Upload
nolan-cabral
View
231
Download
1
Tags:
Embed Size (px)
DESCRIPTION
Plueral Effusion
Citation preview
Trinity University of AsiaSt. Luke’s College of
NursingE. Rodriguez Sr. Avenue, Cathedral Heights,
Quezon City, Philippines
Case 29-2015: A 38-Year-Old Pregnant Woman with Headache and Visual Symptoms
A Case Study
Presented to Mr. Dennis Abellera
Submitted by:
Group 3 – 4NU01
CABRAL, Nolan B.
CAMPOS, Angela A.
CARABIO, Jesica Vanesa N.
FINDLEY, John Paul E.
October 9, 2015
II. Patient’s Profile
A. DEMOGRAPHIC DATA
Name: N/A
Address: N/A
Age: 38 years old
Gender: Female
Date and Time of Admission: N/A
Diagnosis: Embolic Stroke 2° Loffler’s Endocarditis
B. Chief Complaint:
Sudden panic attack followed by narrowing of vision
C. Present History of Illness:
Eleven days priror to admission, patient was rushed to emergency department and the
labor and delivery unit because of neck and pain, occipital headache, vomiting and
elevated temperature of 38.9°c. Urinalysis was done and revealed traces of ketones, 1+
albumin and 2+ urobilimogen. Patient vital signs were normal and patient was
discharged home. On the day of admission, the patient felt onset of panic attacked
followed by tunnel vision. Patient began to hyperventilate and her vision went black
from the periphery to the center. The symptoms lasted about 2 minutes and followed
by spots in her visual fields, headache, neck pain that radiated to her arms, nausea and
dizziness.
D. Past Medical History:
At 17 years old, the patient had presented 20 weeks of gestation with sepsis and still
born fetus. Patient also had a history of anemia, bipolar disorder, panic attakces related
to syncope, chronic pelvic pain, ovarian cysts, asthma and seasonal allergic rhinitis
E. Family History of Illness
Patient’s mother had breast cancer and died at her 50’s
F. Social History
Patient does not smoke, drink alcohol or use recreational and illicit drugs.
G. Allergies
Patient allergic to:
Loperamide
Morphine
Meperidine hydrochloride
Contrast material
H. Physical Assessment
Upon assessment patient’s back was tender, her abdomen was gravid, soft and non-
tender with active fetal movements.
IV. LABORATORY PROCEDURES
Abnormal Results
Lower than normal range
Hematocrito Insufficient fluid intake and possible DM or bleeding
Hemoglobino Insufficient iron intake or bleeding
Lymphocytes
o Chronic infection Monocytes
o Chronic infection HDL
o Unhealthy diet Functional Protein S
o Risk for clotting disorder/thrombus and embolus Free protein S antigen
o Risk for clotting disorder/thrombus and embolusElevated Lab Results
Eosinophilso Parasitic infection
Alkaline Phosphataseo Liver damage
Aspartate aminotransferaseo Liver damage
Lactate dehydrogenaseo Suggests myocardial damage
C-reactive proteino Indicative of infection
Fibrinogeno Risk for thrombus/embolus
Triglycerideso Not enough exercise/unhealthy diet
Cholesterolo Not enough exercise/unhealthy diet
Cardiac Risk Ratioo Risk for cardiac problems such as stroke
Medical Diagnostics Done
Urinalysis CBC Glucose-tolerance test MRI
Transthoracic echocardiogram
Bone Marrow Biopsy
Management
- Urinalysis- Urine culture- Ultrasonography of legs- Neurologic examinations- Mri of the head- Magnetic resonance angiograohy and venography- ECG- Holter monitoring- Lumbar puncture- Blood tests- Ophthalmology consulted- Ultrasound examinations done- Tissue Doppler echocardiography done- Hepatitis screening- Thranthoracic echocardiography- ELISA test done- Serologic tests- Bone marrow biopsy and stool examination
VIII. DRUG STUDY
NAME ACTION INDICATION & CONTRAINDICATION
SIDE EFFECTS & ADVERSE
EFFECTS
NURSING CONSIDERATIONS
GENERIC NAME:
Hydromorphone
BRAND NAME:
Dilaudid
Classifications: NARCOTIC ANALGESIC ANTITUSSIVE
Potent opiate receptor agonist that does not alter pain threshold but changes the perception of pain in the CNS. An effective narcotic anal- gesic that controls mild to moderate pain. Also has antitussive properties.
INDICATION:
Relief of moderate to severe pain.
CONTRAINDICATION:
Intolerance to opiate agonists;; acute or severe asthma; hypercapnia; bronchial asthma. analgesia; upper airway obstruction, GI obstruction; ilieus; severe respiratory depression;
ADVERSE EFFECTS
GI: Nausea, vomiting, constipation.
CNS: Euphoria, dizziness, sedation, drowsiness.
CV: Hypotension, bradycardia or tachycardia.
Respiratory: Respiratory depression.
Note baseline respiratory rate, rhythm, and depth and size of pupils before administration. Respirations of 12/min or less and mitosis are signs of toxicity. Withhold drug and promptly notify doctor.
Monitor vital signs at regular in- tervals. Drug-induced respiratory depression may occur even with small doses and increases progressively with higher doses.
Assess effectiveness of pain relief 30 min after medication administration.
Assess effectiveness of cough. Drug depresses cough and sigh reflexes and may induce atelectasis, especially in postoperative patients and those with pulmonary disease.
NAME ACTION INDICATION & CONTRAINDICATION
SIDE EFFECTS & ADVERSE
EFFECTS
NURSING CONSIDERATIONS
GENERIC NAME:
Prochlorperazine
BRAND NAME:
Compazin
CLASSIFICATION:
ANTIPSYCHOTIC, ANTIEMETIC
Strong antipsychotic effects thought to be due to blockade of postsyn-aptic dopamine receptors in the brain. Antiemetic effect is produced by suppression of the chemore- ceptor trigger zone (CTZ). Effec tive antipsychotic and antiemetic properties.
INDICATIONS:
Management of manifestations of psychotic disorders, of excessive anxiety, tension, and agitation, and to control severe nausea and vomiting.
CONTRAINDICATIONS:
Hyper- sensitivity to phenothiazines; bone marrow depression; blood dyscrasias, jaundice; comatose or severely depressed states; dementia-related psychosis in elderly; children weigh- ing less than 9 kg (20 lb) or younger than 2 y of age; pediatric surgery; short-term vomiting in children or vomiting of unknown etiology; Reye’s syndrome or other enceph lopathies; history of dyskineticreac-
Drowsiness, dizziness, extrapyramidal reactions (akathisia, ystonia, or parkinsonism), persistent tardive dyskinesia, acute catatonia.
CV: Hypotension. GI: Cholestatic jaundice.
Skin: Contact dermatitis, photosensitivity. Endocrine: Galactorrhea, amenorrhea.
Special Senses: Blurred vision.
Position carefully to prevent aspiration of vomitus; may have depressed cough reflex.
Keep in mind that the antiemetic effect may mask toxicity of other drugs or make it difficult to diag- nose conditions with a primary symptom of nausea.
Note signs of increasing of patient’s temperature: Red, dry, hot skin; full bounding pulse; dilated pupils; dyspnea; confusion; temperature over 40.6° C (105° F); elevated BP. Exposure to high environ- mental temperature places this patient at risk for heat stroke.
Monitorlabtests:PeriodicCBCwith differential in long-term therapy.
tions or epilepsy
NAME ACTION INDICATION & CONTRAINDICAT
ION
SIDE EFFECTS & ADVERSE EFFECTS
NURSING CONSIDERATIONS
GENERIC NAME:
Cyclobenzaprine
BRAND NAME:
Amrix
Relieves skeletal muscle spasm of local origin without interfering with muscle function. Believed to act primarily within CNS at brain stem. Depresses tonic somatic mo-
INDICATION: Short-term adjunct to rest and physical therapy for relief of muscle spasm associated with acute musculoskeletal condi tions. Not effective in treatment of spasticity associated with cer- ebral palsy or cerebral
Body as a Whole: Edema of tongue and face, sweating, myalgia, hepatitis, alopecia. Shares toxic potential of tricyclic antidepressants.
CV: Tachycardia, syncope, palpitation, vasodilation, chest pain, orthostatic hypotension, dyspnea; with high doses, possibility of
o Supervision of ambulation may be indicated, especially in the older adult because of risk of drowsiness and dizziness.
o Stop drug if signs of hypersensitivity (e.g., pruritus, urticaria, rash) appear.
CLASSIFICATION:
CENTRAL ACTING SKELETAL MUSCLE RELAXANT, ANTI SPASMODIC
tor activity, although both gamma and alpha motor neurons are af fected. Relieves muscle spasm asso ciated with acute, painful musculo-skeletal conditions.
or cord disease.
CONTRAINDICATION: Acute recovery phase of MI, cardiac arrhythmias, heart block or conduction disturbances, QT prolongation; CHF, hyperthyroidism; closed- angle glaucoma, increased intrao ular pressure; moderate or severe hepatic impairment; MAOI ther
severe arrhythmias.
GI: Dry mouth, indigestion, unpleasant taste, coated tongue, tongue discoloration, vomiting, anorexia, abdominal pain, flatulence, diarrhea, paralytic ileus.
CNS: Drowsiness, dizziness, weakness, fatigue, asthenia, paresthesias,
Skin: Pruritus, urticaria, skin rash.
Urogenital: Increased or decreased libido, impotence.
o Dry mouth may be relieved by in- creasing total fluid intake (if not contraindicated).
NAME ACTION INDICATION & CONTRAINDICATION
SIDE EFFECTS & ADVERSE EFFECTS
NURSING CONSIDERATIONS
GENERIC NAME:
Diphenhydramine
BRAND NAME:
Benadryl
CLASSIFICATION:
Centrally Acting Cholinergic Antagonist; Antihistamine
Diphenhydramine competes for H1- receptor sites on effector cells, thus blocking histamine release. Effects in parkinsonism and drug-induced extrapyramidal symptoms are apparently related to its ability to suppress central cholinergic activity and to prolong action of dopa- mine by inhibiting its reuptake and storage. Has antihistamine, anti- vertigo, antiemetic, antianaphylactic, antitussive, antidyskinetic, and sedative-hypnotic effects.
INDICATION:
Temporary symptomatic relief of various allergic conditions and to treat or prevent motion sickness, vertigo, and reactions to blood or plasma in susceptible patients. Also used in anaphylaxis as adjunct to epinephrine and other standard measures after acute symptoms have been controlled; in treatment of parkinsonism and drug-induced extrapyramidal reactions; as a nonnarcotic cough suppressant; as a sedative-hypnotic; and for treatment of intractable insomnia.
CONDRAINDICATION:
Hyper- sensitivity to antihistamines of similar structure; lower respiratory tract symptoms (including acute asthma); narrow-angle glaucoma; prostatic hy- pertrophy, bladder neck obstruction; GI obstruction
CNS: Drowsiness, dizziness, headache, fatigue, disturbed coordination, tingling, heaviness and weakness of hands, tremors, euphoria, nervousness, restlessness, insomnia; confusion: Excitement, fever.
CV: Palpitation, tachycardia, mild hypotension or hypertension, cardiovascular collapse.
Special Senses: Tinnitus, vertigo, dry nose, throat, nasal stuffiness; blurred vision, diplopia, photosensitivity, dry eyes.
GI: Dry mouth, nausea, epigastric distress, anorexia, vomiting,
Monitor cardiovascular status especially with preexisting cardio- vascular disease.
Monitor for adverse effects especially in children and the older adult.
Supervise ambulation and institute falls precautions as necessary. Drowsiness is most prominent during the first few days of therapy and often disappears with continued therapy. Older adults are especially likely to manifest dizziness, sedation, and hypotension.
or stenosis; constipation, or diarrhea.
Urogenital: Urinary frequency or retention, dysuria.
Respiratory: Thick- ened bronchial secretions, wheezing,
NAME ACTION INDICATION & CONTRAINDICATIO
N
SIDE EFFECTS & ADVERSE EFFECTS
NURSING CONSIDERATIONS
GENERIC NAME:
Oxycodone
BRAND NAME:
Oxycontin
Semisynthetic derivative of an opi- um agonist that binds with stereo- specific receptors in various sites of CNS to alter both perception of pain and emotional
INDICATION:
Relief of moderate to mod- erately severe pain, neuralgia. Re- lieves postoperative, postextractional, postpartum pain.
CNS: Euphoria, dysphoria, lightheaded- ness, dizziness, sedation. GI: An- orexia, nausea, vomiting, consti- pation, jaundice, hepatotoxicity (combinations containing acetami- nophen). Respiratory: Shortness of
o Monitor respiratory status. With- hold drug and notify prescriber if respiratory depression occurs.
o Monitorpatientsresponseclosely, especially to sustained-release preparations.
o Consultprescriberifnauseacontinues after first few days of
response to pain. Active against moderate to moder- ately severe pain. Appears to be more effective in relief of acute than long-standing pain.
CONTRAINDICATION:
Hyper- sensitivity to oxycodone and prin- ciple drugs with which it is com- bined; bronchial asthma
breath, respiratory depression. Skin: Pruritus, skin rash. CV: Brady- cardia. Body as a Whole: Unusual bleeding or bruising. Urogenital: Dysuria, frequency of urination, urinary retention.
therapy.o Note: Light-headedness,
dizzi-ness, sedation, or fainting appear to be more prominent in ambulatory than in non ambulatory patients and may be alleviated if patient lies down.
o Evaluatepatient’s continuedneed for oxycodone preparations. Psychic and physical dependence and tolerance may develop with repeated use. The potential for drug abuse is high.
o Beawarethatseriousoverdosage of any oxycodone preparation presents problems associated with a narcotic overdose (respira- tory depression, circulatory col- lapse, extreme somnolence progressing to stupor or coma).
Nursing Care Plan:
Assessment Diagnosis Planning Intervention Rationale Evaluation
Objective:
Gimacing of the face
rapid breathing
Subjective:
-verbalized high levels of pain (7/10)
-verbalization of increased pain with movement
Acute back pain related to increased weight
Short Term:Reduce pain level of patient to level of 5 within 1 hour of nursing interventions
Long Term:
Educate patient with health teaching regarding generalized pain and more specifically how to deal with back pain within stay at hospital
Monitored patient for changes in pain level
Limited physical activity and encouraged bed rest
Monitored vital signs, with emphasis on blood pressure
Any neurological changes or exacerbations should be controlled as much as possible and can be indicative of a worsening condition
Excessive physical activity may exacerbate symptoms of pain
Vital Signs provide an objective overall measurement of the
Goal Met
Encouraged deep breathing exercises
Encouraged techniques in diversion of focus
Increased fluid intake
patient’s status. Blood pressure can be used as an objective gauge of patient’s pain
Deep beathing exercises can help lower pain levels and provide a distraction to the pain
Other diversion methods may be used to take patient’s focus away from the pain
Increased fluids can promote
Dependent
Administered oxygen as prescribed
Administered medications as prescribed
proper blood flow and can help decrease pain
Oxygen may be necessary to help counteract alterations in breathing due to pain
Medications may be necessary for palliative care
Assessment Diagnosis Planning Intervention Rationale Evaluation
Objective:
Gimacing of the face
rapid breathing
Guarding of head
Subjective:
-verbalized high levels of pain (9/10)
-verbalization of increased pain in lighted areas and excess noise
Acute pain related to headache
Short Term:Reduce pain level of patient to level of 6 within 1 hour of nursing interventions
Long Term:
Educate patient with health teaching regarding generalized pain and more specifically headaches within stay at hospital
Monitored patient for neurological changes
Monitored vital signs, with emphasis on blood pressure
Monitored input and output
Any neurological changes or exacerbations should be controlled as much as possible and can be indicative of a worsening condition
Vital Signs provide an objective overall measurement of the patient’s status. Blood pressure can be used as an objective gauge of patient’s pain
Ineffective
Goal Met
Encouraged deep breathing exercises
Encouraged techniques in diversion of focus
Increased fluid intake
Dependent
Administered
input and output can cause lots of pain and overall problems that can lead to pain
Deep beathing exercises can help lower pain levels and provide a distraction to the pain
Other diversion methods may be used to take patient’s focus away from the pain
Increased fluids can promote
oxygen as prescribed
Administered medications as prescribed
proper blood flow and can help decrease pain
Oxygen may be necessary to help alleviate headache
Medications may be necessary for palliative care
Assessment Diagnosis Planning Intervention Rationale Evaluation
Objective:
Hematocrit: 33.3
Hemoglobin: 10.6
Eosinophils: 33
Subjective:
Verbalized feelings of dizziness, changes in visual sensation and headache
Disturbed sensory perception (visual) related to changes in functioning of organs secondary to parasitic infection
Short Term:
Provide environment that limits the chance of fall within 45 minutes of admission
Long Term:
Health teaching regarding how to limit the chances of reoccurrence of symptoms.
Independent
Monitored vital signs, especially BP
Raised side rails
Provided quiet, peaceful environment
Limited
Vital signs help the health team by giving objective means of assessing the state of the patient
Side rails need to be raised in order to prevent the patient from falls
Quiet and peaceful environments will limit the amount of presenting symptoms and provide a healing atmosphere
Physical
Goal Met.
physical activity
Increased
fluid intake
Limited contract with visitors
Dependent
Provide assistive aids as prescribed
exertion may exacerbate symptoms and lead to further injury
Increased fluid intake will encourage proper blood flow and help prevent further incidences
Excessive visitors can exacerbate symptoms
Assistive aids, such as slip resistant socks and a room with extra side rails may be
Administer medications as prescribed
needed to help prevent further injury to the patient
Medications may be needed to provide palliative care
Assessment Diagnosis Planning Intervention Rationale Evaluation
Objective:
Hematocrit: 33.3
Hemoglobin: 10.6
Subjective:
Verbalized feelings of vertigo, diplopia and floaters
Risk for fall related to changed in visual perception
Short Term
Provide safe environment that helps to prevent falls within 45 minutes of nursing intervention
Long Term:
Prevent any fall incidents during stay in hospital
Limited amount of activity
Raised the side rails
Provided quiet peaceful environment
Increased fluid intake
Limited amount of
Excessive walking can lead to fall with an abnormal state of vision
Raised side rails will protect the patient from falling out of bed
A peaceful environment may help the patient heal faster
Increased fluid intake can promote better blood flow
Excessive visitors may
Goal Met
visitors
Dependent
Administered medications as prescribed
exacerbate symptoms and prevent optimum healing environment
Medications may be necessary to provide palliative care
Assessment Diagnosis Planning Intervention Rationale Evaluation
Objective:
Hemoglobin: 10.6
Risk for bleed related to reduced iron intake and anemia
Short Term:
Provide safe environment to prevent any bleeding episodes within 45 minutes of nursing intervention
Long Term:
Prevent any bleed from occurring during stay in hospital
Avoid contact with sharp objects
Provide extra padding for corners and other areas that may cause bleeding
Increase amount of protein and other iron rich foods
Dependent
Administer medications as prescribed
Administer oxygen as prescribed
Sharp objects can break the skin and cause bleeds
Corners are very common causes of injury, especially is patients who are sensory impaired
Increased iron intake will facilitate the body with the requirements to increase hemoglobin
Decreased hemoglobin can lead to low O2 saturation and oxygen may
Goal partially met
be needed to counteract the side effects of insufficient iron