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Infection (VRE,MRSA, 75 pack/yr hx of smoking, Obesity, Cancer (late stage laryngeal)

Pseudomonas, Cadidemia) CAD, sick sinus syndrome,

Peripheral vascular disease

Cefepime- 100mL, 33.3mL/hr IV- 2 Having multiple Having cancer of the

generation cephalosporin, infections can not throat can make The pt had previously been
bactericidal only be physically simple tasks of eat
Linezolid, 600m,150 mL/hr, undergoing chemotherapy
antibiotic used against resistant gram overwhelming and and drinking painful. and radiation, but was not
positive bacteria (MRSA, VRE) painful, but also It can also make it currently treating the
Bactroban (mupirocin) 2% ointment, emotionally difficult to cancer
inhibits protein synthesis
Nystatin- 100units/g powder,
overwhelming as well communicate with
antifungal binds to fungal others
membranes and causes cell leakage
Diflucan (fluconazole) (C.A, 75 y.o. Female)
400mg/120ml, 100ml/hr, antifungal, Grief with
weakens fungal cell wall Morphine 5mg PO, binds
death/dying r/t
with opioid receptors in
diagnosis the CNS altering the
Pertinent Physical Examination findings: Pt was perception and emotional
alert oriented x,and withdrawn. Skin was enacted
with wounds on both her abdomen and right neck.
response to pain
Pt also had burns from radiation on her neck. Lips
were dry and crack and poor dentition was noted.
Bilateral 2+ non-pitting edema in lower extremities,
lung sounds were coarse bilaterally. Unable to Diagnoses of laryngeal caner and
obtain vital signs. Urine was clear, tan, and multiple infections increased anxiety Pt will need emotional
powerlessness grief stage support from both family and
depression grief stage acceptance medical team while she
Priority Nursing Diagnosis (3 parts) (Lewis p.143) navigates through her
Measurable outcome w/ timeframe:
(Lewis p.277-279) decisions in regards to her
Risk for powerlessness related to terminal illness, loss of care and refusal of care.
independence, and invasive health services as a result of
cancer and infection diagnoses. Music therapy was provided
The patient will participate in care decisions as evidence by (pt had a hx of being active in
expressing options in decision making by 1400 on 2/3/2016. Pt was given teaching of her her church choir).
Nursing interventions you used with rationales: rights as a pt in regards to her
1) Assess the patients need for power and control.
treatment and refusal of
Rationale: patients can identify those aspects of self- Urine Culture: positive for both pseudomonas and
governance that are most important to them. Actively listen treatment. Pt was taught that
the morphine prescribed for VRE
so the patient feels heard.
Blood culture: positive for MRSA
2) Identify the situations that may increase the patients her was absorbed in the
feeling of powerlessness. Wound Culture: positive for MRSA and
mucosa of her mouth and a diphteroids
Rationale: Many medical routines are superimposed on
patients without ever receiving the patients permission, shot or pill was not required. Wound culture on arm : positive for Candida
which can foster feeling of powerlessness. Recognize the HgB:8.0, low likely due to chemotherapy
patients right to refuse procedures. HCT: 25.9,Low due to chemotherapy
3) Support the patients sense of autonomy by involving the Neutrophils: 8, Low due to chemotherapy
patient in decision-making, by giving and accepting
BUN :24,high due to recent chemotherapy and
information, and by assisting the patient with controlling the
environment as appropriate. current antibiotic use.
Evaluation: The goal was met, the patient was able to RBC:2.56:low due to chemotherapy
express her opinions in decision making and was able to
express her feeling of refusal of treatment. 1
(Gualanick &Meyers p.279)