Nursing Care Plan for Post Operative Knee Pain

Nursing Care Plan for Post Operative Knee Pain EMORY UNIVERSITY NELL HODGSON WOODRUFF SCHOOL OF NURSING NRSG 360 Clinical Nursing I Clinical Work Sheet for Weekly Clinicals OVERVIEW: (Preparation for clinical week 2) Client’s Initials__L.W________ Age 74YRS___Admit Date_11/17/2014____ and/or Procedure Date _11/17/2014________ Today’s Date_11/20/2014________ Medical Diagnosis/Reason for Admission __Post-operative _pain____ Admitting Diagnosis: RIGHT KNEE REVISION Describe (Brief Pathophysiology in your own words, including HPI)__Patient is a 74 years female with right knee revision due to acute post-operative pain came in for surgical consultation due to continued pain and a valgus deformity after having cast removed. She is on hinged knee brace for stability. Allergies: Ancef, Tolectin 600, Cephalosporins Social Hx Patient is a retired pharmacist, married with children. She is alert and oriented x4; uses tobacco before but quitted 20years ago.__________________________________________________________ HOW ARE THE ABOVE ITEMS RELATED? (Preparation Add on by Clinical week 3) Treatments (Accuchecks, dressing changes, PT, OT, RT, activity order, diet, Isolation, I/O) Medications (See Medication Summary) Systematic Concise Summary of Physical Assessment findings (See Checklist for Routine Bedside Assessment) General: (includes vital signs) BP: 119/69, P: 93, T: 73.3, R: 18, SaO2: 95, Pain: 8/10 Neuro: Alert and oriented x4, Pupils dilated and face expression is symmetry. Cardiac: Clear on S1 and S2. No extra heart sounds, murmurs, or ribs. Respiratory: Breathing is unlabored, chest movement is symmetric. Integumentary: (include wounds) Skin is normal, warm and moist, no skin discoloration. Wound dressing on the right knee and right femur edema. GI: Normal bowel sounds hyperactive in all quadrants. GU: Clear yellow urine Musculoskeletal: Active range of motion on upper extremities, impaired range of motion on lower extremities with brace on right leg. Right foot is dissented. Safety Concerns Fall risk, Pressure sore risk. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DIAGNOSIS: *Radiology results; lab; micro; orders Pertinent Diagnostic Tests This includes abnormal and significant normal. Test Date Findings/Results Implications/Nursing care X-RAY knee 1or 2 view right 11/17/2014 Degeneration joint disease Revision of the tibia and femoral X-ray chest 1or 2 view 11/12/2014 Cardiomegaly, Tortuous descending aorta, left basilar atelectasis. Surgery Lab Tests with Rationale for Abnormals and Implication of Findings: Name of lab Reference Range Level at Admit Level on Last Lab Nursing Implications Reason for level SS Date Level Date Level Red blood cell count 3.93- 5.22mmol/L 11/17/2014 2.8210E6/mcl 11/20/2014 2.6410E6/mcl Due to Surgery Hemoglobin 11.4-14.4 mmol/L 11/17/2014 7.9gm/dl 11/20/2014 7.4gm/dl Due to Surgery Hematocrit 33.3-41.4 mEq/L 11/17/2014 25.0% 11/20/2014 24.4% Due to Surgery mEq/L mg/dL Nursing Plan of Care Nursing Plan of Care NANDA NURSING DIAGNOSTIC LABEL (Choose #1 priority problem for patient) RELATED FACTORS Secondary to a Disease or Condition DEFINING CHARACTERISTICS* (As evidenced by signs or symptoms) * Remember â€Å"Risk For† Diagnoses do not yet have defining characteristics! Acute pain Related to knee replacement surgery Subjective: As evidence by pain rate of 10/10 Objective: Lower extremity weakness. Nursing Diagnosis Statement: Acute Pain______________________________________________ PATIENT EXPECTED OUTCOMES/GOALS (Specific, Measurable, Achievable, Realistic, Timely) PLANNED NURSING INTERVENTIONS RATIONALE EVALUATION (Not Met, Partially Met or Met) Patient Goal Patient will indicate pain level decrease to less than 5/10 Your Intervention: Administer pain medication Evaluation of Goal Goal partially met, Patient pain level was managed to a level of 6/10. Your Intervention: Facilitate Rest Your Intervention: Provide relaxation and guided imagery. Nursing Plan of Care Nursing Diagnosis Statement_____Ineffective coping ______________________________________________ NANDA NURSING DIAGNOSTIC LABEL (Choose #1 priority problem for patient) RELATED FACTORS Secondary to a Disease or Condition DEFINING CHARACTERISTICS* (As evidenced by signs or symptoms) Ineffective coping Related to pain due to ineffective function Subjective: patient report of anxiety Objective: patient appears withdrawn PATIENT EXPECTED OUTCOMES/GOALS (Specific, Measurable, Achievable, Realistic, Timely) PLANNED NURSING INTERVENTIONS RATIONALE EVALUATION (Not Met, Partially Met or Met) In patient terms only, summarize response to intervention Patient Goal (may have several) Patient will learn two coping skills Your Intervention: Encourage family support Evaluation of Goal Goal met, patient was able to relax by listening to , and daughter was there to give a moral support Your Intervention: Administer antidepressant /antianxiety medication Your Intervention: Involve relaxation therapy Nursing Plan of Care Nursing Diagnosis Statement: Risk for ineffective peripheral tissue perfusion. NANDA NURSING DIAGNOSTIC LABEL (Choose #1 priority problem for patient) RELATED FACTORS Secondary to a Disease or Condition DEFINING CHARACTERISTICS* (As evidenced by signs or symptoms) Risk for ineffective peripheral tissue perfusion. Related to coagulating factors released by bone during surgery. Subjective: Objective: PATIENT EXPECTED OUTCOMES/GOALS (Specific, Measurable, Achievable, Realistic, Timely) PLANNED NURSING INTERVENTIONS RATIONALE EVALUATION (Not Met, Partially Met or Met) In patient terms only, summarize response to intervention Patient Goal (may have several) Prevent clotting Your Intervention: Give anticoagulant medication Evaluation of Goal Goal met, Your Intervention: Encourage ambulation Your Intervention: Give compression stockings Nursing Plan of Care Nursing Diagnosis Statement: Risk for fall _________________________________________________ NANDA NURSING DIAGNOSTIC LABEL (Choose #1 priority problem for patient) RELATED FACTORS Secondary to a Disease or Condition DEFINING CHARACTERISTICS* (As evidenced by signs or symptoms) Risk for fall Related to lower extremity weakness Subjective: Objective: PATIENT EXPECTED OUTCOMES/GOALS (Specific, Measurable, Achievable, Realistic, Timely) PLANNED NURSING INTERVENTIONS RATIONALE EVALUATION (Not Met, Partially Met or Met) In patient terms only, summarize response to intervention Patient Goal (may have several) Prevent patient from falling Your Intervention: Assist with ambulation Evaluation of Goal Met, patient was able to ambulate to bedside Commode. Your Intervention: Make sure bed is in low position with the rails at the top of the bed up Your Intervention: Involve physical therapy References for your entire clinical worksheet: Ruth F. Craven, Constance J. Hirnle, Sharon Jensen, (2013) Fundamental of nursing: human health and function, (7th Ed). Philadelphia, PA: Lippincott Williams Wilkins Inc. Gulianick, M. and Myers, J. (2003). Nursing Care Plans: Nursing Diagnosis and Interventions. Mosby: St Louis Pearson Education http://wps.prenhall.com/ Nursing Central (200-2014) Using web sources in writing, Retrieved from http://www.unboundmedicine.com/ Schedule: *Pt Care Summary; Med list; Pt schedule; task list 7am Visit with patient and getting report from night shift staff. 8am Perform vital signs 9am Giving medication 10am Assist with morning care, mouth care, assist with bath. 11am Head to toe Assessment 12pm Assist to bathroom, Accu-check. State1 personal learning goal for this clinical day: ________Be able to give IV push and make my patient more comfortable. _________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ Did you meet your personal goal for the day? _____________________________________________Goal Met, I was able to give IV push of 5% dextrose to my patient after noticing low level of glucose. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Checklist for Routine Bedside Nursing Assessment Mental/Neuro Status LOC Alertness/Orientation PERRLA Mood Behavior Check Patient ID Band Cardiopulmonary Heart Sounds Apical Rate/rhythm Lung sounds Breathing pattern Peripheral pulses Edema Capillary refill Hemodialysis Access – Graft/Fistula – bruit/thrill Oxygen Equipment Vital Signs BP P R Temp Pain SaO2 Gastrointestinal Bowel sounds Abdominal palpation Degree of ABD distension Bowel elimination problems (diarrhea/constipation/flatulence) Nausea/vomiting Genitourinary I O (quantity) Quality (color, clarity, burning) Continence/incontinence (Assistive devices) Reproductive problems/sexual concerns Motor Sensory Function ROM Paralysis Weakness_______________________________________________________________________________________________________________________________/Numbness/Tingling Assistive Devices Ambulation Wound Cleanliness Swelling/redness.infection Drainage Bandage dressing Integumentary Color Temp Turgor Moisture Integrity Braden Scale Score (Mon, Thurs: rescore at EUH) Invasive Tubes (IV’s, NGT, Wound drains, Catheters, etc..) Device and location IV Line(s): Fluids, Meds, Date of insertion/dressing/tubing Patency and position Redness, swelling, tenderness at site Drainage/Infusion rate Modified by Erin Poe Ferranti, 2005, 2007; Corrine Abraham, 2007 Adapted From: Elkin, Potter Perry (2004) Nursing Interventions Clinical Skills (3rd ed.) Mosby: St. Louis Medications MAR; MAR Summary: Medication Profile* Medication: Name/Dose/Route Time Classification Purpose Side Effects/Nursing Considerations OxyCODONE(10mg=1tab) 1 tablet PO 9:00 am Opioid analgesics Reduce pain Respiratory Depression May cause drowsiness Exenatide (10mcg injection) 1 each BID PRN Antidiabetics Lower blood sugar Pancreatitis, weakness Insulin aspart (BG > 150) (BG -100) /40= unit Antidiabetics Lower blood sugar Anaphylaxis, hypoglycemia Atorvastin (liptor) 20mg=1 tab, 1 tablet PO 9:00 am Antilipidemia Reduce Cholesterol level Chest pain, Rhabdomyolysis BuPRion 300mg=1tab 1tablet PO 9:00 am Antidepressant Treatment for depression Seizure, anxiety, dry mouth, depression ClonazePAM (0.5mg=1tab) 1mg=2tablets PO 9:00 am Anticonvulsant Prevention of seizure Fatigue, constipation, suicidal thought Docusate sodium (100mg=1cap) 1capsule PO 9:00 am laxative Prevent constipation Mild cramps, diarrhea, rashes Enoxaparin 30mg =0.3ml subq 9:00 am anticoagulant Blood thinner Constipation, urinary retention Levothyroxine (25mcg=1tab) 1tablet PO 7:00 am hormonal Treatment for hypothyroidism Tachycardia. Abdominal cramps Alprazolam (0.25mg=1tab) 9:00 am antianxiety Relief of anxiety Constipation, blurred vision Venlafaxine (75mg=1cap )150mg= 2capsule PRN Antidepressant antianxiety Decrease depression, anxiety and panic attack Chest pain, anorexia, itching, epistaxis Hydrocodone (10mg-1tab) 1tablet PO 9:00 am opioid Decrease pain Respiratory depression, apnea, anaphylaxis

Poverty and Child Development Essay -- essays research papers fc

From the very second I was born, until this very day, I had understood life to be a certain way. Life had taken its course and my family, as well as myself, have suffered ups and downs. We’ve been through times which were good and which were the worst of the worst – all families do. What I didn’t know is that regardless of the good and the bad, that the life I lived was sheltered to the point where I couldn’t fathom the idea that all people had not lived a life similar to ours. Sure, I understand that some were more fortunate and some were less fortunate, but to which extent? Within my circle of influence, our friends and family, there was a certain level at which we enjoyed our lives in a comfortable sense. We’d occasionally see a homeless person on the subway or in the city, but I never knew that there was a whole class of people in between. I’ve always heard of poverty and didn’t know much more about it except for the fact that peo ple existed that were less fortunate, those who lived in this supposed poverty.   Ã‚  Ã‚  Ã‚  Ã‚  Jonathan Kozol’s book â€Å"Amazing Grace† depicts the issues that face families who are living in a world of poverty, homelessness and in a world where less fortunate is an understatement. Kozol writes about his experience in the South Bronx where he comes across some of the most disturbing facts about our fellow human beings. He speaks of families who live in an undernourished, impoverished society where a great majority of the inhabitants have been faced with disease. He visited a building in which one particular family has contracted the HIV virus. A woman contracted AIDS from her husband who she thought was faithful. Her daughter later contracted the deadly virus when she was raped by the father. In fact, in his conversation with a nurse who takes care of Alice Washington, a woman that Kozol interviews, in this building there are â€Å"Including the children, maybe 27 people† (Kozol p. 13, in Amazing Grace) She continues to say â€Å"The re’s lots of other people have it but don’t know.† People are so under-educated and under-privileged in the society where they live, that they are afraid to even find out if they have contracted the disease. This brings us to another problem that the families here are faced with, deprivation of help from the government.   Ã‚  Ã‚  Ã‚  Ã‚  Although Jonathan Kozol implies that there may... ... problems with women who have children out-of-wedlock. Although she defends the fact that they shouldn’t be judged as a whole because of that fact, it seems to me that she feels strongly about traditional family settings including a two parent, heterosexual household. Sidel also comes across as someone who has a hint of religion in her values. Personally, I agree more with the liberal standpoint. I feel that all people should be equal, especially since we’re all citizens of the same city, nation, and world. I believe we should have the same opportunities, almost as much as I believe that those who want to achieve something in live – will take the initiative and shape their destiny to reach their goals. Bibliography Kozol, Jonathan. Amazing Grace. NewYork: Crown, 1995. 1-24. Kozol, Jonathan. Amazing Grace. NewYork: Crown, 1995. 27-54. Sidel, Ruth. â€Å"The Enemy Within† Keeping Women And Children Last. NewYork:   Ã‚  Ã‚  Ã‚  Ã‚  Penguin, 1998. 1-32. Surgrue, J. Thomas. â€Å"Poor Families in an Era of Urban Transformation.† American   Ã‚  Ã‚  Ã‚  Ã‚  Families. Stephanie Coontz, Maya Parson, Gabrielle Railey, Routledge, 1999.   Ã‚  Ã‚  Ã‚  Ã‚  243-257.

Resilience

Resilience No matter how old, or young you are there Is no doubt that life has had a tough and rigorous grip on you. It could have been so rough that you think that there Is no way to recover. But you seem to always recover In time. This Is the meaning of human resilience. It Is the ablllty to be knocked down by life but picked back up and become stronger by yourself. The way you become stronger Is not only based off of yourself (internal sources) but by your environment (external sources). With these sources you can become resilient to life and always become stronger!To be resilient means, â€Å"the power or ability to return to the original form, position, etc. , after being bent, compressed, or stretched; elasticity. † (The Free Dictionary). This definition would be for the non-living. Just like a tree being blown in the wind it will bend all it can but as soon as the wind stops it will regain Its normal posture. This is what we humans do too! We all take pressure from life , whether it's good or bad, we will become stressed or hurt (bent like the tree). As soon as that pressure goes away we can recover to our normal being.The oak fought the wind and was broken, the willow bent when It must and survived. † (Robert Jordan, The Fires of Heaven). Just Ilke this willow tree, we must bend when life takes Its toll on us. Humans have the ablllty to recover, so we must use it often to survive life's rough times. Overall the meaning of human resilience is the ability to recover quickly when we are being bent from life's everyday pressures. Human resilience comes from internal and external sources. The external source is the environment that you are in. I say it is the environment because environments ive you more options to be able to be resilient.Here is an example. If you live in a small rundown town In Virginia, which has basically no companies or industries thriving In the area, compared to New York City. New York City is a place full of opportunities to become resilient because there Is so many companies and Industries that are growing, so you will have a much greater chance to recover from something if you would live in New York City just like Jeannette Walls. The main idea is that if you are becoming resilient it would be easier in the right environment, with he right opportunities just like in the Glass Castle.The most important source is the internal source, which is our mind and soul. Without our mind and soul we would have no self-motivation, and without self- motivation we cannot be resilient. â€Å"No matter how much falls on us, we keep plowing ahead. That's the only way to keep the roads clear. † (Greg Kincacid) This quote is perfect because it shows self-motivation! Without it you cannot keep plowing ahead. Everyone who Is resilient has self-motivation, Just Ilke Jeannette Walls when she was otivated to leave Vlrglnla and to move to New York.

Gender in Bram Stokers Dracula Essay - 2700 Words

Gender in Bram Stokers Dracula During the Victorian Era, women struggled to attain gender equality by challenging the traditional roles that defined them. These women no longer wanted to remain passive and obey the demands of their husbands nor be domestic and the caretakers of their children. They strived to attain the role of a New Woman, an intelligent, liberated individual who was able to openly express her ideas (Eltis 452). Whereas some women were successful in attaining this new role, others were still dominated by their male counterparts. The men felt threatened by the rising power of women and repressed them by not allowing them to work, giving them unnecessary medications, and diagnosing them with hysteria (Gilman†¦show more content†¦(Stoker 80). Lucy wants to be free from societal marriage constraints and pursue all the men; however, societal constraints decide that she can only be with one man, Arthur Holmwood. She writes to Mina, ?You and I, Mina dear, who are engaged and are going to settle down soon soberly in to old married women? (Stoker 78). Lucy follows the collective belief that marriage institutes settling down with one man. Whereas Lucy portrays the ?New Woman? with her sexual tendencies and flirtatiousness, Mina represents the ?New Woman? through her intelligence. She is an assistant schoolmistress, knows how to write in shorthand, and shows interest in learning how to use the phonograph, one of the new technologies of the time. She says, ?I shall try to do what I see lady journalists do: interviewing and writing descriptions and trying to remember conversations?with a little practice, one can remember all that goes on or that one hears said during one day? (Stoker 76). Mina is trying to learn a trade, and reverse the male ideology that only men can have jobs. Furthermore, like Lucy, Mina is also loyal to one man, Jonathan Harker. Mina wants to marry Jonathan and settle down. She writes to Lucy, When we are married I shall be able to be useful to Jonathan, and if I can stenograph well enough I can take down what he wants to say in this way and write it out for him on the typewriter (Stoker 75). In this example,Show MoreRelatedDracula, By Bram Stoker1291 Words   |  6 Pages ​Bram Stoker, author of Dracula, not only creates the early depiction of vampire stories; but writes more to contradict the age old beliefs of women and their role in society. Dracula is more that just a vampire story. There is a deeper level to this. A level in which it can incite change in the way one percieves women. There is a noition that all women were to be the same but Dracula refutes that. 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