Bowie State University Nursing Care Plan Presentation

Bowie State University Nursing Care Plan Presentation Bowie State University Nursing Care Plan Presentation Make a powerpoint presentation from your careplan and teach your follow student our patient case I uploaded my care plan paper and sample of PowerPoint presentation .how it will look like uche_complex_care_careplan.docx uche_sample_critical_care_plan_for_diabetic_kda.pptx ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS 1 BOWIE STATE UNIVERSITY DEPARTMENT OF NURSING NURS 411 Concept Mapping/Care Plan The Concept Mapping assignment is worth 100 points and 10% of your NURS 411 grade. Submit this grading tool with your Concept Map. Criteria Admissions Assessment a. Included primary and secondary medical diagnoses b. Included definitions for primary and secondary Medical diagnoses c. Included nursing assessment data: physiological, spiritual psychological, developmental, and socio-cultural. Pathophysiology, Lab & Diagnostic a. Discussed the pathophysiology r/t medical diagnosis b. Identified significant lab and diagnostic data and their interpretation as it relates to the client Possible Grade Comments Points 10 points 10 points _____ Nursing Diagnosis 20 points a. Identified at least 3 problems based on assessment data b. Prioritized Nursing diagnoses based on Maslow’s Hierarchy of Needs, and ABC’s (airway, breathing, circulation) c. All three parts of the nursing diagnoses are appropriate Planning a. Goals are appropriate (2) b. Outcomes are measurable (6)) c. Outcomes are specific and relate to the nursing diagnoses _____ 20 points _____ _____ Nursing Interventions 20 points _____ a. Therapeutic interventions reflect: (5) 1. cultural congruence 2. therapeutic communication 3. ethical consideration 4. legal standards 5. caring and concern b. Nursing interventions are stated as dependent, independent, or collaborative c. Rationales are listed for nursing interventions. (text & journal articles) Evaluation 20 points _____ a. Describes clients response to nursing interventions b. States the extent to which each outcome has been obtained c. Determines the extent to which overall goals have been met d. Reflects current data collected by the student. 2 Uchenna Owunna Myocardial Infarction Nur 411 care plan 3 Background Information Mr. SB. is a 64 -year-old male who was brought into the emergency department via ambulance 8:13 pm on 3/06/2020. Client complained of chest pain 1 hour after meal. Client rated pain 2 on a scale of 1 to 5 and described pain as a “grabbing pressure” located midsternal. He stated that pain radiates down left arm and to the back and denied nausea or vomiting. Client was pale and diaphoretic upon admission. He was admitted into the hospital on 3/06/2020 with a diagnosis of unstable angina. He is full code and NKA per medical record. Client is alert and oriented. Client reports no previous episodes of chest pain or pressure. He smoked two packs of cigarettes per day for 20 years. He has no family history of heart disease. 4 Concept Map Physiologic Primary Medical Diagnosis: Unstable Angina Secondary Medical Diagnosis: Myocardial infarction Neurologic Cardiovascular Respiratory Gastrointestinal Risk Factors: Coagulopathy Hypertension Cigarette use 2ppd for 20 yrs Stress Urinary Musculoskeletal Integumentary Reproductive Pathophysiology: (If needed complete on following page) Psychological Client is alert and oriented 3x . Development (Erickson’S) Client is a 64-year-old. Erickson’s appropriate psychosocial task for this age is generativity vs. stagnation Diagnostic Findings & Laboratory Values: 12-lead electrocardiogram Chest x-ray Cardiac enzyme measurement Angiography Sociocultural Client smoked 2 packs of cigarette daily for 20 years. Mother died of Alzheimer’s and father died of cancer Spiritual Not available 5 Physiologic If more space is required, please use this box; instead of the box on page one. General: 64-year-old African-American. He is pale, diaphoretic and is short of breath. He has his hands over is chests. Height 173 cm, weight 104 kg, BMI 35.9 (Obese) Neurologic: Client is alert and oriented 3x. Cardiovascular: Normal S1 and S2 auscultated with the presents of an S3 sound. Bowie State University Nursing Care Plan Presentation No S4 present. No JVD present, the carotid arteries were 2+/4 without bruits. Point of maximum impulse in fifth intercoastal space. BP 140/90 mm Hg, HR 92 92 bpm and regular, SaO2 95% on oxygen 4L/min. Respiratory: Respiratory effort is labored, reports SOB. Vesicular lung sound noted with scattered wheezes. No crackles heard. Respirations 32 breaths/min. Gastrointestinal: Soft and non-distended. Bowel sound present and normal. Gag reflex present. Genitourinary: No Foley catheter present, Client has yellow colored urine and clear. Client’s urine output is <30 ml/hr. No bladder distention noted. Musculoskeletal: Full ROM, limbs move purposeful upon request. Integumentary: Skin is pale, diaphoretic and intact. No ulcers noted. No edema. Pulses are palpable. Temperature 36.9°C (98.5°F) Reproductive: Unavailable 6 Pathophysiology Primary diagnosis: Unstable angina- Angina is associated with a significant obstruction of at least one major coronary artery. Normally, the myocardium extracts a large amount of oxygen from the coronary circulation to meet its continuous demands. When there is an increase in demand, flow through the coronary arteries needs to be increased. When there is blockage in a coronary artery, flow cannot be increased, and ischemia results which may lead to necrosis or myocardial infarction. Secondary Diagnosis: Anterolateral Myocardial infarction- Cardiac muscle tissue death from lack of blood flow. The blood carries oxygen and nutrients to the cells. When this is decreased, cells die also called necrosis. Cardiac muscle cells dying is problematic as they do not regenerate Pathophysiology Prescribed medications at home: Generic & trade name & classification of medication Dose/route Frequency Purpose None Medications ordered this hospitalization: Generic & trade name Dose/route & classification of medication Heparin sodium (Hep-lock) 8000U/IV Anticoagulant Frequency 10 ml/hr (Stat/Bolus) Aspirin (Bayer, Ecotrin) Anti- inflammatory, anticoagulant 81 mg / PO Daily Alteplase recombinant (Activase, Cathflo Activase) Thrombolytic 100 mg/IV Lidocaine hydrochloride (2g/500ml in D5W) 2mg/min/ IV (100 mg total dose infused over 1.5 hr): 15 mg IVP bolus over 1-2 minutes, THEN 50 mg IV infusion over next 30 minutes, and THEN remaining 35 mg over next 60 minutes Initially, 1–1.5 mg/ kg. Refractory ventricular Reason administered to this client Inhibits clot in the coronary artery Effects of medication on this client Client remains free from complications of MI. Used as platelet aggregation inhibitor in the prevention of transient ischemic attacks (TIAs), cerebral thromboembolism, MI or reinfarction. For lysis of thrombi in coronary arteries, acute ischemic stroke, acute massive pulmonary embolism. Reduction in platelet count Rapid control of acute ventricular arrhythmias Resolution of V-tach Reduction in chest pain (Xylocaine, Otocaine) Antiarrhythmic Dobutamine (Dodutrex) 5ug/kg/min/ IV NTG (50mg/250 mg in D5W) (Minitran, Tridil, Gonitro) Antianginal 20ug/min (6ml/hr/ IV) Metoprolol titrate (Lopressor) Beta1- adrenergic blocker. 5mg IVP Dopamin (Intropin) Dopaminergic, Vasopressor Abciximab (ReoPro) Glycoprotein IIb/IIIa receptor inhibitor, Antiplatelet 2ug/kg/min Enoxaparin (Lovenox) Anticoagulant 100mg/ subq Diagnostic studies: Test & definition 0.25 mg/kg/ IV Initial admission test tachycardia: Repeat dose at 0.5–0.75 mg/ kg q10– 15min after initial dose for a maximum of 3 doses. 2.5–20 ug/kg/min titrated to desired response. following MI, cardiac catheterization, cardiac surgery, digitalis-induced ventricular arrhythmias. Short-term management of cardiac decompensation. Positive inotropic agent in myocardial dysfunction. 5ug /min in increment for Dilates coronary arteries, non-responsive angina. improves collateral blood flow Then up to 20 ug/min to ischemic areas within Q 3-5 minutes. Bowie State University Nursing Care Plan Presentation myocardium Q 5mins three times Slows heart rate, decreases cardiac output, reduces B/P. Decreases myocardial ischemia severity. Initially, 1–5 ug/kg/min Adjunct in treatment of up to 20 ug/kg/min. hypotension, shock IV bolus followed by Prevents occlusion of treated 21ml/hr for 12 hours coronary arteries (PCI). Prevents acute cardiac ischemic complications. 2 times daily Treatment of acute coronary syndrome (ACS): unstable angina, non–Q-wave MI, acute ST-segment elevation MI (STEMI). Significance of results Most recent test results (if Increase cardiac function Reduction in chest pain Reduction in BP of 90/60 mm Hg and heart rate. Increase in BP of 133/59 mm Hg Artery is free from occlusion Artery is free from occlusion Significance of repeated results & date performed to client’s condition test repeated) & date performed test results to client’s condition CK (U/L) 254 (3/06/2019) time: 2013 5638 (3/07/2020) time: 0400 CK-MB (%) normal 0% 10 (3/06/2020) time: 2013 Myocardial muscle creatine kinase (CK-MB) is found mainly in the heart. Signifies heart infarction. heart muscle is damaged Initial therapy is unsuccessful, further damage done to the heart. Initial therapy is unsuccessful, further damage done to the heart. Troponin I (ng/ml) normal normal <0.2 ng/dL 3.5(3/06/2019) time: 2013 To measure levels of cardiac troponins. Signifies heart infarction. >50 (3/07/2020) time: 0400 Initial therapy is unsuccessful, further damage done to the heart. ECG Frequent PVCs/ V-tach ST-segment elevation in lead 1, aVL, V2, V6. ST-segment depression in leads III and aVf. Q waves in V2 through V4. (3/06/2020) time 2015 Signifies MI ST segment almost baseline Q waves in V2 through V4. Inverted T waves in V2 through V6. AvR waves now upright (3/07/2020) time: 0650 Progressive resolution of MI X-ray 1. Cardiomegaly 2. Mild congestive heart failure (3/06/2020) 1. Signifies reduced cardiac N/A output 2. Due to reduction in cardiac output, blood backs into the lungs causing congestive heart >300 (3/07/2020) time: 0400 N/A failure. Echocardiogram 1.Thin layer myocardial effusion. Normal no effusion. 2. Left ventricular ejection fraction 25%-30% (normal range – 55% to 70%) 3. Mild mitral valve regurgitation (3/07/2020) This signifies decrease in heart function causing damage, fluid buildup and decreased cardiac output. Angiogram 90% blockage of left Signifies decreased anterior descending artery. perfusion to the heart (3/07/2020) muscles causing necrosis of heart tissue. N/A N/A N/A N/A Based on your assessment data and the chart above, identify as many problems (listed as problems not medical nor nursing diagnosis) as possible. 1. Chest Pain 2. Shortness of breath 3. Smoked 2 packs of cigarette daily (Risk for lung cancer) 4. Abnormal breath sound (Wheezing) 5. Dysrhythmia 6. Decreased urine output 7. Ventricular tachycardia 8. Hypotension 9. Skin discoloration 10. Deficient knowledge about condition Based on the problems you have listed, identify the top three problems, and prioritize them. 1. Acute pain related to tissue ischemia (coronary artery occlusion) as evidenced by reports of chest pain with/without radiation and facial grimacing 2. Activity Intolerance related to presence of ischemic/necrotic myocardial tissues as evidenced by development of dysrhythmias and changes in skin color/moisture 3. Decreased Cardiac Output related to changes in rate, rhythm, electrical conduction; Reduced preload/increased SVR; Infarcted/dyskinetic muscle Using the problem with the highest priority, identify an appropriate nursing diagnosis based on NANDA and develop a careplan for your client. Bowie State University Nursing Care Plan Presentation Concept Map Tool for Care Planning #1Nursing Diagnosis: Acute pain related to tissue ischemia (coronary artery occlusion) as evidenced by reports of chest pain with/without radiation and facial grimacing Client’s Primary Medical Dx: Unstable angina Secondary Medical Dx: Anterolateral Myocardial infarction Evaluation: 1. Client states decrease in pain 2. Client is resting, will display reduced tension and sleep comfortably. 3. Will require decreased analgesia, nitroglycerin and thrombolytic therapy 4. Client will have improved feeling and control and verbalize control over current situation Goals & Outcomes: 1. Verbalize relief/control of chest pain within appropriate time frame for administered medications. 2. Display reduced tension, relaxed manner, ease of movement. 3. Demonstrate use of relaxation techniques. Nursing Interventions (With Rationale): 1. Monitor and document characteristic of pain, noting cues (moaning, restlessness, diaphoresis, clutching of chest) and BP or heart rate changes. Rationale: Variation of appearance and behavior of patients in pain may present a challenge in assessment. Most patients with an acute MI appear ill, distracted, and focused on pain (Ackley et al, 2017). 2. Obtain full description of pain (PQRST) Rationale: Pain is a subjective experience and must be described by patient. Provides baseline for comparison to aid in determining effectiveness of therapy, resolution and progression of problem(Ackley et al, 2017). 3. Instruct patient to report pain immediately. Provide quiet environment, calm activities, and comfort measures. Rationale: Decreases external stimuli, which may aggravate anxiety and cardiac strain, limit coping abilities and adjustment to current situation(Ackley et al, 2017). 4. Administer medication as prescribed. Rationale: Nitrates are useful for pain control by coronary vasodilating effects, which increase coronary blood flow and myocardial perfusion(Ackley et al, 2017). 5. Obtain ECG on admission and then each tine chest pain recurs. Rationale: Serial ECG and stat ECGs record changes that can give evidence of further cardiac damage and location of MI(Ackley et al, 2017). 6. prepare client for percutaneous transluminal coronary angioplasty. Rationale: PTCA can be carried out either electively in a patient with stable angina, or as an emergency in high-risk patients with unstable angina(Ackley et al, 2017). #2Nursing Diagnosis: Activity Intolerance related to presence of ischemic/necrotic myocardial tissues as evidenced by development of dysrhythmias and changes in skin color/moisture Goals & Outcomes: 1. Demonstrate measurable/progressive increase in tolerance for activity with heart rate/rhythm and BP within patient’s normal limits and skin warm, pink, dry. 2. Report absence of angina with activity. 3. Patient will identify factors that aggravate activity intolerance. 4. Patient will report the ability to perform required activities of daily living. 5. Patient will identify methods to reduce activity intolerance. Client’s Primary Medical Dx: Unstable angina Secondary Medical Dx: Anterolateral Myocardial infarction Evaluation: 1. Within days of intervention, client tolerated activity without excessive dyspnea. 2. Client utilizes breathing and energy conservation techniques. 3. Client increased and achieve desired energy level, with no intolerance symptoms noted. Nursing Interventions (With Rationale): 1. Document heart rate and rhythm and changes in BP before, during, and after activity. Correlate with reports of chest pain or shortness of breath. Rationale: Trends determine patient’s response to activity and may indicate myocardial oxygen deprivation that may require decrease in activity level, changes in medication regimen, etc (Ackley et al, 2017). 2. Encourage rest initially. Bowie State University Nursing Care Plan Presentation Then limit activity on basis of pain and/or adverse cardiac response. Rationale: Reduces myocardial workload and oxygen consumption, reducing risk of complications (Ackley et al, 2017). 3. Instruct patient to avoid increasing abdominal pressure (straining during defecation). Rationale: Activities that require holding the breath and bearing down (Valsalva maneuver) can result in bradycardia and rebound tachycardia with elevated BP (Ackley et al, 2017). 4. Explain pattern of graded increase of activity level: getting up to commode or sitting in chair, progressive ambulation, and resting after meals. Rationale: Progressive activity provides a controlled demand on the heart, increasing strength and preventing overexertion (Ackley et al, 2017). 5. Refer to cardiac rehabilitation program. Rationale: Provides continued support and/or additional supervision and participation in recovery and wellness process (Ackley et al, 2017). #3 Nursing Diagnosis: Decreased Cardiac Output related to changes in rate, rhythm, electrical conduction; Reduced preload/increased SVR; Infarcted/dyskinetic muscle Client’s Primary Medical Dx: Unstable angina Goals & Outcomes: 1. Patient demonstrates adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within normal parameters for patient; strong peripheral pulses; and an ability to tolerate activity without symptoms of dyspnea, syncope, or chest pain. 2. Patient exhibits warm, dry skin, eupnea with absence of pulmonary crackles. 3. Patient remains free of side effects from the medications used to achieve adequate cardiac output. 4. Patient explains actions and precautions to take for cardiac disease. 5. Patient remains free of side effects from the medications used to achieve adequate cardiac output. Secondary Medical Dx: Anterolateral Myocardial infarction Evaluation: 1. Client will be able to maintain optimal cardiac output and show no sign and symptom of decreased cardiac output. 2. Client demonstrate a decrease in episodes of dyspnea. 3. Client returns to normal activity and exercise level, considering extent of cardiac damage. 4. Physical examination reveals that arrhythmias are absent Nursing Interventions (With Rationale): 1. Note skin color, temperature, and moisture. Rationale: Cold, clammy, and pale skin is secondary to compensatory increase in sympathetic nervous system stimulation and low cardiac output and oxygen desaturation (Gulanick & Myers, 2014). 2. Check for any alterations in level of consciousness. Rationale: Decreased cerebral perfusion and hypoxia are reflected in irritability, restlessness, and difficulty concentrating. Aged patients are particularly susceptible to reduced perfusion (Gulanick & Myers, 2014). 3. Assess heart rate and blood pressure. Rationale: Most patients have compensatory tachycardia and significantly low blood pressure in response to reduced cardiac output (Gulanick & Myers, 2014). 4. Check for peripheral pulses, including capillary refill. Rationale: Weak pulses are present in reduced stroke volume and cardiac output. Capillary refill is sometimes slow or absent (Gulanick & Myers, 2014). 5. Inspect fluid balance and weight gain. Weigh patient regularly prior to breakfast. Check for pedal and sacral edema. Rationale: Compromised regulatory mechanisms may result in fluid and sodium retention. Body weight is a more sensitive indicator of fluid or sodium retention than intake and output (Gulanick & Myers, 2014). 6. Record urine output. Determine how often the patient urinates. Rationale: The renal system counterbalances low BP by retaining water. Oliguria is a classic sign of decreased renal perfusion (Gulanick & Myers, 2014). 7. Assess heart sounds for gallops (S3, S4). Rationale: S3 indicates reduced left ventricular ejection and is a class sign of left ventricular failure. S4 occurs with reduced compliance of the left ventricle, which impairs diastolic filling (Gulanick & Myers, 2014). References Ackley, B. J., Ladwig, G. B., & Makic, M. B. (2017). Nursing diagnosis handbook: An evidencebased guide to planning care (11th ed.). St. Louis, MO: Elsevier. Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, & outcomes (8th ed.). St. Louis, MO: Elsevier. Presentation by: Instructor: Professor Concept Map 2 ? ? ? ? Patient is 40 year old female diagnosed with diabetes mellitus, ran out of insulin 3 days ago and was unable to get to the pharmacy to fill prescription. Patient is presented to ED with generalized weakness and palpitation for the past 1-2 days. Primary diagnosis: Diabetes Mellitus Secondary diagnosis: Diabetic Ketoacidosis ? ? ? ? ? ? ? Ackley, B. J., & Ladwikg, G.B (2008). Nursing diagnosis handbook: an …Bowie State University Nursing Care Plan Presentation Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . 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