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Evaluation Oxygenation was measured by SpO2 and the patients level of consciousness.

His lungs were auscultated for signs of distress or obstruction. Through the use of incentive spirometry, albuterol nebulizer, and deep breathing, the patient was able to maintain proper oxygenation saturations over 97% on room air so the desired outcome was met. Infection and leukocytosis was controlled through the administration of antibiotics Clindamycin and Vancomycin. The desired outcome was met based on the patients WBC count returning to normal limits. Pain management was controlled through the use of a patient controlled pain pump containing bupivacaine and the two PRN medications morphine and oxycodone. With these options, the outcome of maintaining a pain level below 3 (on a scale of 0 to 10) was met. By maintaining pain control through medication and patient education on the reasoning and care of his chest tubes, his anxiety levels remained minimal, meeting the desired outcome. The patient was limited on his mobility due to his chest tubes. The risks associated with this limitation, such as skin integrity, were minimized through active range of motion exercises and assistance to a portable toilet chair to eliminate the need for a bed catheter, bed pan or briefs. Diabetes Mellitus was being controlled by insulin aspart (Novolog Flexpen) on a sliding scale with meals along with nateglinide for stimulating insulin production. These two medications in combination allowed for continued glucose control and met the desired outcome. Malnutrition was overcome by managing the patients nausea and vomiting symptoms with PRN medications ondansetron and promethazine. The patients albumin, prealbumin, RBC, WBC, and electrolyte levels were monitored and returned to normal levels prior to discharge.

Discharge Plan/Patient Teaching 1. Placement/type of dwelling: This patient was discharged to live with his sister on Oahu at her single family home. 2. Support system: This patient has the support of his sister, mother, father, and two cousins, all of whom live on Oahu. 3. Assistance needed with ADLs: Upon discharge, this patient did not need assistance with ADLs. 4. Equipment needs: Patient will need supplies for IV antibiotic administration via his left brachial PICC line. His sister received IV administration training through a company called Parmacare. 5. Patient teaching: This patient preferred to learn by visual demonstrations due to English not being his first language (He grew up in Guam). His sister, whom he will be living with, lives on Oahu and speaks and understands English fully. She was willing and able to learn how to administer this patients IV antibiotics as directed by Pharmcare. Diabetic discharge teaching included: diabetes control through glucose monitoring, foods appropriate for a diabetic diet, exercise and weight control, importance of medication compliance, and signs and symptoms of hypoglycemia and hyperglycemia and when to notify his physician or emergency services. Teaching also included the importance of antibiotic medication compliance in relation to his disease process (bacterial pneumonia) along with the signs and symptoms of infection (both systemic and local) and when to notify his physician or emergency services. Alcohol abuse and community services such as 12-step programs were discussed prior to discharge by a social worker at the hospital.

The need for a one to two week follow-up appointment was discussed and agreed to by the patient and his sister prior to discharge.

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