CRITICAL THINKING SUMMARY

Student: Jordan Lentz____________ Client Dx: Abdominal pain_______________________ Age: ___60__ Allergies: Lisinopril______________________________________ The MEDICAL DIAGNOSIS that brought the client to the hospital is:

Splenic Infarction
PATHOPHYSIOLOGY of diagnosed disease: (From text)

When oxygen to the spleen is interrupted it can cause a partial or complete infarct, leading to death of the organ (Huether, S. E., & McCance, K. L. 2012).

SYMPTOMS typically seen with this diagnosis include (as identified in your text):

Left upper quadrant pain, fever, nausea, vomiting, chest pain and left shoulder pain (Huether, S. E., & McCance, K. L. 2012.
CLIENTS SYMPTOMS of the diagnosed disease include:

Severe abdominal pain, left shoulder pain and abdominal distention.

NUTRITIONAL ASSESSMENT: Height (actual or estimated): 182.8cm__ Weight (actual or estimated): 97.2kg_____ Estimate Ideal Body Weight (Male: 105lb + 6 lb/inch > 5. Female: 100lb + 5lb/inch > 5): 80.5 kg___ Does this client have characteristics of a well-nourished person? Yes _____ No ___+__ Explain your answer.

The patient is an overweight male with a BMI of 29. He has no hair, dry skin and nails and he also stated that he has put on about 45 pounds in 5 years now. The patient had low sodium (130), low BUN (6), low bicarbonate (20) and high glucose (187). Not sure what patients albumin level was. His strength and muscle tone were moderate but he did not have much energy because he became short of breath very fast. He was a diabetic that did not manage his diabetes very well and ate a diet high in carbohydrates and fats. He did admit to eat fruit almost every day but not nearly enough vegetables.

PSYCHOSOCIAL STAGE OF DEVELOPMENT What is the clients developmental stage?

The clients developmental age according to Erikson is middle adulthood.

Has he/she met the necessary accomplishments? Yes _____ No __+___

Explain.

In middle adulthood the client needs to either have stagnation or generatively in their life. This means they need to have positive changes that benefit others in their lives and it should be important to them. The client has no children and is often finds himself unhappy.
How is this illness affecting the clients ability to meet these necessary accomplishments?

His current illness is holding him back because he isnt able to accomplish daily activities. He has a long medical history that has set him behind in life and not allowed him to grow and mature into middle adulthood (McLeod, S. 2008). He could also be using his illness an excuse not to grow into middle
adulthood.

NURSING DIAGNOSIS/OBJECTIVES/INTERVENTIONS Indicate below the 2 priority nursing diagnoses that are most relevant for your client. #1 NURSING DIAGNOSIS (problem r/t)

Acute abdominal pain of unknown/unspecified cause.

DEFINING CHARACTERISTICS (S/S) that support this diagnosis:

Patient self-reported using 0-10 pain scale, increased BP, pulse and respiratory rate. The patient had left shoulder pain and severe abdominal pain.
OBJECTIVE/CLIENT OUTCOME for this diagnosis:

Pain control by as evidence by demonstrating how to properly use analgesics appropriately and use nonanalgesic relief measures by discharge date.
NURSING INTERVENTIONS that will assist the client to resolve the above identified diagnosis: 1. Teach patient about proper use of his current analgesic pain medications. 2. Teach patient about pain medications alternative such as splinting and hot/cold compress. 3. Patient verbalizes not to take more medication or more frequently than prescribed.

(Ladwig, G. B., & Ackley, B. J. 2011).

#2 NURSING DIAGNOSIS (problem r/t)

Risk for unstable blood glucose levels related to inadequate blood glucose monitoring.
DEFINING CHARACTERISTICS (S/S) that support this diagnosis:

High blood sugars though out hospital stay and patient verbalized that he doesnt check sugars regularly.
OBJECTIVE/CLIENT OUTCOME for this diagnosis:

Patient will monitor blood sugars every day morning and night by June 1st A1c levels will decrease.
NURSING INTERVENTIONS that will assist the client to resolve the above identified diagnosis:

1. Teach about foods that are high in carbohydrates. 2. Teach client about proper techniques to loose/manage weight. 3. Teach client how to use glucometer correctly.

(Ladwig, G. B., & Ackley, B. J. 2011).

COMPLICATIONS: If this clients condition were to worsen, what would be the most likely reason and why?

Worsening symptoms include infection of the infarcted area leading to abscess, death of partial or entire organ splenic hemorrhage or rupture. Depending on where the infarct happened in spleen, it could present differently.
How would you know this is happening?

Increased WBC, fever, chills for abscess. Splenic hemorrhage/rupture signs include: severe left sided abdominal pain (under rib cage), Blood pressure drops and patient will have decreased LOC, confusion, dizziness, fainting and signs of shock.

What will you do if this happens? Sit the patient up, apply oxygen, keep patient calm, give fluids if have order and notify the doctor of these changes. Anticipate culture and antibiotics for possible sepsis, Hgb, type and cross, CT scan or preparation for operating room if ruptured.
PHYSICIAN PRESCRIBED MEDICATIONS AND INTERVENTIONS MEDS/IVs/TX/DIET (Include dose, route, frequency) REASON PRESCRIBED (Drug Classification, What is it treating?) NURSING IMPLICATIONS FROM TEXT (Checking for adverse reactions, preparation & administration concerns) Adverse reactions: GI bleeding, tinnitus, dyspepsia, epigastric pain, nausea, allergic reactions. Preparation/Administration: use lowest effective dose, administer after meal or with food, do not crush or chew enteric coated tablets, take with full glass of water and remain in upright position. Adverse reactions: fatigue, headache, yellow or green halos, bradycardia, nausea vomiting, arrhythmias. Preparation/Administration: give1 hour before meals or 2 hours after, can use D5W or CLIENT DATA FROM YOUR ASSESSMENT (What data is important to know before & after giving) Before: Hx of GI bleed drugdrug such as warfarin, asthma, allergies nasal polyps. Liver function, salicylate levels. After: Liver function, salicylate levels, watches for signs of bleeding.

Aspirin 81 mg PO, daily

Antipyretic and nonopiod analgesics. Prophylaxis of MIs

Digoxin 250 mg PO daily

Antiarrhythmic/ Inotropic Treating atrial fibrillation and flutter.

Before: apical pulse for 1 min, drug to drug interactions. After: digitalis, rate, rhythm electrolyte levels, renal and hepatic function.

Docastate-Seena sp 1 tablet PO

Stool softer. It is given on a prophylaxis basis. For prevention of constipation.

Fenofibrate 134 mg PO daily

Lipid-lower agent. Treating high cholesterol.

Gabapentin 600 mg PO daily in am

Analgesic adjuncts, anticonvulsants, mood stabilizer. Treating neuropathic pain.

Hydralazine 50mg PO BID

Antihypertensives. Treating hypertension.

Novolog sub q corrective dose

Antidiabetics. Treating type 2 diabetes.

Lantus 40 units sub q daily

Hormones. Treating type 2 diabetes.

0.9% NaCl. Adverse effects: throat irritation, mild cramps, diarrhea and rashes. Give with full glass of water or juice. Do not give within 2 hr of other laxatives. Adverse reactions: fatigue weakness, pulmonary embolism, rash, rhabdomyolysis. Preparation/Administration: some are taken with foods and others are not, do not skip/double doses. Adverse reactions: confusion, depression, dizziness, hypertension, weight gain, anorexia, flatulence, ataxia, multi-organ hypersensitivity reactions. Preparation/Administration: antacids may decrease absorption, morphine may increase absorption, can be cut in half, maybe given without drugs. Adverse reactions: dizziness tachycardia, angina, orthostatic hypotension, sodium retention, nausea, vomiting Preparation/Administration: BP and pulse before administration. Give with meals. Continue to take even if patient feels bad. Adverse reactions: hypoglycemia, pruritis, swelling, erythema and allergic reactions. Preparation/Administration: blood sugar, nurse must get another nurse to verify the dosage; can be kept at room temp for 28 days. Peak: 1-2 hours Onset:<15min duration: 3-6 hours. Adverse reactions: hypoglycemia, pruritis, swelling, erythema and allergic reactions. Preparation/Administration: blood sugar, nurse must get another nurse to verify the

Before: abd distention, bowel sounds. After: color, consistency and amount of stool produced.

Before: Diet history, exercise, weight loss, gallbladder, problems. After: lipid levels, increased AST, ALT, muscle tenderness, may decrease Hgb, Hct and WBC. Before: location, characteristics and intensity of pain. Renal insufficiency After: leukopenia, suicidal thoughts, location, characteristics and intensity of pain and renal tests.

Before: BP, pulse, and sodium. After: BP, pulse, CBC, electrolytes, sodium

Before: Blood sugar, get double check, hypoglycemia, hyperglycemia, drug to drug interactions. After: blood sugar, hypoglycemia.

Before: Blood sugar, get double check, hypoglycemia, hyperglycemia, drug to drug interactions. After: blood sugar, hypoglycemia.

Nicotine 21mg/24 hours transdermal

Smoking deterrents. Treating smoking.

Tiotropium 18 mcg 1 cap in the inhaler.

Bronchodilator. Treating COPD.

dosage; can be kept at room temp for 28 days. Peak: usually no peak Onset: 1-2 hours Duration: up to 24 hours. Adverse reactions: headache, insomnia, nervousness, tachycardia, burning at patch site, pruritis, chest pain and hypertension. Preparation/Administration: can be worn for 16-24 hours, apply on upper arm. Adverse reactions: glaucoma, tachycardia, dry mouth, constipation, urinary retention, rash, angioedema. Preparation/Administration: rinse mouth after use, go through correct way to use.

Before: assess smoking history, smoking withdrawal. After: evaluate smoking cessation program.

Before: assess rate, breath sounds, degree fo dyspnea, pulse. After: assess rate, breath sounds, degree of dyspnea, pulse. If wheezing occurs call doctor. Retrieved information from Nursing central

Analysis of Diagnostic Tests

DIRECTIONS: 1. List all diagnostic and laboratory tests pertinent to the patient's medical diagnosis or medical treatments (i.e. medications) and provide the patient values for each test. Explain why they are pertinent for this patient. List any screening diagnostic and laboratory tests that are not within normal limits. Explain why these tests are increased or decreased in relation to your patient's medical condition. Diagnostic/Lab Test Sodium 130 L Patient Values Analysis of Values Addisons disease, DKA diuretic therapy, excessive loss from GI tract and excessive perspiration. Within normal limits Unmanaged type 2 diabetes,

2.

Potassium Glucose

3.8 N 187 H

WBC Hgb Hct PT

11.09 H 11.8 L 36.2 L 13.4 N

There is an infectious process going on. Anemia due to chronic alcoholism Anemia due to chronic alcoholism Within normal limits but on higher end. Vitamin K deficiency or warfarin therapy.

INR

1.3 L

Higher risk of forming a blood

clot BUN
Creatine Chloride HCO3 No Chest x-rays CT thorax with IV contrast Abnormal findings Bilateral plural effusions Small non-specific pulmonary nodules Emphysema 6L Malnutrition, severe liver disease and renal disease. Within normal limits Within normal limits Compensated respiratory alkalosis or metabolic acidosis.

0.80 N 99 N 20 L

References
Huether, S. E., & McCance, K. L. (2012). Understanding Pathophysiology. St. Louis: Mosby Inc. Ladwig, G. B., & Ackley, B. J. (2011). Guide to Nursing Diagnosis (3rd ed.). Maryland Heights, Missouri: Mosby.

McLeod, S. (2008). Erik Erikson. Retrieved from http://www.simplypsychology.org/Erik-Erikson.html