Abbreviations

Definitions

GI/GU
ETA N/V PMH CAD DM SBO VS O2/NC S/S NGT LWS Na K Cl CO2 Diagnosis/Medical Condition Colon Cancer Ventral Hernia Arthritis

Gastrointestinal/Genitourinary Estimated Time of Arrival Nausea/Vomiting Past Medical History Coronary Artery Disease Diabetes Mellitus Small Bowel Obstruction Vital Signs Oxygen Nasal Cannula Signs and Symptoms Nasogastric Tube Intermittent Low Wall Suction Sodium Potassium Chloride Carbon Dioxide Description/meaning of diagnosis

Medications: Brand and generic

Class, indications, contraindications, side effects, food and drug interactions

Furosemide Lasix

Trazadone-Trialodine

KCL

Lovastatin-mevinolin

Antihypertensive, diuretic. Reduce edema caused by cirrhosis, heart failure, and renal disease, including nephritic syndrome. Inhibits sodium and water reabsorption and increases urine formation. Contraindication-anuria unresponsive to furosemid; hypersensitivity to furosemide. Adverse reactions- dizziness, fever, headache, restlessness, vertigo, orthostatic hypotension, blurred vision. Use cautiously in pts with advanced hepatic cirrhosis, especially those who also have hx of electrolyte imbalance or hepatic encephalopathy;may lead to lethal hepatic coma. Obtain pts weight before and during drug therapy Antidepressant, anxiolytic Class C. To treat major depression with or without generalized anxiety. Contraindication-hypersensitivity to trazodone or its components, recovery from acute MI. Adverse reactions- dizziness, drowsiness, fatigue, headache, nervousness, suicidal ideation. Give shortly after patient has a eal or light snack, give larger portion of daily dose at bedtime solution for fluid and electrolyte replenishment in a single dose container for intravenous administration febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation and hypervolemia. Antihyperlipidemic to reduce LDL and total cholesterol levels in patients with primary hypercholesterolemia. Contraindications- acute hepatic disease, breastfeeding hypersensitivity to lovastin or its components, pregnancy, unexplained elevated liver function test results. Administer cautiously in patients who have a history of liver disease and patients whom consume large amounts of alcohol.

Treatments, interventions, and therapeutic procedures

Method of delivery, purpose/desired outcome, indications, contraindications, and precautions

Laboratory tests and diagnostic procedures

2. Identify five things you would assess for and state your rationale for each. Check alertness and wakefulness- if decrease in alertness or decrease in mental status can indicate a potential in blood loss from a rupture of AAA. Pain-could indicate a possible rupture of AAA. Assess for change or increase of pain Implement measures to decrease risk of aneurysm rupture: Straining can cause rupture of aneurysm. Monitor cardiac-diminished myocardial blood flow that can result from pre-existing coronary artery disease Monitor abdomen-increasing feeling of abdominal and/or gastric fullness unrelated to oral intake 3. What is the most serious, life-threatening complication of AAA, and why? The most serious and life threatening complication of abdominal aortic aneurysm is rupture of the aneurysm which results in profuse internal bleeding. Rupture of an AAA is a serious medical emergency and is associated with a high mortality rate. Massive bleeding from a ruptured abdominal aortic aneurysm into the abdominal cavity can lead to cardiovascular collapse and shock. A ruptured abdominal aortic aneurysm is an acute medical emergency and must be diagnosed and treated urgently to improve the patient's chances of survival. 4. What single problem mentioned in the first paragraph of this case study presents a risk for AAA rupture? Why?

Hypertension causes increased pressure against walls of aorta thus leading to greater chances for AAA to rupture. 5. What is the minimal acceptable urinary output per hour? 25-55ml/hr- this rate optimizes renal function and maintains adequate hydration 6. What assessments should be made specific to his postoperative care? assess peripheral circulation including Doppler assessment of pulses and ankle brachial index. cardiac monitoring: increased risk of cardiac complications control BP respiratory management: analgesia 7. List five problems that should be high priorities in A.H.s postoperative care. major bleeding wound bleeding: if superficial this is not usually associated with significant swelling and the bleeding vessel can usually be seen intra-abdominal bleeding. Measurable increase in abdominal girth is a late finding: detectable only after 2-3 l of blood have accumulated. BP: maintain systolic BP between 110 and 160 8. Postoperative care of the patient undergoing aneurysmectomy includes preservation of the graft, preservation of tissue perfusion, and prevention of infection. List three interventions that would address these issues, and explain the rationale for each. Assess for and report signs and symptoms of cardiac dysrhythmias - irregular apical pulse; pulse rate below 60 or above 100 beats/minute; apical-radial pulse deficit; syncope; palpitations; abnormal rate, rhythm, or configurations on ECG. Perform actions to decrease stimulation of the sympathetic nervous system sympathetic stimulation increases the heart rate and causes vasoconstriction, both of which increase cardiac workload and decrease oxygen availability to the myocardium Assess cardiovascular status frequently and report signs and symptoms of inadequate tissue perfusion - decrease in B/P, cool skin, cyanosis, diminished peripheral pulses, urine output less than 30 ml/hour, restlessness and agitation, shortness of breath. 9. Identify four health-related issues you might appropriately address with him and what you would teach in each area. Eat a heart-healthy diet Exercise Reduce stress to help lower chances of having a blocked artery again. 10. A.H. wukk be receiving follow up visits from the home health care nurse to change his dressing and evaluate his incision. What can you discuss with him before discharge that will help him understand what the nurse will be doing? Evaluating the healing process of incision from AAA repair. Looking for signs of infections or problems of slowed healing. Changing bandage and importance of keeping wound clean and dry. 11. What link could be between A.Hs diet and his depression?

Case study does not state A.Hs current diet before or after his AAA. Though there could be a link related to depression and ones diet. anxiety, and the nation's increasing reliance on ready meals and processed food, which are heavy in pesticides, additives and harmful trans fats. Eating a diet without fresh fruit and vegetables, fish, pulses or nuts deprives the brain of the essential vitamins and nutrients needed to regulate it.

Critical Thinking in Nursing Dr. Phelps

Lindsay Wishmier April 5, 2011

References