Jennifer Lopez is a 25-year-old female patient G1P0 who is currently 39 3/7 weeks gestation. She is admitted to the hospital to be induced for being post-date. She is positive for Group Beta streptococcus and receiving IV antibiotics per protocol. She is 65 inches (162.5 cm). Her pre-pregnancy weight was 115 pounds (52.3 kg). She gained 18 pounds (6.8 kg) during this pregnancy. She just had spontaneous rupture of membranes with a moderate amount of thick meconium fluid at 9 pm. The nurse performed a vaginal check, and her cervix is dilated to 4 cm, 8 percent effaced and -1 station. Pitocin is infusing at 8 mU/minute intravenously.
Jennifer lives with a roommate and is no longer involved with the father of her baby. Her family support is limited to her older brother, Sal. She smokes one pack of cigarettes a day and has not had a job for over a year and states money is tight. She admits to not eating very healthy during the pregnancy because it is easier to grab hamburger and coke than cook. She missed a few of her prenatal visits due to transportation issues and did not attend any prenatal classes. Her sister is present as her support person during labor and delivery.
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Erickson’s Developmental Stage Related to pt. & Cite References (1) L.D. is in the stage of generativity versus stagnation which is when people reach their 40s which is also known as middle adulthood and extends to the mid 60s. In this stage middle aged adults start contributing to the next generation in caring for others; they also start engaging in meaningful work and contributing to society. Copstead & Banasik, J. L. (2013). This is also known as the generativity stage where it involves finding your life’s work by contributing. Those who do not feel like they have mastered this task will feel the stagnation stage. In this stage they feel as though they still haven’t left their meaningful mark on the world or make little interest in self-improvement and connection with others. Copstead & Banasik, J. L. (2013). L.D. views her life with generativity because she continuously speaks about her charity work. She also enjoys talking about how much she was able to help people through her yoga classes by helping them relax and leave their daily living stresses behind while in class. She also enjoys socializing with others and helping around. Even in the hospital she is always good with people and being able to cheer others up. I believe now more than ever she will continue to contribute in helping others . Patient Education (In Pt.) L.D. should continue her high protein, low fat diet as well as continue drinking fluids daily. She should completely stop smoking as it only weakens her immunize system and contributes to poor circulation and slow wound healing. L.D. should clean the area around the wound gently with mild soap and water. Do not rub the incision, allow water to flow gently over it. After your wound is healed, keep it open to the air. After dressings have been removed , wash your stump daily with mild soap and water. Do not soak it. Dry it well. Inspect your stump every day. Use a mirror if it is hard for you to see all around it , inspect for any red areas or dirt. Wear your elastic bandage all the time. Rewrap it every 2 to 4 hours. Make sure there are no creases in it. Wear your stump protector whenever you are out of bed. Always notify any changes. Discharge Planning (home needs ) Refer L.D. to her dietitian to further provide her with at home details of her dietary plan. This will involve a high protein, low saturated fats, and increased fluids. She will continue her physical and occupational therapy on a daily basis. This will allow her to fully heal as well as learn how to manage her new body part functions. Concept Map Nursing Week 7 Discussion
L.D. and her family members will be taught about the adverse effects and medication regimen she must follow at home with the appropriate parameters to follow. Patient will be provided with transportation on a daily basis to attend all her therapeutic appointments. Medical Management/ Orders/ Medications & Allergies (2) Name Dose RT Freq. MOA RN Considerations Enoxaparin (Lovenox) 30mg SubQ Every 12 hours Enoxaparin binds and potentiates antithrombin to form a complex that irreversibly inactivates clotting factor Xa. Assess for bleeding signs and teach patient to report any bleeding, bruising, and pain. Notify if any black stools, bleeding gums, or bruising occurs. Oxycodone (Roxicodone) 10mg PO Every 4 hours PRN Act on receptors located on neural cell membranes. Assess pain level (0-10) before and after administering . Monitor respirations/vitals and report if any dizziness or slow breathing occurs. Leave call light near (risk for falls). Docusate Sodium (colace) 100mg PO Twice daily Anionic surfactant that allows water and lipids to penetrate stool. Monitor for any electrolyte imbalances and assess for abdominal distention. Notify if any rectal bleeding occurs. Make sure liquid intake is implemented. Amoxicillin (Augmentin) 125 mg PO Every 12 hours Acts on bactericidal activity by inhibition of bacterial cell wall synthesis by binding to penicillin-binding protein 1A. Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported. Assess for infection, vital signs; appearance of wound, sputum, urine, and stool;WBC) at beginning of and throughout therapy . Alprazolam (Xanax) 0.5mg PO Twice a day Benzodiazepines bind to GABA receptors in the brain and enhance GABA mediated synaptic inhibition. Assess for any suicidal ideation. Monitor vitals. Assess patient for drowsiness, light-headedness, and dizziness. Adams, M., Holland, L. N., & Urban, C. Q. (2019). Chief Complaint “ Patient presents for rehabilitation after amputation of left lower extremity as a result of osteomyelitis complaining of swelling and pain on amputated stump.” Admitting Diagnosis Sw e lling and pain . Cultural considerations, ethnicity, occupation, religion, family support, insurance. (1) (14) L.D. is a white American female who used to be a yoga instructor. Her highest level of education is a college level degree. She enjoys socializing with the nurses as well as petting the hospitals therapy dog. L.D. is a catholic. Patient Information (1) Name: Concept Map Nursing Week 7 Discussion
L.D. Age: 4 5 Gender: Female Code Status: Full code DPOA: No Living Will: No History of Present Illness (HPI), Pathophysiology of Admitting Dx (Cite References) Medical, Surgical, Social History (1). L.D. is a 45-year-old white American female who currently lives alone. L.D. was admitted to the E.R. after her leg became necrotic due to her previous medical history of osteomyelitis and underwent amputation of the lower left extremity . L.D. afterwards was omitted for rehabilitation complaining of swelling and pain on amputated stump. She is now being carefully treated and undergoes physical therapies to better assist her in fully healing. Medical History Osteomyelitis is inflammation and destruction of bone caused by bacteria. Copstead & Banasik, J. L. (2013). Osteomyelitis occludes local blood vessels, which cause bone necrosis and local spread of infection which can expand through the bone cortex and spread. Copstead & Banasik, J. L. (2013). Certain things such as trauma, surgery, the presence of foreign bodies, or the placement of prostheses may disrupt bony integrity and lead to the onset of bone infection. Copstead & Banasik, J. L. (2013). Osteomyelitis is an infection of the bone; these infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs some of the main known factors are s mokers and people with chronic health conditions, such as diabetes or kidney failure. Copstead & Banasik, J. L. (2013)Concept Map Nursing Week 7 Discussion
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