NURSING CARE PREPARATION

Student Name:

Jason Villavicencio, SN

Unit/Room Number: REU/247

Age: 72
Gender: FEMALE
Eriksons Developmental Level: Ego Integrity vs.
Despair: Older adults need to look back on life and
feel a sense of fulfillment. Success at this stage leads
to feelings of wisdom and with the relationships
developed by raising a granddaughter; the patient can
pass on experiences to future generations within the
family. The patient has a strong bond with her
granddaughter and great granddaughter replacing a
strained a strained relationship with daughter.

Date of Care:

10/28/14

Date of Admission: 10/24/14

Ethnic/Cultural Preferences:
SINGLE/WHITE/RETIRED/DISABLED/RETAIL
Allergies: AMITRIPTYLINE/ASPIRIN/CELEBREX/
CORTISONE/DEMEROL/FLUTICASONE/GARLIC/HYDRO
CORTISONE/MELOXICAM/PENICILLINS
Code Status: FULL CODE

Primary Diagnosis:
Post-surgical- Laparoscopic Appendectomy
Co-morbidities:
COPD, PERIPERAL VASCULAR DISEASE, APPENDECTOMY

Discharge Plan (add day of clinical):

Patient plans on returning home with husband and dog at time of DC. Patient should be able to return to
usual activity in 1 to 2 weeks. According to physician, discharge should be within 2-3 days with current rate of
progress. Patient has progressed to clear liquids with removal of NG. Increased GI motility evident with flatus,
hyperactive bowel sounds in all quadrants, and regular bowel movements.
Preliminary Integrated Pathophysiology primary diagnosis (what is going on with your client at the cellular
level for the health condition, due before clinical shift; (typed 1-3 pages with APA formatting). Explain how
your clients primary diagnosis, co-morbidities, medications and labs interrelate.

Data Collection (Record exactly what is written on the personal information sheet [aka Kardex]. Any
assessment/elaboration should be made on the assessment sheet):
Diet (Type) NPO
IV (Fluid type, rate, access type): PERIPHERAL, RT
FOREARM, 22G, PUMP, CONTINUOUS; PERIPHERAL
LT, FOREARM, 22G, SALINE LOCK.
I&O (MD order/Nursing Order/Frequency): STRICT
CBG (Yes/No, frequency): NO
Fall Risk/Safety Precautions (Yes/No): YES; CALL
Activity (Patients activity level ): 1-2 PERSON ASSIST
LIGHT, UPPER BED RAILS, BED LOW & LOCK, BED
CLOSE TO NURSES STATION IF NEC.
Wound Care (Yes/No):NO
Oxygen (Yes/No, Delivery method, how much):
YES; 4 LPM, NASAL CANNULA
Drains (Yes/No, Type): YES, JP, STRIP EACH SHIFT, PRN Last BM: 10/26/14
Other Tubes: NG

ASSESSMENTS
(Include Subjective & Objective Data)
Integumentary:
Upper bilat extremities dry, warm, thin; trunk warm,
dry; Surgical incision X3, open to air clean dry intact,
no drainage; below umbilicus JP closed wound vac;
Bilat lower extremities dry, flakey, smooth, no hair;
cap refill < 3sec., turgor: loose, no clubbing; Nails
smooth pink; Hair color appropriate for age/race,
distribution even; scalp mobile, nontender.
Peripheral IV X2 LT/RT forearm dry, clean, intact,
patent, no drainage/redness.

Eyes/Ear/Nose/Throat:
color vision/visual field intact, eyes parallel, PERRLA,
symmetrical, extraocular motion intact OU, no
wandering, + corneal reflex, pupil 3-5mm
Ears: able to repeat whispered words bilaterally,
external ear non-tender, no lesions
Nose symmetrical moist, pink septum intact hair
appropriate for age.
Throat: Hard and soft palate pink and intact; no
exudate; uvula symmetrical, + swallow and gag
Cardiac:
Upper and lower Cap refill <3sec.
Negative bruit
Distal extremities warm bilat
+pulse at apex; Neck vessels pulse equal, +2, no thrills
or irregular rhythm, tachycardic, + pedal pulse
bilaterally
Genitourinary:
Smooth, hair color appropriate for race, age.
Continent, dark yellow, clear, concentrated, mild odor
Bowel movement: loose, black, neg for blood, flatus

Neurological / Psychosocial
Alert, oriented, aware person, place, time.
Speech clear, coherent, appropriate
Responsive, cooperative, periodic agitation,
discomfort, fatigue.

Head and Neck:

Head: normocephalic, erect, midline, symmetrical, no
pain, scalp freely movable
Face: expression appropriate; nasolabial folds and
palpebral fissures symmetrical; hair distribution age,
sex, and ethnicity appropriate; no lesions/abnormal
movements/edema/discharge; periorbital edema, no
sinus pain; Lips pink, dry, intact, no lesions or unusual
odor; Oral mucosa pink, dry, no lesions; partial top
denture, missing teeth, Tongue pink, dry, coated,
intact, midline, with full mobility; Uvula symmetrical
rise, +swallow and gag
Neck: no edema or redness, AROM, skin intact; Larynx
and trachea rise with swallowing, sinuses nontender
Thorax/Lungs:
tachypnea
Lungs diminished throughout, rhonchi bilat lower
lobes.
Respirations shallow, symmetrical, excursions
uniform,
No barrel chest or spinal deformities
Chest non-tender, no masses
E to A consolidation
Musculoskeletal:
AROM Bilat upper extremities +5 strength
Bilat upper extremities nontender to touch
Bilat lower extremities AROM, strength +5.
Gait unsteady, stooped, SBA, ambulation ad lib.
Tolerates poorly
Gastrointestinal:
Smooth, soft, warm, tender, pain RUQ incision sites
No bruits/hums/rubs
Umbilicus midline, inverted, no
discoloration/discharge.
+ respiratory movement
Hyperactive bowl tones all quads
Vital signs: T:100.8F R:20 BP: 107/52 P:87 spO2: 98%
NC 4LPM
Pain (chronic or acute): ACUTE 6/10 scale Tolerated,
9/10 WITH ACTIVITY, ABDOMEN umbilicus
Pain management: Rx IVP Dilaudid 0.5-2mg variable

Q2H

CURRENT MEDICATIONS
List ALL regularly scheduled and prn medications scheduled on your client.
(Due morning of clinical)
Generic &
Trade Name

Classification

Ciprofloxacin
400mg/D5W

Quinolone
Antibiotic

Dose/Route
/
Rate if IV

Onset
/Peak

200ML IV
Q12H

Peak
imme
diate
releas
e 0.52h
IV
O:
Imme
diate
P: 20
Min
D: 5-8
HR
1-3hrs

(CIPRO IV
400MG/D5W)
Metoprolol
(Lopressor)

Flagyl
500mg/NS
100ML
(Metronidazo
le)
Potassium
Chloride

NS 0.9% + KCl
20MEQ/LITER

Beta Blocker

5MG =5ML
IV RT Q6H

AntiTrichomonal
Amebicide

100ML IV
Q8H

Electrolytic
replacement
solution

10
MEQ/100M
L IV Q1H X2

(1000ML
BAG) IV @

O:
unkno
wn
P: 12 hr
D:
unkno
wn
O:
unk

Intended
Action/Therapeuti
c use. Why is this
client taking med?
Blocks
neuromuscular
transmission of
nerve impulses.

Adverse
reactions (1
major side
effect)
Peripheral
neuropathy

Decreased BP and
HR, decreased
frequency of
angina.

Fatigue,
weakness,
bronchospasm,
wheezing,
bradycardia,
pulmonary
edema.

Exhibits
antibacterial
activity against
obligate anaerobic
bacteria
Supplement

Mineral and
electrolyte

Vertigo

Nursing Implications for this client.

(No more than one)

Report tendon inflammation or pain.

Drug should be discontinued.

Assess BP, and take apical pulse

before administration. If <60 bpm,
LESS THAN 100 SBP withhold.
Direct IV diluent: Administer
undiluted
Rate: Over 1 minute
Discontinue therapy immediately if
symptoms of CNS toxicity develop.
Monitor for seizures and peripheral
neuropathy.

Avoid laying 10
min after

Monitor I&O ratio and pattern in

patients receiving the parenteral drug.

Arrhythmias

Monitor for EKG changes

CLINDAMYCI
N/D5W
600MG
PREMIX

Lincosimide;
Antibiotic

DWNS + KCl
20MEQ/LITER

Enoxaparin

Anticoagulant
(LMWH)

(Lovenox)

Benadryl
(diphenhydra
mine
hydrobromid
e)
Oxycodone I
mm Rel (Roxi
codon)

Centrally
acting
cholinergic
antagonist;
Antihistamine,
H-Receptor
antagonist
opioid agonist

125 ML/HR
OVER 10HR
CONTINUO
US
50ML IV
Q6H

(1000ML
BAG) IV @
100 ML/HR
OVER
10.5HR
CONTINUO
US
40mg =
0.4mL SC
daily

25 mg po
Q6
PRN itching

P: 1-2
h
HL:
unk
P:3h
D:812h
HL:23h
O:
unk
P: 1-2
h
HL:
unk

replacements/supp
lements

Peak
3h
Half
life
4.6h

Onset
1530min
Peak
1-4h

5 MG-10MG O: 10PO Q4H

15 min
PRN
P: 6090 min
D: 3-

Infection;
anaerobic
streptococci,
aerobic gram
positive cocci
Mineral and
electrolyte
replacements/supp
lements

N/V/D

Monitor BP and pulse, watery stools.

Arrhythmias

Monitor for EKG changes

An effective
anticoagulant
agent, it is used for
prophylactic
treatment as an
antithrombotic
agent following
certain types of
surgery.
Itching

Hemorrhage
(bleeding gums
may be
indicator)

Inspect subcutaneous site for S&S of

site reaction (itching, swelling,
redness, pain, tenderness, or
hardened skin)that usually last for
less than 7 days post injection.

Cardiovascular
collapse

Monitor cardiovascular status

especially with preexisting
cardiovascular disease.

Pain

Respiratory
depression

Assess type, location, and intensity of

pain prior to and 1 hour after
administration.

Alpradolam
(Xanax)

Benzodiazepin
e

HYDROmorph Opioid
one (Dilaudid Analgesics
INJ)

Pantoprazole
(Protonix)

Albuterol
NEB Soln 0.08
3% 3 ML
(Ventolin,
Proventil)
Ondansetron
INJ (Zodran
INJ)

Antiulcer
agents

0.5 MG=1
Tab PO
DAILY PRN

0.5-2 MG IV
Q2H PRN

40 MG = 1
tab PO/
40MG=
10ML IV
daily
May give
INJ
formulation
IV instead if
PO not TOL
Bronchodilator 2.5 = 3 ML
TID PRN
SOB

Antiemetics

6 hr
O: 1-2
hr
P: 1-2
hr
D: Up
to 24
hr
O: 1015 min
P: 1530 min
D: 2-3
hr
O: 2.5
hr
P:
unkno
wn
D: 1
wk

O: 1530 min
P: 23 hr
D: 46 hr
4 MG= 2 ML
O:
IV Q4H PRN rapid
P: 1530 min
D: 4-8
hr

Anxiety

SEVERE Pain

Dizziness

Respiratory
depression

Assess degree and manifestations of

anxiety and mental status. Monitor
CBC and renal function. May cause
decreased hematocrit and
neutropenia.
Flumazenil is antidote
Assess type, location, intensity of pain
prior and after, high alert medication.
Assess LOC, BP, pulse, respirations. If
respirations <10/min assess level of
sedation. Assess bowel function.
Narcan antidote
Assess patient for epigastric or
abdominal pain and or frank of occult
blood in stool, emesis, or gastric
aspirate. May cause abnormal liver
function tests including increased AST,
ALT, alkaline phosphatase, and
bilirubin. May cause
hypomagnesemia.

Diminished
accumulation of
acid in the gastric
lumen, with
lessened acid
reflux.

Diarrhea

SOB

Palpations

Assess lung sounds, pulse, and BP

before administration and during
peak of medication.

Nausea/Vomiting

Drowsiness

Assess effectiveness. Assess patient

for nausea, vomiting, abdominal
distention, and bowel sounds prior to
and following administration. Assess
patient for extrapyramidal effects.
Monitor ECG in patients with

FS-Sodium
Chloride 0.9%

Fluid
replacement

FLUSH IV
PRN IV
ACCESS

Acetaminoph
en
(Tylenol)

Pain
Reliever/Antip
yretic

Acetaminoph
en
(Tylenol)

Pain
Reliever/Antip
yretic

650mg 2
tabs Q6H
prn mild
pain/temp
above 101F
IF UNABLE
PO GIVE
RECTAL
SUPP
650mg = 1
SUPP
RECTAL Q6H
prn mild
pain/temp
above 101F
IF PO TOL
MAY GIVE
ORAL TAB
INSTEAD

O:
unkno
wn
P:
unkno
wn
D:
unkno
wn
O:
within
1H
P:0.52H

O:
within
1H
P:0.52H

Fluid
administration

Fluid overload

Pain reliever/fever
reducer

Elevation of
ALT/AST

Pain reliever/fever
reducer

Elevation of
ALT/AST

hypokalemia or hypomagnesemia.
May cause transient increase in serum
bilirubin, AST, and ALT levels.
Monitor for fluid overload

ANTIDOTE: Acetylcysteine (NAC)

Monitor for therapeutic effects (pain
relief)
Monitor for signs/symptoms of
hepatotoxicity

ANTIDOTE: Acetylcysteine (NAC)

Monitor for therapeutic effects (pain
relief)
Monitor for signs/symptoms of
hepatotoxicity

DIAGNOSTIC TESTING
Include pertinent labs [ABGs, INRs, cultures, etc] & other diagnostic reports [X-rays, CT, MRI, U/S, etc.]
NOTE: Adult values indicated. If client is newborn or elder, normal value range may be different.
Date
Lab Test
Patient Values/
Interpretation as related to Pathophysiology
Normal Values
Date of care
cite reference & pg #
10/27 Sodium
134L
Patient may have excessive fluid volume with
135

145
mEq/L
/14
continuous iv fluids (Laboratory test and
Diagnostics Procedures with Nursing diagnoses,
Pg. 111)
Potassium
3.1L
Pt has had NG tube following appendectomy
3.5 5.0 mEq/L
which can increase pH creating alkolidic
environment decreasing K levels d/t
compensation. (Laboratory test and Diagnostics
Procedures with Nursing diagnoses, Pg. 1071)
Chloride
101
97-107 mEq/L
Co2
23-29 mEq/L
Glucose
75 110 mg/dL
BUN
8-21 mg/dL
Creatinine
0.5 1.2 mg/dL
Uric Acid Plasma
4.4-7.6 mg/dL
Calcium
8.2-10.2 mg/dL
Phosphorus
2.5-4.5 mg/dL

Total Bilirubin
0.3-1.2 mg/dL
Total Protein
6.0-8.0 gm/dL
Albumin
3.4-4.8gm/dL

30
111H
10
0.55

7.9L

2.2L

2.5L

Cholesterol
<200-240 mg/dL
Alk Phos
25-142 IU/L
SGOT or AST
10 48 IU/L
ALT
LDH
70-185 IU/L
CPK
38-174 IU/L
WBC
4.5 11.0

9.8

Serum calcium level reflect serum albumin

levels since half is in free ionized form and half
is protein bound in albumin. Pg 204
Phosphorus levels are dependent on dietary
intake. Patient is NPO d/t NG tube and
aspiration, limiting dietary intake of
phosphorus. (Laboratory test and Diagnostics
Procedures with Nursing diagnoses, Pg. 1025)

Albumin is 60% of total protein in blood

effected by malnourishment from surgery or a
possible liver problem. Pg 263

RBC
male: 4.7-5.14 x 10
female: 4.2-4.87 x 10

HGB
male: 12.6-17.4 g/dL
female: 11.7-16.1 g/dL

3.98L

11.4L

HCT
male: 43-49%
female: 38-44%

33L

MCV
85-95 fL
MCH
28 32 Pg
RDW
11.6-14.8%
Platelet
150-450
BAND

83

Indicator of abnormal loss or destruction of

erythrocytes ((Laboratory Tests and Diagnostic
Procedures 8th Ed. Pg 28)
Levels directly correlate with RBC (Laboratory
Tests and Diagnostic Procedures 8th Ed. Pg 27)
Low levels indicate true decrease in RBCs
(Laboratory Tests and Diagnostic Procedures 8th
Ed. Pg 27)

28.7
13.7
168
26H

NEUTS,ABSOLUTE

9.1H

LYMPH,ABSOLUTE

0.4L

Indicative of ongoing acute bacterial infection

resulting from ruptured appendicitis.
(Laboratory Tests and Diagnostic Procedures 8th
Ed. Pg 990)
Indicative of ongoing acute bacterial infection
resulting from ruptured appendicitis.
(Laboratory Tests and Diagnostic Procedures 8th
Ed. Pg 990
Decrease in lymphocytes mark inflammation or
infection. Patient incurred both with
appendicitis followed by rupture, then
appendectomy. Indicative of ongoing acute
bacterial infection resulting from ruptured
appendicitis. (Laboratory Tests and Diagnostic
Procedures 8th Ed. Pg 1375)

DIAGNOSTIC TESTING
Date

UA

Normal
Range

Results

Interpretation as related to
Pathophysiology cite reference &
pg #

Color/Appearance
pH
Spec Gravity
Protein
Glucose
Ketones
Blood
Date

Other
(PT, aPTT, PTT, INR,
ABGs, Cultures,
etc)
10/27/14 PT

Normal
Range

Results

11.5-13.8

33 SEC

Interpretation as related to
Pathophysiology cite reference &
pg #
Increased PT results from

anticoagulation medication,
Lovinox.
INR
10/22/14 STOOL CULTUREC.DIFF TOX B

0.9-1.1

3.6H
TOXIGENIC C.
DIFF, PCR:
POSITIVE

Date
Radiology
10/26/14 X-Rays: 1 Chest
View

Scans: CT
Head/Brain
EKG-12 lead

Telemetry
Other

Results
1. Infiltrate and consolidation
in the right mid and lower
lung, likely
representing pneumonia.
2. Right pleural effusion.

Sinus tachy, Anterior infarct,

old, Q>40MS, ABNORMAL STT, V2-V5
ST ELEVATED, SONSIDER
INFERIOR INJURY ST >0.08MV,
II III AVF
PROLONG QT INTERVAL QTC
>500MS

Interpretation as related to
Pathophysiology cite reference &
pg #

DAR NURSING PROGRESS NOTE

Include the same note that was written in the client record for the priority nursing diagnostic
statement.
Include the date/time/signature.

10/28/14 1040 SBA from commode to bed, grunting, guarding abdomen, verbalized pain level 9/10. Admin
PRN dilaudid 1 mg, verbalized tolerance with past admin. In bed, HOB semi-fowlers position, call light,
bedside table within reach, bed lowest position, alarm on.--------------------------------------------J. Villavicencio, SN
10/28/14 1105 Verbalized pain level tolerable level 5/10.---------------------------------------------J. Villavicencio, SN

PATIENT CARE PLAN

Patient Information: 72-year-old, white, female, post-surgical care for appendectomy following ruptured
appendix. NG tube placed following aspiration and vomiting. Pt has history of COPD, peripheral vascular
disease, GERD.

Nursing Diagnosis should include Nanda Nursing Diagnostic statement, related to (R/T), as evidenced by (AEB).

Problem #1: Ineffective breathing pattern r/t aspirative pneumonia aeb chest x-ray, SOB
Desired Outcome: Pt will have respiratory rate and rhythm within normal limits by 1400
Nursing Interventions
Client Response to Intervention
1.Assess rate rhythm, depth, effort of respirations
1. Resp. 24, regular, deep with exertion/pain;
Rest/pain Rx decrease to 18 rpm.
2. Monitor effects of breathing treatments on respiratory
2. Breathing treatment not admin. resp. rate
status.
controlled with rest and pain Rx, o2 sat 98%
3. Teach to use incentive spirometer, deep breath and
3. Receptive, verbalized need for spirometry,
cough.
demonstrated back. Encouraged deep
breath/cough with encounters.
Evaluation: Patient was receptive to interventions, verbalizing importance to increase lung healing to get
home. Has concerns about pneumonia, taught about need to strengthen lungs and the difference between
bacterial pneumonia and pneumonia from aspiration. By end of goal time patient rate and rhythm were within
normal limits. Goal was achieved.
Problem #2: Risk for infection r/t surgical procedure and aspiration
Desired Outcome: Pt will be without s/s of infection throughout 0700-1400
Nursing Interventions
Client Response to Intervention
1. 1. Assess skin/incision color, temp, and integrity
1. Skin around incision was dry, intact, without
redness, swelling.
2. Monitor temp, note chills
2. Temp flux 97.7F- 98.9F, without shivers, need
of blanket with toileting.
3. Administer antibiotics per MAC
3. IVPB Flagyl, clindamycin per MAK
Evaluation: Patient presented with pneumonia d/t aspiration but was afebrile throughout shift without
antipyretic. Patient did not have signs of infection of integumentary system, no swelling, redness, drainage in
wounds or other. Goal was achieved.
Problem #3: Impaired oral mucous membrane r/t mouth breathing, NPO secondary to NG aeb dry cracked lips
Desired Outcome: Pt will demonstrate oral hygiene as prescribed and instructed
Nursing Interventions
Client Response to Intervention
1. Monitor for dryness of oral mucosa
1. Dryness present of oral mucosa. No lesions,
soars, cracks present.
2. Admin moist toothettes to mouth and lips prn
2. Toothettes not used; lip moisturizer, ice chips
were used.
3. Teach to admin oral care
3. Able to admin oral care without assistance.
Evaluation: Patient was able provide oral care for self. Instruction was well received, eager to have NG tube
removed to drink fluids. Goal was accomplished but, mucous membrane was not impaired. Mucosa was dry
which would be properly diagnosed as risk for impaired oral mucous membrane. Impaired nasal membrane
d/t NG tube and 4 lpm continuous oxygen therapy would be more appropriate.

Running head: PATHOPHYSIOLOGY AT A CELLULAR LEVEL

Pathophysiology at a Cellular Level

Appendicitis
Jason Villavicencio, NS
Southwestern Oregon Community College
Instructor Dustin Hawk

Running head: PATHOPHYSIOLOGY AT A CELLULAR LEVEL

Introduction
The patient was admitted with appendicitis followed by a laparoscopic appendectomy
for a perforated appendix. The patient has a history of chronic obstructive pulmonary disease
(COPD), peripheral vascular disease (PVD), and gastroesophogeal reflux disease (GERD).
Appendicitis
Appendicitis is an acute inflammation of the appendix. The inflammation is usually
caused by a blockage of the opening of the appendix and the proximal cecum leading to
bacterial infection (Huether & McCance, 2012). As a result of the inflammation, peritonitis can
develop with rapid onset (Ignatavicius & Workman, 2013). As fluid builds up, due to blockage,
pressure increases, decreasing mucosal blood flow causing the appendix to enter a hypoxic
state (Huether & McCance, 2012). With the patient, severe right lower quadrant pain was
experienced, which is commonly associated with appendicitis. According to physicians notes,
the patients appendix swelled to the size of a hot dog.
Gastroesophogeal reflux disease (GERD)
With GERD the patient may have issues with oral medications and possible
complications with aspiration. Post-surgery, this can inhibit nutrition and comfort. Aspiration a
major concern due to increased chances of pneumonia following sedation from anesthesia.
COPD
COPD increases the chances of contracting pneumonia due to limited perfusion of
alveoli resulting from long term scaring. The increase in carbon dioxide creates an alkalotic
state that promotes bacteria growth which can increase chances of infection.
Medications

Running head: PATHOPHYSIOLOGY AT A CELLULAR LEVEL

The patient has a history of COPD and GERD with a history of smoking. Abuterol is a
bronchodilator which targets beta2 receptors relaxing the smooth muscle of the lungs.
Protonix are being taken for GERD reducing the production of acid in the GI tract. This could
contribute to the alkalotic state decreasing potassium levels.
Lab
Laboratory values indicate electrolyte imbalances with decreased sodium and potassium
levels resulting from possible metabolic alkalosis. Chest x-ray indicates pneumonia in right
lower lobe with consolidation consistent with aspiration.
Treatments
The patient will receive continued IV antibiotics with Cipro and Flagyl for infection risk.
Nasogastric tube is continued to allow GI rest and limit risk for continued aspiration. Incentive
spirometry is a must for continued lung maintenance as well as Albuterol for bronchodilation
and supportive oxygen therapy with nasal cannula. Electrolyte deficiencies are being addressed
with IV fluids, potassium with normal saline. Anticoagulants are being administered to reduce
chance of deep vein thrombi with sequential compression devices. Constant monitoring for
signs of infection and skin break down are essential for skin integrity. Acetaminophen is used
for pain and temperature control. For moderate to severe pain dilaudid is used.
Conclusion

Patient was eager to cooperate with treatment to increase health status. Verbalization
of patients need to get home was expressed multiple times during care. Patient was also
continually on personal phone with husband and friends. Physician indicated possible
discharge in two days with current rate of progress. NG tube was clamped and possible

Running head: PATHOPHYSIOLOGY AT A CELLULAR LEVEL

discontinue with four hour residual less than 150ml. Patient GI motility was evident with
multiple bowel movements and hyperactive bowel tones throughout shift. Fluid in lungs should
decrease with increased activity, spirometry, and deep breathing with cough. Antibiotic
therapy will be continued with discharge.

Running head: PATHOPHYSIOLOGY AT A CELLULAR LEVEL

References
Huether, S. E., & McCance, K. L. (2012). Understanding Pathophysiology. St. Louis, MO: Mosby
Elsevier.
Ignatavicius, D. D., & Workman, M. L. (2013). Medical-Surgical Nursing. St. Louis: Elsevier
Saunders.