Nursing Care Plan

 


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Medical Diagnoses:  Arthritis, Chronic Pain, End Stage Renal Disease, Osteoporosis


Assessment

Nursing DX/Clinical Problem

Client Goals/Desired Outcomes/Objectives

Nursing Interventions/Actions/Orders and Rationale

*I

Evaluation

Goals

Interventions

Subjective

         

         

Pain

      

         

         

Objective:

         

N/A


Problem

      

      

Chronic Pain

      

 

Long Term:

Client will function on acceptable ability level with minimal interference from pain and medication side effects two months.

Tell the client to report pain location, intensity and quality when experiencing pain.  Assess and document the intensity of the pain with each new report of pain and at regular intervals.   Systematic ongoing assessment and documentation provide the direction for pain treatment plans ; adjustments are based on the client’s response.

N/A

Not enough time has lapsed to evaluate

Not enough time has lapsed to evaluate

R/T

      

      

Progression of joint deterioration, injury, surgical procedure, and chronic kidney disease

      

      

      

      

Short Term:

         

Use pain rating scale to identify current level of pain intensity, and determine comfort/function goal.

Ask the client to describe past and current experiences with pain and the effectiveness of the methods used to manage the pain, including experiences with side effects, typical coping responses and the way the client expresses pain.  A study revealed that barriers can affect a client’s willingness to report pain and use analgesics.  Many harbored fears and misconceptions regarding the use of analgesics, management of side effects and risk of addiction.

N/A

      

      

AEB

      

as evidenced by patient self report of pain level.

      

      

      

      

      

      

      

*I = Implementation.  Check those interventions/actions/orders that were implemented


 
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Describe pathophysiology of primary illnesses: 

Osteoarthritis:  There is degeneration of cartilage between two bones and a joint.  Cartilage covers the area of articulation normally, in osteoarthritis it degenerates and eventually leads to bone rubbing on bone…a very painful condition.  In addition, there are osteophytes…areas of excess bone that are created, leading to really big joints.  This can cause malalignment (leading to more pain and chronic problems/pain in the hip, back).  The pain created by this condition can stem from several products of this disease process.  Increased pressure within the subchondral bone can cause pain, thickening of the joint capsule and the formation of osteophytes can cause pain, as well as inflammation of the synovium.


         

Medications

Name/Dose

Why does resident receive?

Major Side Effects

Nursing Implications

         

Lorazepam 0.25 mg, every 8 hours, PRN.

         

         

Anxiety

Anterograde amnesia, drowsiness, sedation, dizziness, weakness, unsteadiness, disorientation, depression, sleep disturbances, restlessness, confusion, and hallucinations

Supervise ambulation of older patients for at least 8 hours after administration to prevent falling and injury.

         

Premarin-0.625 mg/1 gm cream

         

         

Vaginal dryness, itching and burning

Vaginal discomfort or pain, itching, breast pain, vaginitis

Monitor for and report any vaginal bleeding, assess for relief of symptoms

         

Metoprolol XL 25 mg once daily

         

         

Hypertension

Erythematous rash, fever, headache, muscle aches, sore throat, laryngospasm, respiratory distress, dizziness, bradycardia, fatigue, insomnia, mental depression, Raynaud’s phenomena, nausea, heartburn, dry mouth and mucous membranes, hypoglycemia, SOA

Take apical pulse and BP prior to administration, report significant changes, monitor I&O, daily weight, auscultate daily for pulmonary rales, withdraw drug if patient exhibit mental depression, can progress into catatonia. 

         

Acetaminophen

-500 mg PRN q 4

         

Pain


Neglible with recommended dosage, rash

Monitor for s/s of hepatotoxicity.

Maalox 30 mL q6 PRN

         

GERD

Chalky taste, constipation, diarrhea, increases thirst, stomach cramps

Monitor for s/s of allergy, monitor bowel elimination

Hydrocodone 5/500 PRN q6, not to exceed 4 gm per 24 hours

Pain

Dry mouth, constipation, nausea, vomiting, light-headedness, sedation, dizziness, drowsiness, euphoria, dysphoria

Monitor for effectiveness of pan relief, monitor for n/v, especially in ambulatory patients, monitor respiratory status and bowel elimination

Senna 8.6 mg

Constipation

Strong cramping and griping pains in the abdomen, electrolyte imbalance (loss of potassium) and loss of body fluids, nausea, rash, swelling of the fingertips, weight loss, and dark pigmentation in the colon

Monitor for effectiveness of bowel relief, monitor for electrolyte imbalances, monitor for n/v, monitor for rash

Furosemide 10 mg

Hypertension/Renal Failure

Hypotension, dizziness with excessive diuresis, hypovolemia, dehydration, hyponatremia, hyperglycemia, anemia

Monitor BP during periods of diuresis, monitor I&O ratio and pattern, monitor for dehydration and hypovolemia, monitor glucose, monitor for electrolyte imbalances

Ferrous Sulfate 325 mg

Anemia

Nausea, heartburn, anorexia, constipation, diarrhea, epigastric pain, abdominal distress, black stools.

Monitor HgB and reticulocytevalues during therapy.  Monitor bowel movements.

Ibuprofen  400 mg

Pain

Headache, dizziness, light- headedness, anxiety, emotional lability, fatigue, drowsiness, confusion, depression, aseptic meningitis, dry mouth, GERD, v/n/d, acute renal failure, GI bleeding

Monitor for effectiveness, periodic Hgb, renal and hepatic function and auditory and ophthalmic examinations.  Monitor for GI distress and S/s of GI bleeding.

Calcium Carbonate

Indigestion/hyperphosphatemia

Constipation or laxative effect, acid rebound, n/v, flatulence

Monitor for bowel functio, determine serum and urine calcium, observe for s/s of hypercalcemia

         



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