MS Care Plan
MS Care Plan
Client InitialsClient Initials: : JBAJBA Room Room #: #: 513- 513-1
1
Age
Age: : 7070 Gender: MGender: M Allergies
Allergies: NKA: NKA Code Status
Code Status: : Full Full codecode WtWt: : 80 80 kg kg (176(176 lbs.) lbs.) Ht Ht: : 172.2 172.2 cmcm (5’6”) (5’6”) BMI: 27 BMI: 27 Admit Date Admit Date: 11-05-11: 11-05-11 Admitting Diagnosis/Symptoms Admitting Diagnosis/Symptoms::
Lower left extremity DVT (Left knee to groin) Lower left extremity DVT (Left knee to groin)
DVT can occur as the result of several combined events, including venous stasis, DVT can occur as the result of several combined events, including venous stasis, injury to the vessel wall, and the coagulation rate is altered. These conditions injury to the vessel wall, and the coagulation rate is altered. These conditions cause the formation of a blood clot, which becomes dangerous when the clot cause the formation of a blood clot, which becomes dangerous when the clot
fragments and occlude the vessel. Complications of DVT include increased venous fragments and occlude the vessel. Complications of DVT include increased venous pressure, increased distal pressure, fluid stasis, and edema. (Smeltzer 2008)
pressure, increased distal pressure, fluid stasis, and edema. (Smeltzer 2008) Current Medical Dx
Current Medical Dx: LLE DVT w/ IVC : LLE DVT w/ IVC filter placementfilter placement
An IVF filter (or umbrella filter) is inserted to prevent recurring pulmonary An IVF filter (or umbrella filter) is inserted to prevent recurring pulmonary
embolisms. The device is inserted through the internal jugular vein and advanced embolisms. The device is inserted through the internal jugular vein and advanced into the inferior vena cava, where it is opened and operates as a filter for the
into the inferior vena cava, where it is opened and operates as a filter for the bloodstream that prevents large thrombi from passing through. (Smeltzer 2008) bloodstream that prevents large thrombi from passing through. (Smeltzer 2008) good explanations here and with PMH
good explanations here and with PMH PMH/PSH
PMH/PSH::
Polycythemia vera
Polycythemia vera: (Bone marrow disease that leads to an abnormal increase in: (Bone marrow disease that leads to an abnormal increase in the number of blood cells. WBS and platelets are also increased. Thrombosis is a the number of blood cells. WBS and platelets are also increased. Thrombosis is a complication of this disease.)
complication of this disease.) RLE DVT in 2008:
RLE DVT in 2008: (Formation of a blood clot in a vein. This is the pt’s current(Formation of a blood clot in a vein. This is the pt’s current issue, though now in the opposite leg. PMH of past DVT and polycythemia identify issue, though now in the opposite leg. PMH of past DVT and polycythemia identify pt is at higher risk for venous stasis, vessel wall injury, and hypercoagulability. ) pt is at higher risk for venous stasis, vessel wall injury, and hypercoagulability. ) Prostatectomy:
Prostatectomy: (Total removal of prostate gland in 2006. Denies complications(Total removal of prostate gland in 2006. Denies complications from surgery.)
from surgery.) Appendectomy:
Appendectomy: (Total removal of appendix in 1990s. Denies complications from(Total removal of appendix in 1990s. Denies complications from surgery. History of abdominal surgery is associated with thrombus/emboli).
surgery. History of abdominal surgery is associated with thrombus/emboli). Social history (ethnicity, occupation, marital status,
Social history (ethnicity, occupation, marital status, family support, livingfamily support, living situation)
situation)::
White; married w/ grown children; retired; financially independent and fully mobile. White; married w/ grown children; retired; financially independent and fully mobile.
Relevant Medical Orders
Relevant Medical Orders
VS freqVS freq: q4h: q4h Diet
Diet: : Coumadin dieCoumadin diet what t what would this would this be?be? Blood sugarsBlood sugars: N/A: N/A Activity
Activity: : No No restrictionsrestrictions Oxygen
Oxygen: : RARA Respiratory TxRespiratory Tx: N/A: N/A Dressing Changes
Dressing Changes: q4d: q4d Other relevant orders Other relevant orders::
Continuous telemetry (baseline HR 87 & sinus rhythm with no ectopy, meaning all Continuous telemetry (baseline HR 87 & sinus rhythm with no ectopy, meaning all heart beats originate from the proper place in the heart.
heart beats originate from the proper place in the heart.
Safety & Communication
Safety & Communication
PrimaryPrimary Language: Language: English English Translator Translator required: required: NN Special
Sign Language Interpreter Required: N Sign Language Interpreter Required: N Isolation
Isolation: N/A: N/A Falls Risk Score
Falls Risk Score: : Min. Min. fall fall riskrisk Aspiration Risk
Aspiration Risk : N/A: N/A Bleeding Precautions
Bleeding Precautions: : Yes. No Yes. No aspirin; soft aspirin; soft toothbrush; electric toothbrush; electric razor only; razor only; reportreport constipation.
Assessment
Assessment
Physical Assessment Findings Physical Assessment Findings
Analysis of Findings Analysis of Findings (Norma
(Normal or l or not? not? What iWhat is thes the significance of abnormal findings?) significance of abnormal findings?) VS VS BP 131/76 BP 131/76 HR: 83 HR: 83 T: 98.5 T: 98.5 O2 Sat: 98% on RA O2 Sat: 98% on RA
Normal, though BP is high, when Normal, though BP is high, when
compared to baseline BP of 140/80 and compared to baseline BP of 140/80 and no history of HTN.
no history of HTN.
General appearance General appearance
Well groomed and pleasant Well groomed and pleasant
Behavior and speech appropriate Behavior and speech appropriate
Normal Normal
Weight appears normal though BMI Weight appears normal though BMI slightly high
slightly high Pain
Pain
Pt reports pain at 0 on a scale from 0-10 Pt reports pain at 0 on a scale from 0-10
Normal Normal Neuro/Psych
Neuro/Psych
A & O x 3 to person, place, and time A & O x 3 to person, place, and time Moves all extremities
Moves all extremities Reports no dizziness Reports no dizziness Normal Normal CV CV Venous thromboembolism Venous thromboembolism
Anticoagulation therapy: Heparin IV Anticoagulation therapy: Heparin IV +1 edema on LLE; no edema present +1 edema on LLE; no edema present elsewhere on body
elsewhere on body
HR 83 BPM, Rhythm regular HR 83 BPM, Rhythm regular
No S3, no S4 or other extra sounds, no No S3, no S4 or other extra sounds, no murmurs
murmurs
No visible pulsations, no heave or lift. No visible pulsations, no heave or lift. Palpated apical impulse in 5
Palpated apical impulse in 5thth ICS and MCL,ICS and MCL,
no thrill no thrill
Capillary refill >3 seconds Capillary refill >3 seconds
Pt monitored for improvement of edema Pt monitored for improvement of edema in LLE; monitored for response to
in LLE; monitored for response to anticoagulant therapy.
anticoagulant therapy.
Respiratory Respiratory
RR 18, even and unlabored RR 18, even and unlabored BS CTA, no adventitious sounds BS CTA, no adventitious sounds O2 Sat: 98% on RA O2 Sat: 98% on RA Normal Normal GI GI
Abdomen soft and NT, BS present in all four Abdomen soft and NT, BS present in all four quadrants. No bruits.
quadrants. No bruits.
Abdomen flat and symmetric with no Abdomen flat and symmetric with no apparent masses.
apparent masses.
Reports 0 abdominal pain on 1-10 scale. Reports 0 abdominal pain on 1-10 scale.
Normal Normal GU GU Continent, no catheter Continent, no catheter Normal Normal MS MS
Full ROM, no pain with walking. Full ROM, no pain with walking.
Can walk without assistance. Full mobility. Can walk without assistance. Full mobility.
Normal Normal
Integumentary Integumentary
Purple bruise approx. 4 in. x 2 in on RU arm Purple bruise approx. 4 in. x 2 in on RU arm
Monitor IV sites. Monitor IV sites.
Monitor bruises for progression; risk for Monitor bruises for progression; risk for
Pink-red bruise on center thorax, 3 in. x 3 in. Pink-red bruise on center thorax, 3 in. x 3 in. Pt reports “I bruise easily.”
Pt reports “I bruise easily.”
Skin WD and intact except in IV therapy sites Skin WD and intact except in IV therapy sites
impaired skin integrity or pressure ulcers. impaired skin integrity or pressure ulcers.
IV IV
Central line with 1 lumen, RT int. jugular Central line with 1 lumen, RT int. jugular Peripheral IV in right antecube
Peripheral IV in right antecube Skin around both insertions WDI. Skin around both insertions WDI.
Dressings on neck and RU extremity CDI. Dressings on neck and RU extremity CDI.
Care should include dressing changes Care should include dressing changes according to hospital protocol, which according to hospital protocol, which includes strict sterile technique. If includes strict sterile technique. If
dressings become saturated with blood dressings become saturated with blood r/t to patient’s treatment with
r/t to patient’s treatment with anticoagulants, notify physician. anticoagulants, notify physician.
Laboratory Tests
Laboratory Tests
Diagnostic Tests
Diagnostic Tests
T Teesstt RReeaassoonn for test for test Results/ Results/ Findings Findings Significance of Significance of Results Results Venogram. This Venogram. This is a contrast is a contrast enhanced x-ray enhanced x-ray study of the study of the venous system venous system of an of an extremity. extremity. (Pagana p. (Pagana p. 1139) 1139) Suspected Suspected DVT DVT DVT knee to DVT knee to groin in LLE. groin in LLE. Pt should begin Pt should begin anticoaglulation anticoaglulation therapy therapy TTeelleemmeettrryy MMoonniittoorr continuous continuous HR r/t DX of HR r/t DX of DVT DVT Sinus rhythm Sinus rhythm with no ectopy. with no ectopy. Pt has no new CV Pt has no new CV problems related to problems related to current medical DX of current medical DX of DVT. DVT. L Laab b TTeesstt NNoorrmmaall Values Values Patien Patien tt Result Result Significance of Result Significance of Result Partial Partial Thromboplastin Thromboplastin Time (PTT) BID Time (PTT) BID 60-70 60-70 seconds seconds 92.3 92.3 second second s s
Used to determine how long it Used to determine how long it takes for the blood to clot. takes for the blood to clot.
(MedLine Plus) Monitors the effects (MedLine Plus) Monitors the effects of treatment with Heparin, an
of treatment with Heparin, an anticoagulant. PTT level used to anticoagulant. PTT level used to determine dosage of Heparin, determine dosage of Heparin, according to a sliding scale. The according to a sliding scale. The sliding scale states that if the PTT is sliding scale states that if the PTT is >90, it should be held for 1 hour >90, it should be held for 1 hour and then restarted at a reduced and then restarted at a reduced rate. If the PTT is 60-70, the rate. If the PTT is 60-70, the medication should be held. medication should be held. Prothrombin Prothrombin Time Time PT: 11-12.5 PT: 11-12.5 seconds; seconds; INR: INR: 0.8-1.1 1.1 PT: PT: 19.71 19.71 second second s; INR: s; INR: 1.61 1.61
PT is used to evaluate the PT is used to evaluate the
adequacy of the extrinsic system adequacy of the extrinsic system and common pathway (factor 1: and common pathway (factor 1: fibrinogen, factor 2: prothrombinin, fibrinogen, factor 2: prothrombinin, and factors 5, 7 and 10) in the
and factors 5, 7 and 10) in the clotting mechanism. This is a clotting mechanism. This is a common test for people with common test for people with
thromboembolic disease and being thromboembolic disease and being treated with Coumadin. PT is used treated with Coumadin. PT is used with PTT to determine the function with PTT to determine the function of coagulation factors. (Pagana p. of coagulation factors. (Pagana p. 448)
MEDICATIONS MEDICATIONS D
Drruugg DDoossee FFrreeqq RRttee IINNDDIICCAATTIIOONNS S aannd d NNuurrssiinngg Considerations
Considerations (side effects, adverse(side effects, adverse reactions, interactions) reactions, interactions) O Oxxyyccooddoonnee 5//35 3225 5 mmgg qq44hh PRN PRN P
POO OOpipiooid id ananalalgegesisic uc usesed fod for mr moodederaratete to severe pain. Action unknown, to severe pain. Action unknown, binds with opioid receptors in the binds with opioid receptors in the CNS, altering perception of and CNS, altering perception of and
emotional response to pain. Adverse emotional response to pain. Adverse effects include bradycardia,
effects include bradycardia,
respiratory depression, constipation, respiratory depression, constipation, nausea, vomiting. Do not use with nausea, vomiting. Do not use with products containing aspirin, or MAO products containing aspirin, or MAO inhibitors. Nursing considerations inhibitors. Nursing considerations include reassessing patient’s level of include reassessing patient’s level of pain at least 15 and 30 minutes after pain at least 15 and 30 minutes after administration. Drug is potentially administration. Drug is potentially addictive. Instruct patient to take addictive. Instruct patient to take drug before pain is intense. (Nursing drug before pain is intense. (Nursing Drug Handbook pp 1017-1019) Drug Handbook pp 1017-1019) H Heeppaarriinn//DD55WW 2255,,000000 units/5 mL units/5 mL (500 mL) (500 mL)
Draw blood to determine baseline Draw blood to determine baseline coagulation levels. What is heparin coagulation levels. What is heparin actually used for?
actually used for? C
Coouummaaddiinn 5 5 mmgg qq88hh PPOO AnAnttiiccooaagguullaannt t ffoor r ddeeeep p vveeiinn thrombosis. Adverse reactions thrombosis. Adverse reactions
include fever, hemorrhage, hepatitis, include fever, hemorrhage, hepatitis, rash, and anaphylactic reactions. rash, and anaphylactic reactions. Draw blood to determine baseline Draw blood to determine baseline coagulation levels. Drug interactions coagulation levels. Drug interactions include many medications, including include many medications, including anabolic steroids, NSAIDs, salicylates, anabolic steroids, NSAIDs, salicylates, and thyroid drugs. Provide teaching and thyroid drugs. Provide teaching to patient about foods to avoid. to patient about foods to avoid.
Patient must monitor the daily intake Patient must monitor the daily intake of vitamin K. Avoid all IM injections. of vitamin K. Avoid all IM injections. (Nursing Drug Handbook pp. (Nursing Drug Handbook pp. 1403-1406)
1406) P
Prroottoonniixx 440 0 mmgg BBIIDD PPOO AAnnttiiuullcceer r aannd d pprroottoon n ppuummp p iinnhhiibbiittoorr for gastroesophageal reflux disease. for gastroesophageal reflux disease. Give drug without regard for food. Give drug without regard for food. Don’t crush or split tablets. Drug Don’t crush or split tablets. Drug inhibits proton pump activity by inhibits proton pump activity by binding to hydrogen-potassium binding to hydrogen-potassium adenosine triphosphase, located at adenosine triphosphase, located at the secretory surface of parietal cells. the secretory surface of parietal cells. Adverse Reactions include
Adverse Reactions include
hyperglycemia, hyperlipemia. Drug hyperglycemia, hyperlipemia. Drug interactions include St. John’s Wort. interactions include St. John’s Wort. Patient may be more sensitive to Patient may be more sensitive to sunlight. Instruct patient to take sunlight. Instruct patient to take exactly as prescribed and at about exactly as prescribed and at about the same time every day. (Nursing the same time every day. (Nursing Drug Handbook pp 1040-1041) Drug Handbook pp 1040-1041) A
Ammbbiieenn 110 0 mmgg PPRRNN PPOO HHyyppnnoottiic c aannd d ccoonnttrroolllleed d ssuubbssttaannccee schedule IV. For the short-term schedule IV. For the short-term management of insomnia. For rapid management of insomnia. For rapid
*Ordered mid-shift to begin the patient’s discharge process. Patient was *Ordered mid-shift to begin the patient’s discharge process. Patient was taken off Heparin drip two hours after the Lovenox shot was administered. taken off Heparin drip two hours after the Lovenox shot was administered.
Nursing Diagnosis #1 Nursing Diagnosis #1::
Ineffective tissue perfusion (peripheral) (LWW pp. 608-614) Ineffective tissue perfusion (peripheral) (LWW pp. 608-614) R
R//TT: I: Inntteerrrruuppttiioon n oof f vveennoouus s ffllooww AAEEBB: D: DVVT T iin n LLLLEE
+1 edema in LLE +1 edema in LLE
PTT lab values abnormal PTT lab values abnormal Overall goal
Overall goal (measurable(measurable))::
By the end of shift, patient will demonstrate increased perfusion AEB lab results WNL; By the end of shift, patient will demonstrate increased perfusion AEB lab results WNL; decreased swelling in LLE according to
decreased swelling in LLE according to measurements and assessment; pt free of pain ameasurements and assessment; pt free of pain andnd discomfort according to 0-10 scale.
discomfort according to 0-10 scale.
IInntteerrvveennttiioonnss:: RRaattiioonnaalle e ffoor r IInntteerrvveennttiioonn:: EExxppeecctteed d OOuuttccoommee:: (Measurable)
(Measurable) Administer medication as
Administer medication as ordered by physician and ordered by physician and monitor effectiveness. monitor effectiveness.
Medications will help the Medications will help the patient return to baseline patient return to baseline levels, but need to be levels, but need to be
monitored due to serious side monitored due to serious side effects.
effects.
Medications will work Medications will work effectively and improve effectively and improve the patient’s condition, the patient’s condition, with no notable side with no notable side effects.
effects. Monitor lab values to assess
Monitor lab values to assess effect of anticoagulant therapy effect of anticoagulant therapy and report lab values outside the and report lab values outside the desired range.
desired range.
Lab values reflect progress of Lab values reflect progress of the patient’s venous flow and the patient’s venous flow and peripheral tissue perfusion. peripheral tissue perfusion. HB/Hct
HB/Hct
Patient’s PTT levels will Patient’s PTT levels will be within the normal be within the normal range. Other related lab range. Other related lab values (PT and INR,
values (PT and INR, HCT/HB) also within HCT/HB) also within normal range.
normal range. Educate patient on avoiding
Educate patient on avoiding activities that could cause activities that could cause bruising and bleeding. bruising and bleeding.
Bleeding can become a Bleeding can become a medical emergency due to medical emergency due to anticoagulant therapy. anticoagulant therapy.
Patient will verbalize an Patient will verbalize an understanding of understanding of precautionary precautionary measures. measures. Monitor swelling in LLE and
Monitor swelling in LLE and check for pedal pulses. Monitor check for pedal pulses. Monitor pain associated with edema (per pain associated with edema (per pt’s earlier report of feeling pain pt’s earlier report of feeling pain in LLE with the onset of edema, in LLE with the onset of edema, before treatment).
before treatment).
Leg
Leg measurememeasurementnt
discrepancies of more than 2 discrepancies of more than 2 cm warrant further
cm warrant further
investigation. Swelling or lack investigation. Swelling or lack of swelling indicates whether of swelling indicates whether venous flow is efficient.
venous flow is efficient.
Pt reports no pain, and Pt reports no pain, and there is no tenderness there is no tenderness or swelling on the lower or swelling on the lower extremities.
extremities.
E
Edduuccaattiioon n ((pptt//ffaammiillyy)): : RRaattiioonnaallee:: EExxppeecctteed d OOuuttccoommee:: Discuss
Discuss relevant relevant risk risk factors. factors. Information necessary Information necessary forfor client to make informed client to make informed choices about remedial risk choices about remedial risk factors and lifestyle
factors and lifestyle changes.
changes.
Discussion regarding Discussion regarding risk factors will
risk factors will
continue until patient continue until patient demonstrates demonstrates accurate knowledge accurate knowledge of risk factors. of risk factors. Discuss care of LLE with regard to
Discuss care of LLE with regard to DVT and edema. DVT and edema. When circulation is When circulation is impaired, changes in impaired, changes in
sensation place client at risk sensation place client at risk for injury.
for injury.
Client will recognize Client will recognize how to care for
how to care for affected extremity. affected extremity. Educate client about reportable
Educate client about reportable
symptoms, including any changes in symptoms, including any changes in pain level, difficulty walking, etc. pain level, difficulty walking, etc.
Reporting symptoms will Reporting symptoms will provide opportunity for provide opportunity for timely evaluation and timely evaluation and intervention. intervention. Pt will verbalize an Pt will verbalize an understanding of the understanding of the importance of early importance of early interventions. interventions. D
What is anticipated length of stay? Where is pt being discharged to? What support do they What is anticipated length of stay? Where is pt being discharged to? What support do they have and/or need
have and/or need?? Patient was discharged on 11-7-11, the day I was in the hospital Patient was discharged on 11-7-11, the day I was in the hospital with him.
with him.
Work toward discontinuation of Work toward discontinuation of Heparin drip so that client can be Heparin drip so that client can be discharged, per physician order. discharged, per physician order.
With lab values within With lab values within normal ranges, the client normal ranges, the client should have the option of should have the option of treatment with a method treatment with a method that is convenient for life that is convenient for life after discharge. after discharge. Heparin treatment Heparin treatment will be successfully will be successfully discontinued with no discontinued with no complications. complications.
Nursing Diagnosis #2
Nursing Diagnosis #2: Readiness for enhanced self health management (LWW pp. 425-: Readiness for enhanced self health management (LWW pp. 425-428)
428) R
R//TT: : PPrreevveennttiioon n oof f DDVVT T rreeccuurrrreennccee AAEEBB: : PPt t eexxpprreessssees s ddeessiirre e tto o mmaannaagge e tthhee illness.
illness.
Verbalizes no difficulty w/ prescribed Verbalizes no difficulty w/ prescribed regimens.
regimens.
Describes reduction of risk factors. Describes reduction of risk factors. Overall goal
Overall goal (measurable(measurable)): Before being discharged, patient will demonstrate proactive: Before being discharged, patient will demonstrate proactive management by anticipating and planning for eventualities of condition or potential
management by anticipating and planning for eventualities of condition or potential complications.
complications.
IInntteerrvveennttiioonnss:: RRaattiioonnaalle e ffoorr Intervention: Intervention: Expected Outcome: Expected Outcome: (Measurable) (Measurable) Identify individual’s expectations of
Identify individual’s expectations of long-term treatment needs and
long-term treatment needs and anticipated changes.
anticipated changes.
This allows the nurse to This allows the nurse to
evaluate whether the evaluate whether the patient’s expectations of patient’s expectations of long-term treatment are long-term treatment are accurate, or if he needs accurate, or if he needs further teaching.
further teaching.
Patient will express Patient will express accurate knowledge accurate knowledge of what to expect of what to expect from long-term from long-term treatment. treatment. Identify any concerns or underlying
Identify any concerns or underlying issues related to the patient’s health issues related to the patient’s health or mental status.
or mental status.
Secondary issues could Secondary issues could have an effect on the have an effect on the
patient’s ability to follow a patient’s ability to follow a medication or therapeutic medication or therapeutic regimen.
regimen.
Patient will report no Patient will report no secondary problems secondary problems that could interfere that could interfere with the success of a with the success of a therapeutic regimen. therapeutic regimen.
E
Edduuccaattiioon n ((pptt//ffaammiillyy)): : RRaattiioonnaallee:: EExxppeecctteed d OOuuttccoommee:: Explore with patient areas of health
Explore with patient areas of health over which each individual has
over which each individual has control and discuss barriers to control and discuss barriers to healthy practices.
healthy practices.
This education will help the This education will help the
client plan to improve client plan to improve health practices.
health practices.
Patient will verbalize Patient will verbalize foods and activities foods and activities that could interfere that could interfere with a full recovery or with a full recovery or that could cause a that could cause a recurrence.
recurrence. Verify client’s level of knowledge and
Verify client’s level of knowledge and understanding of therapeutic
understanding of therapeutic regimen.
regimen.
This provides the This provides the patient/nurse an patient/nurse an
opportunity to ensure opportunity to ensure accuracy and
accuracy and competenccompetencyy for future learning.
for future learning.
Patient will provide a Patient will provide a high level of
high level of
knowledge about the knowledge about the therapeutic regimen. therapeutic regimen.
D
Diisscchhaarrgge e PPllaannnniinngg:: RRaattiioonnaallee:: EExxppeecctteed d OOuuttccoommee:: What is anticipated length of stay? Where is pt being discharged to? What support do they What is anticipated length of stay? Where is pt being discharged to? What support do they have and/or need? Patient was discharged 11-5-11 with medication orders. He was
have and/or need? Patient was discharged 11-5-11 with medication orders. He was
discharged due to a PTT value within normal limits. Patient still had +1 edema on LLE but discharged due to a PTT value within normal limits. Patient still had +1 edema on LLE but reported 0 pain on 0-10 scale.
reported 0 pain on 0-10 scale. His wife was with His wife was with him at discharge and drove him back tohim at discharge and drove him back to their home.
their home.
Provide teaching on medications Provide teaching on medications ordered by clinician; including ordered by clinician; including adverse effects; precautions; adverse effects; precautions;
Patient must follow Patient must follow
medication regiment and medication regiment and report and side effects such report and side effects such
Patient will Patient will demonstrate demonstrate proactive proactive
dosages; routes; and when to take dosages; routes; and when to take the medication. the medication. as bleeding, immediately to as bleeding, immediately to physician. physician. management by management by anticipating and anticipating and planning. planning. Provide teaching on any special diets
Provide teaching on any special diets related to the medications ordered. related to the medications ordered.
With Coumadin therapy, the With Coumadin therapy, the patient must monitor daily patient must monitor daily intake of vitamin K; no more intake of vitamin K; no more than 120 mcg of vitamin K than 120 mcg of vitamin K should be ingested per day. should be ingested per day. Also, avoid cranberry juice, Also, avoid cranberry juice, as it might increase the risk as it might increase the risk of bleeding.
of bleeding.
Patient will verbalize Patient will verbalize how to properly
how to properly follow the restricted follow the restricted diet.
References References
Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). 23 & 31.
Brunner, L. S., Suddarth, D. S., & Smeltzer, S. C. (2008). 23 & 31. Brunner & Suddarth's Brunner & Suddarth's textbook of medical-surgical nursing
textbook of medical-surgical nursing (11th ed., p. 666 p. 1005). Philadelphia:(11th ed., p. 666 p. 1005). Philadelphia: Lippincott Williams & Wilkins.
Lippincott Williams & Wilkins.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010).
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nurse's pocket guide diagnoses, Nurse's pocket guide diagnoses, prioritized interventions, and rationales
prioritized interventions, and rationales (12th ed.). Philadelphia: F.A. Davis.(12th ed.). Philadelphia: F.A. Davis. Lippincott's nursing drug handbook 2012
Lippincott's nursing drug handbook 2012. (2012). Philadelphia, Pa.: Lippincott Williams &. (2012). Philadelphia, Pa.: Lippincott Williams & Wilkins.
Wilkins.
Pagana, K. D., & Pagana, T. J. (2010).
Pagana, K. D., & Pagana, T. J. (2010). Mosby's manual of diagnostic and laboratory tests Mosby's manual of diagnostic and laboratory tests (4th ed.). St. Louis, Mo.: Mosby Elsevier.
(4th ed.). St. Louis, Mo.: Mosby Elsevier.
Partial thromboplastin time (PTT): MedlinePlus Medical Encyclopedia.
Partial thromboplastin time (PTT): MedlinePlus Medical Encyclopedia. National Library National Library of Medicine - National Institutes of Health
of Medicine - National Institutes of Health. Retrieved November 10, 2011, from. Retrieved November 10, 2011, from http://www.nlm.nih.gov/medlineplus/ency/article/003653.htm
http://www.nlm.nih.gov/medlineplus/ency/article/003653.htm Polycythemia vera - PubMed Health.
Polycythemia vera - PubMed Health. National Center for Biotechnology Information National Center for Biotechnology Information.. Retrieved November 10, 2011, from
Retrieved November 10, 2011, from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001615/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001615/
