1-ABDOMEN

Because the patient is having diarrhea, assessment should be done to determine whether the patient has any bacterial, viral or parasitic infections of the abdomen, especially the intestines. Assessment should also be done to determine if the patient has a tumor in the gastrointestinal tract. The hyperactive bowel sounds are indicative of digestion problems caused by possible bowel obstruction by a tumor. When doing an assessment, the nurse should also consider the possibility of peptic or stomach ulcers?

The doctor can ask the following questions:

For how many days have you felt the pain?

Where is the pain located?

Have you tried any medications to make the pain better? Did it work?

Is there anything that exacerbates the pain?

Does the pain get severe when you sit or stand up?

Do you have the previous history of a similar pain?

Do you pass gas or feel constipated?

What was your last meal?

Are you on diet restriction?

 Is the pain exacerbated by acidic foods or hunger?

The most probable cause of the patient’s problem is a bacterial or viral infection of the gastrointestinal tract. This is evidenced by the cramping, diarrhea, and hyperactive bowel sounds in all the four quadrants of the abdomen. Food poisoning, stomach flu, and indigestion are also possible causes of the problem although these are less likely due to the conditions described in the subjective data.

Problem list

Cramping

Diarrhea

Anxiety

Crohn’s disease

 Depression

The plan of care should include a mechanism for monitoring the patient’s condition and collecting baseline data to help improve the patient’s condition. The plan should also contain a program for patient education with an emphasis on what care should be taken to avoid contaminations.   

Interventions:

Observe and record the characteristics, amount, time and frequency of stool for a possible change in precipitating factors.

Begin venoclysis and intravenous replacement to prevent further dehydration and loss of weight.

Administer anti-diarrhea and anti-biotic agents as indicated.

Restrict foods containing too much oil, milk, fruits and caffeine to prevent irritation of the stomach and bowels.

Restrict intake of solid foods to reduce intestinal workload and allow for bowel rest.

Provide non-stimulating and quite environments and teach patient relaxation techniques to reduce anxiety and stress that can aggravate diarrhea.

2- SKIN, HAIR, NAILS

 Assessments should be done on changes in pigmentation to determine whether the patient is suffering from conditions such as arsenic toxicity, vitiligo or uremia. Assessments should also focus on whether the patient has rashes and bruising. Any previous problems with the skin such as excessive sweating or dryness should be assessed as these may indicate endocrine disorders such as hypothyroidism. Also, nail bed color, capillary refill, and clubbing should be assessed to ascertain the conditions of the nails and any changes over time.

The most likely case of edema is a lack of physical activity. Edema is prevalent among people who exercise or walk very little. The condition is common among people who stand or sit for too long. The patient being a truck driver has high chances of suffering from edema because he or she sits in the truck most of the time as he or she drives. Driving involves minimal physical activity and is a major risk factor for various other health complications such as cardiovascular diseases.  

The two known nursing diagnoses are wellness and risk diagnoses. Wellness diagnoses can help the nurse in obtaining crucial information that can be used to enhance the integrity of the patient’s nails, skin and hair. Risk diagnoses can identify risks for impaired skin and nail integrity as a result of the underlying condition such as edema.

The care plan should consider the following:

Acute pain management

Skin care regimen (deficient knowledge)

Disturbed body image

Risk for skin and deep tissue infection

Impaired nail and skin integrity

Interventions:

Encourage the patient to reduce salt intake to avoid further accumulation of fruits under the skin.

Protect the swollen toe from injury.

Encourage the patient to avoid using headbands, reaching into hot ovens, carrying heavy bags or any other thing that may interfere with the normal flow of blood in the body.

 Do not give intravenous fluids as these will cause further edema.

Give prescription medications to treat any medical condition causing the toe to swell. The medications should not result in adverse side effects that may worsen the condition.

3- LUNGS

The doctor may ask about the patient’s medical history, including whether he has had asthma, allergies, and related medical conditions. The doctor may also ask whether the patient had a cold or flu recently and whether he spends time around people who smoke. Additionally, the patient should be asked whether he works or has been around an area with intense air pollution, fumes or dusts such as a factory or waste disposal facility.

Problem list:

Coughing

A painful sore throat

Hypertension

Diabetes mellitus

The following nursing diagnoses can be derived from the above problem list:

Abnormal breathing pattern related to chest wall expansion as a result of a chest infection.

Obstruction of the airwaves due to increased respiratory secretion due to infection of lungs.

Poor gas exchange due to reduced lung surface as a result of the presence of cavities or infiltrates in the lung tissue. This can be caused by opportunistic infections of the respiratory system such as tuberculosis or pneumonia.

First, the plan of care should make an assessment of and report any symptoms of compromised respiratory function. Shallow and rapid respirations would indicate damaged respiratory function. Secondly, the plan should implement actions to improve respiration by maintaining activity restrictions to reduce oxygen needs. The plan should also include actions for promoting prompt removal of any pulmonary secretions from the system. Lastly, the care plan should include actions for promoting plan and fatigue reduction.

Common risk factors for senior citizens include:

Chronic pain

Indoor and outdoor air pollutants

Allergens

Post-infectious chronic respiratory diseases

Increase in physical health conditions

Side effects from medications

Loneliness and social isolation

Depression due to grief and loss

Lack of proper nutrition

The following are the most likely causes of a cough:

Postnasal drip: this condition causes the sinuses to produce extra mucus which drips down the throat and triggers coughing.

Asthma may appear after an infection of the respiratory tract. It gets worse when the patient is exposed to certain fragrances or cold air.

Gastroesophageal reflux disease: this condition causes stomach acid to flow back into the esophagus, triggering chronic coughing.  

Flu, pneumonia or cold infection: these infections affect the upper respiratory tract, causing wheezing sounds when breathing and coughing.

Chronic bronchitis: this condition causes inflammation of the bronchial tubes which can cause a cough with phlegm.

4- HEART

The doctor may ask the following questions about the fatigue:

What time do you go to bed at night?

After you lie down, how long does it take you to fall asleep?

Do you experience any pain at night?

Do you feel rested when you wake up?

Do you nap during the day?

What are the side effects or symptoms of the fatigue?

Does it cause a change in eating habits or weight loss?

Does it affect your daily activities?

Do you have any anxiety or depression?

Do you take alcohol or use other rugs?

Do you exercise during the day?

The assessment should include a blood test and physical exam. A physical examination of the body is necessary to check general signs of ill health or anything that might be unusual. During the physical examination, the doctor will look for problems such as walking difficulties, loss of muscle strength and difficulties in breathing. A blood test assessment will help to determine if the patient has anemia. This will involve complete blood count or peripheral blood smear.

The most common causes of fatigue are anemia, celiac disease, chronic fatigue syndrome, sleep apnea, diabetes, myocardial infarction and underactive thyroid. Anxiety and depression are also common causes of fatigue, especially among elderly people.

Problem list

Fatigue

Swollen ankles

Myocardial infarction

 Hyperlipidemia

Hypertension

A nursing care plan for the patient will include diagnosis, nursing outcomes, and interventions. During the diagnosis, the nurse will assess the patient to ascertain signs and effects of fatigue. The patient will discuss with the doctor about how she feels. As part of the interventions, the doctor will guide the patient on crucial energy saving techniques to decrease fatigue. By owing to the patient’s advanced age, it is necessary to avoid engaging in any strenuous activities as these may worsen the condition.

The most likely cause of fatigue for this patient is anemia. This is because the patient experiences fatigue and loss of energy with exercise. Anemia causes a decrease in blood, which in turn causes fatigue. The patient’s anemia could be related to the history of hypertension and myocardial infarction.  

5-NEURO

The following questions should be asked about the seizure:

What was the patient doing when the seizure occurred?

Did the patient get any prior warnings just before the seizure?

Did the patient feel a black out or lose consciousness? For how long?

Did the patient experience post-event confusion?

Did the patient take any medications?

Did anyone take the patient’s vital sign such as pulse rate?

The assessment should include a thorough checking of the patient’s airwaves, circulation, breathing and disability to determine possible risk effects and risk factors. Also, blood glucose level, as well as temperature, should be assessed to determine any changes in either of these can cause a seizure. The assessment should also look at what type of seizure it was and if the patient had taken any recent medications that exacerbate chances of seizure.

The most common cause of the seizure is injuries to the brain that occur during birth or as an adult. A seizure is also caused by low oxygen during birth, presence of tumors in the brain, infections such as encephalitis and meningitis, stroke and abnormal levels of glucose or sodium in the blood.

Problem list:

Seizure

Headache

Fatigue

A plan of care should include medications for stopping the seizure. It should also include measures for protecting the patient from any possible injuries. The patient should be assisted to breathe normally by placing them in a recovery position once the seizure recovers.  

Risk factors for seizure include a family history of seizures and related disorders, injuries to the brain, previous brain infections, and stroke. Long term sleep deprivation, and medical conditions that affect the balance of electrolytes in the body are also risk factors for seizure. Use of illicit drugs, tobacco smoking, and heavy alcohol consumption are also known risk factors for seizure.

Based on the subjective data and the readings, the patient most likely had a partial seizure. This type of seizure occurs when there is electrical discharge into one part of the brain. Partial seizures are common if the patient has a history of seizures, and are mostly caused by brain injuries or infections.

6-PVD AND HEART

Subject information will be required about what the patient feels like, how long she had the conditions, and whether it interferes with her normal activities. Information will also be required about the patent’s eating habits, effects of any medication she is taking and the history of related conditions in the family.

Since the patient has high blood pressure and edema, the best places to check the pulse are at the wrist, the side of the neck and inside the elbow. Pulse can also be taken at the groin or behind the knees.

To assess the adequacy of collateral circulation before an arterial blood gas sample, the nurse will compress the patient’s arteries on both hands while the patient clinches fists. The pulse rate in the arteries is felt with the index or middle fingers of the non-dominant hands. When doing the arterial gas sampling, the nurse should wear gloves and follow applicable policies regarding management of blood samples.

The most likely cause of the patent’s shortness of breath, leg swellings and productive cough is pulmonary edema. This condition is characterized by shortness of breath and difficulties in breathing, high blood pressure, and swellings in both feet. The condition can also cause fatigue, rapid weight loss, and rhonchi in the bases of the lungs. Another likely cause of the symptom is congestive heart failure (CHF). This condition causes a decrease in the pumping abilities of the heart, which leads to the diversion of blood from less vital organs to the heart and blood. The congenital heart disease is characterized by swellings in the body, especially legs, shortness of breath and intolerance to strenuous activities. The two likely causes should be considered when attending the patient.