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 overwhelming 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the CNS altering the Pertinent Physical Examination findings: Pt was perception and emotional alert oriented x,and withdrawn.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 malodorous. 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) 2