Nursing Case Analysis-AVF

8/2/2019 Nursing Case Analysis-AVF

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Nursing Case Analysis:

Laparoscopic Cholecystectomy

Submitted by:

Jed Mikhail Tabangcura RLE 3-9.


2/19

I. Assessment

I. Demographic Profile

Clients Initials: SVE

Age: 56 y/o

Address:Purok 2 Barangay Mercedes,Camarines norte

Religion: Roman Catholic

Civil Status: Widowed

Nationality: Filipino

Date of Birth: July 4,1955

Place of Birth: Daet, Camarines Sur


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History

Family History:

(+) Hypertension- Mother

(+) Allergy to sea foods siblings

(-) DM,CVD,Asthma,Cancer,Thyroid Disease

Medical History:

1 month PTA patient complained of non-radiating epigastric pain

relieved by food intake.. Admitted for 3 days at a local hospital. 2 weeks

PTA- (+) vomiting for 5 hours of previously ingested food. Was admitted for

3 days UTZ- cholelithiasis. Was advised surgery. Opted for a second

opinion in our institution,was advised surgery. Hence,admission.


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II. Anatomy and Physiology

Gallbladder- The gallbladder is a small pear-

shaped organ that lies near the liver. The

function of the gallbladder is to store bile and

concentrate. Bile is a digestive liquid

continually secreted by the liver. The bile

emulsifies fats and neutralizes acids in partly

digested food. A muscular valve in thecommon bile duct opens, and the bile flows

from the gallbladder into the cystic duct, along

the common bile duct, and into the


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III.Pathophysiology

Steal Syndrome-Clinical conditon caused by

arterial insufficiency distal to a hemodialysis

AV fistula or graft due to the diversion of

blood into the fistula or graft.


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Creation of arterio-venous

fistula

Backflow of blood from artery

to vein due to low flow

resistance of vein

Arterial insufficiency

Decrease in tissue perfusion in

the distal extremities

Weakness and loss of

function of limb

Pain and tenderness due to

tissue ischemia

Pallor of the extremity due

to poor blood flow


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IV. OR Procedure

AVF Ligation- An arterio-venous fistula is aconnection or passageway between an artery and

a vein. It may be congenital, surgically created

for hemodialysis treatments, or acquired due

to pathologic process, such as trauma or erosion of

an arterial aneurysm. Ligation of AVF is performed to

stop the blood flow through the fistula.


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Procedure-The patient was brought to the operating

room and placed on the operating room table

in supine position .

-The whole body was draped with only the left

arm exposed. The arm was then prepared by

Glutacept spray to the entire forearm

-The area overlying the proximal portion of

the fistula was infiltrated with 2% lidocaine.

-A transverse incision was then made

overlying the fistula. Following this,the

proximal outflow tract of the fistula was

encircled. This was then ligated with Silk 4.0

ties.

-The flow in the fistula was thus

stopped. Hemostasis was inspected and

found obtained. The wound was closed in two

layers with Silk 4.0 sutures.


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V. Drug analysis

Generic name Brand name Action Rationale NursingIntervention

Amlodipine Norvasc acts by relaxing

the smooth

muscle in

the arterial

wall,

decreasing tota

l peripheral

resistance and

hence

reducing bloodpressure; in

angina it

increases blood

flow to

the heart

muscle.

is a long-

acting calcium

channel

blocker used as

an anti-

hypertensive a

nd in the

treatment

of angina.

Take BP before

giving.

Give only if BP

is not below

120/80

Report

shortness of

breath,palpitations,

irregular

heartbeat,

nausea, or

constipation to

physician.


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Saxagliptin Onglyza slows down the

breakdown of

incretin

hormones,

including

increasing

insulin

production in

response to

meals anddecreasing the

amount of

glucose that

the liver

produces.

Blood sugar

reduction and

control for DM

type 2

Instruct

patient to take

saxagliptin as

directed. Take

missed doses

as soon as

remembered,

unless it is

almost time for

next dose; donot double

doses.


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Atovorstatin Lipitor used to

lower cholester

ol levels by

inhibiting the

enzyme HMG-

CoA reductase,

which plays a

central role in

the production

of cholesterolin the liver.

for the

treatment

of dyslipidemia

and the

prevention

of cardiovascul

ar disease

Administer

drug without

regard to food

but at the

same time

each day

Monitor for

concurrent

alcohol use.(Alcohol may

affect liver

function.)


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Isosorbide

mononitrate

Imdur acts by dilating

the blood

vessels so as to

reduce

the blood

pressure

used principally

in the

treatment

of angina

pectoris

Give oral

preparations

on empty

stomach,1 hr

before or 2 hrs

after meals

Create a

nitrate free

period tominimize

tolerance


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Pregabalin Lyrica binds to

calcium

channels on

nerves and

may modify the

release of

neurotransmitt

ers .Reducing

communication

betweennerves may

contribute to

its effect on

pain and

seizures.

an anticonvulsa

nt drug used

for neuropathic

pain

Pregabalin

therapy should

be stopped

gradually over

at least 1 week

to decrease

risk of seizure

activity and

avoid

unpleasantsymptoms such

as diarrhea,

headache,

insomnia, and

nausea.


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Celecoxib Celebrex Analgesic and

anti-

inflammatory

activities

related to

inhibition of

Cox-2 enzyme

Management

of pain and

inflammation

in the surgical

site

Assess patient

for allergy to

sulfonamides,

aspirin, or

NSAIDS.

Patients with

these allergies

should not

receive

celecoxib.

May be

administered

without regard

to meals.


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Advise patient

to notify health

care

professional

promptly if

signs or

symptoms of GI

toxicity

(abdominal

pain, blackstools), skin

rash,

unexplained

weight gain,

edema occurs.


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Co-amoxiclav Augmentin destroys

bacteria by

disrupting their

ability to form

cell walls.

Prophylactic

antibiotic

If the patient

develops a

rash, wheezing,

itching, fever or

swelling in the

joints, this

could indicate

an allergy and

should be

reported.- Patients must

ensure they

take the full

course of the

medicine.

- The medicinemust be taken


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Documents

Nursing Case Analysis-AVF