Elise Chirco

Weekly Goals Report

Goals must be well thought-out and appropriate for clinical site and clinical course. To
meet goals student should provide evidence of having
used appropriate resources
identified own learning needs
sought out new learning e!periences
"y goals for ne!t week are
# to pass medications on a patient with supervision from a registered nurse or my instructor. I
would also like to do a dressing change or some sort of sterile procedure.
$ow % met my goals from last week
# I did not meet my goal to pass medications last week. This is because while I was looking up
my medications to be administered at a nearby computer my patients registered nurse went into
the room without me and passed them. I heard her in the room talking with the patient and went
in there. By this time the administration was already completed and the patient did not have any
medications ordered for the remainder of the day.
%nsights gained
I learned to never leave your assigned registered nurse unattended during medication passing
time. From what I have learned this time is about an hour prior to nine in the morning and up to
an hour after.
CRITICAL THINKING SUMMARY
Student: ______Elise Chirco_______________
Patient Dx: __________COPD- Emphysema_______________________ Age: __69_
Allergies: ____asprin and icodin____________________________
!he MEDICAL DIAGNOSIS that "rought the patient to the hospital is:
Shortness o# "reath that $orsened in the last %& hours
PATHOPHYSIOLOGY o# diagnosed disease: '(rom text)
-an a"normal permanent enlargement o# the air spaces "eyond the terminal "ronchioles* $hich result in
the destruction o# respiratory $alls 'this syndrome includes chronic "ronchitis and emphysema)
-the a##ected terminal "ronchioles contain mucous plugs that $hen enlarged results in the loss o# elasticity
o# lung aleoli
- causes di##iculty in the expiratory phase and trapped car"on dioxide
SYMPTOMS typically seen $ith this diagnosis include 'as identi#ied in your text):
Constant coughing* shortness o# "reath $ith actiity* producing a lot o# sputum* $hee+ing* #eeling li,e you
can-t "reathe or ta,e a deep "reath* chest tightness
PATIENTS SYMPTOMS o# the diagnosed disease include:
.pon admission patient has stated he has $orsening shortness o# "reath* "ut is "etter no$
NUTRITIONAL ASSESSMENT:
/eight 'actual or estimated): ____01inches______ 2eight 'actual or estimated): __340l"s_____
Estimate 5deal 6ody 2eight '7ale: 318l" 9 6l":inch ; 8-< (emale: 311l" 9 8l":inch ; 8-): ___368l"s___
Does this patient hae characteristics o# a $ell-nourished person= >es _____ ?o __@__
Explain your ans$er<
/e does not hae the characteristics o# a $ell-nourished person "ecause his actual $eight is less that his
ideal $eight<
PSYCHOSOCIAL STAGE OF DEVELOPMENT
2hat is the patient-s deelopmental stage=
Ego 5ntegrity s Despair
/as he:she met the necessary accomplishments= >es _____ ?o _@__
Explain<
5 #eel that he has not met the necessary accomplishments #or his deelopmental stage "ecause he seems
to "e #illed $ith regret* "itterness and despair< /e is also an alcoholic<
/o$ is this illness a##ecting the patient-s a"ility to meet these necessary accomplishments=
/e is una"le to complete many tas,s $ithout ta,ing "rea,s to catch his "reath<
NURSING DIAGNOSIS/OBJECTIVES/INTERVENTIONS
5ndicate "elo$ the % priority nursing diagnoses that are most releant #or your patient<
#1 NURSING DIAGNOSIS 'pro"lem r:t)
Actiity intolerance r:t im"alance "et$een oxygen supply and demand
DEFINING CHARACTERISTICS (S/S) that support this diagnosis:
A"normal "lood pressure response to actiity* a"normal heart rate response to actiity* exertional
discom#ort* exertional dyspnea* er"al report o# #atigue* er"al report o# $ea,ness
OBJECTIVE/PATIENT OUTCOME #or this diagnosis:
Patient $ill "e a"le to demonstrate increased tolerance to actiity $ithin a $ee,
NURSING INTERVENTIONS that $ill assist the patient to resole the a"oe identi#ied diagnosis:
3< 7o"ili+e the patient as soon as possi"le
%< 2hen appropriate* gradually increase actiity* allo$ing the client to assist $heneer possi"le $ith
positioning* sel#-care and trans#erring
4< 7onitor and record clients a"ility to tolerate actiity* note pulse* "lood pressure* monitor pattern*
dyspnea and use o# accessory muscles
# NURSING DIAGNOSIS 'pro"lem r:t)
5mpaired gas exchange r:t aleolar-capillary changes<
DEFINING CHARACTERISTICS (S/S) that support this diagnosis:
A"normal "reathing* diaphoresis* dyspnea* hypercapnia* hypoxemia* nasal #laring* tachycardia
OBJECTIVE/PATIENT OUTCOME #or this diagnosis:
7aintain clear lung #ields and remain and remain #ree o# respiratory distress in 4 days<
NURSING INTERVENTIONS that $ill assist the patient to resole the a"oe identi#ied diagnosis:
3< O"sere #or signs o# cyanosis o# the s,in* especially note the color o# the tongue and mucous
mem"ranes
%< 7onitor the respiratory rate* depth and ease o# respirations< 2atch #or use o# accessory muscles and
nasal #laring<
4< Auscultate "reath sounds eery 3 to % hours< Aisten #or diminished "reath sounds crac,les* rales and
$hee+es<
COMPLICATIONS:
5# this patient-s condition $ere to $orsen* $hat $ould "e the most li,ely reason and $hy=
Death* ina"ility to exchange oxygen and car"on dioxide success#ully and then not "e a"le to proide
enough oxygen to the organs and tissues< ?ecrosis occurs<
/o$ $ould you ,no$ this is happening=
5ncreased shortness o# "reath* $ea,ness and #atigue< Cyanosis* cold s,in and decreased leel o#
consciousness $ould all "e symptoms<
2hat $ill you do i# this happens=
?oti#y the physician and patient #amily* proide end o# li#e care and com#ort #or the patient in the dying
process<
PHYSICIAN PRESCRIBED MEDICATIONS AND INTERVENTIONS
MEDS/IV!/T"/DIET
(I#$%&'( ')!(* +)&,(*
-+(.&(#$/)
REASON
PRESCRIBED
(D+&0 C%1!!2-2$1,2)#*
341, 2! 2, ,+(1,2#05)
NURSING
IMPLICATIONS FROM
TE"T
(C4($62#0 -)+ 1'7(+!(
+(1$,2)#!* 8+(81+1,2)#
9 1':2#2!,+1,2)#
$)#$(+#!)
PATIENT DATA FROM
YOUR ASSESSMENT
(341, '1,1 2! 2:8)+,1#,
,) 6#); <(-)+( 9 1-,(+
0272#0)
Al"uterol-
4mA* ?E6* B6C
6ronchidilator !achycardia and
palpitation* hypo,alemia
Allergies* heart disease
history* dia"eties*
glaucoma* lier:,idney
disease
Chlordia+epoxide-
%8mgD 3 ta"* P<O<*
BEC
Anxiety and alcohol
$ithdra$al
C?S depressant
/allucinations*
respiratory depression*
di++iness
(all Fis, 7edC Any
respiratory issues in
history* allergies
Enoxaparin-
&1mgD1<&mA* Su"G*
daily
Anticoagulant
Clot preention
!hrom"ocytopenia*
"leeding out
/istory o# "leeding
disorders* C6C-P!-aP!!
(olic acid-
3mgD3 ta"* P<O< daily
Synthesis o# D?A
itamin< Decrease
E!O/ $ithdra$al*
depression and sei+ures
/igh doses may cause
se+uires* sleep
distur"ances* allergic
reaction* nausea
Allergy* ,idney disease*
Anemia* alcohol
consumption
Huai#enesin EF-
611mgD3 ta"* P<O<*
B3%C
Expectorant
Cough* loosen phlegm
Do not crush* high doses
can cause omiting*
headache* allergic
reaction
Allergy* a#e pregnant*
"reast #eeding
7ethylpredisone-
41mgD1<08mA*
Hlucocorticoid*
corticosteroid* anti-
in#lammitory and
immunosuppressie
properties
7ood s$ings* $eight
gain* hyperglycemia*
hypo,alemia* H5 ulcers
(ungal in#ectionsCDo ?ot
ta,eC hypertension* heart
disease* head inIury*
thyroid disorder
!hiamine-
311mgD3ta"* P<O<
daily
Jitamin 6 de#iciency Cyanosis* chest pain*
Shortness o# "reath* H5
"leed* allergic reaction
Allergies* do not ta,e or
use her"al products or i#
you hae other medical
issues
ANALYSIS OF DIAGNOSTIC TESTS
Diagnostic:Aa" !est Patient Jalues Analysis o# Jalues
DF Chest x-ray
?o acute cardiopulmonary
process identi#ied
?o changes
!$o Jie$- Chest 3<no acute cardiopulmonary
a"normality
%< emphysema
Exacer"ation o# emphysema
Sodium
3%0-lo$ 5nadeBuate inta,e or poor sodium
retention
Chloride
98-lo$ Could possi"ly "e due to chronic
respiratory acidosis
Hlucose
3%3-high !his could possi"ly "e high due to
ta,ing a steroid
Calcium Aeel !otal
E<&-lo$ Possi"le related to patient-s alcohol
a"use
/g"
34<1-lo$ Possi"ly due to nutritional de#icit
#rom alcohol a"use
Hct 37.0-low Possi"ly due to nutritional de#icit or
start o# cirrhosis
F6C
&<1%-lo$ Seen in chronic in#lammatory
diseases
?eut Auto
0<8-lo$ Seen in chronic in#lammatory
diseases
Aymph Auto 0<8-lo$ Possi"ly related to malnutrition
7ono Auto 3&<8-high Possi"ly related to cirrhosis
Aymph A"solute 1<&3-lo$ Possi"ly related to malnutrition
7ono A"solute 1<98-high Possi"ly related to the start o#
cirrhosis