 2 PRIORITY nursing diagnoses below specific to the patient;Fill the table Write 2 Patient Outcomes/goals for EACH nursing diagnosis. The first outcome will focus on the day that you cared for the patient and the second will focus on the outcome at discharge. Use the SMART acronym (Specific, Measurable, Attainable, Realistic and Timed. Write a PIEP Note that communicates relevant information. P-Include significant data relevant to the nursing diagnosis on the day that care was provided I-Interventions were actually implemented E-Evaluation relative to outcomes/goals (resolved, improved, unchanged, too soon to evaluate, worse) P-Plan (interventions that need to be implemented or further follow up r/t the problem or interventions that should have been implemented). Provide evidence-based rationales for EACH nursing intervention in the intervention and plan parts of the 2 PIEP notes. One intervention/rationale should come from a Clinical Practice Guideline, Systematic Review, Joanna Briggs, RNAO, or professional journal article for each nursing diagnosis. (Provide a reference). 1. Patient has physical deconditioning with impaired mobility and ADLs due to COVID-19 pneumonia and hypoxic respiratory failure . 2. Potential risk for bleeding due to thrombocytopenia, activity intolerance due respiratory distress ISBAR ISBAR the Primary Healthcare Provider about a patient concern or problem. I: Identify yourself, including credentials & the patient with the following identifiers: Patient x, date of birth 2-30-20xx and medical record number 1234. You are on unit A at University Hospital. I: S: Situation that you are calling about, key concerns & assessment findings (relevant analysis of a symptom) S: B: Background of the patient (admitting diagnosis, surgery, major procedures, & dates, RELEVANT health conditions, vital signs, assessment findings, labs/tests & trends, medications/IVs, allergies, & DNR status. Indicate what you did about the problem prior to contacting the provider. B: A: What do you think the problem is? A: R: Recommendations to correct the situation. (See the patient or family, transfer the patient. Obtain a consult. Would you like me to obtain orders for labs, tests, meds, a consultant, or a new admission. When should a patient update occur? R: What orders/prescriptions do you anticipate? Anticipated Orders: CLINICAL LEADERSHIP Discuss YOUR direct contribution to the inter-professional plan of care or discharge plan by describing an interaction with a professional from another discipline (Provider, Pharmacist, Physical Therapist, Social Worker, family, etc). This section should focus on what you did or would have done as a student not what the nurse did. QUALITY & SAFETY Describe a safety or quality improvement issue for the practicum unit/microsystem and its impact on patient care. Discuss a potential solution for the issue and the role of the CNL when a quality/safety issue arises.
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