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Biming Wang Biming - Coggle Diagram

- - - - REASON: To establish the nursing diagnosis and intervention, the admitting diagnosis should be define.
  - - - Patient: Biming Wang
    - - Health perception-health management: IV Drug and alcohol abuse
        
        REASON: Substance abuse and alcoholism are risk factors for having hepatitis
      - Nutritional-metabolic:
        
        feeling of fullness in the right upper quadrant
        
        caloric intake 1000 calories less than recommended
        
        can usually find one meal per day
        
        typically eat leftovers from fast food chains
        
        ate ¼ of his lasagna in the hospital
        
        REASON: These data will prove that the patient has IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS related to nausea and loss of appetite which is common in patient with viral hepatitis
      - Elimination
        
        light-colored stools, diarrhea, and skin rashes
        
        REASON: Conjugated bilirubin cannot flow out of the liver d/t obstruction and inflammation. Skin rashes or pruritus d/t accumulation of bile salts beneath the skin.
      - Cognitive-perceptual
        
        headache, right upper quadrant pain, and liver tenderness
        
        REASON: Common manifestations of Viral Hepatitis. Can be attributed to SELF-CARE DEFICIT D/T PAIN.
      - Activity-exercises
        
        Fatigue, arthralgia, myalgias
      - Role-relationship
        
        Have family close by
        
        REASON: Patient need to be screened for depression and other mood disorders before starting interferon-based treatment for hepatitis. Can be attributed to his problem with IMPAIRED HOME MAINTENANCE.
      - Self-perception
        
        Depression and anxiety
    - - Subjective
        
        Use and misuse of heroin via intravenous
        
        REASON: Risk factors for Hepatitis B
      - Objective:
        
        Given dimenhydrinate 50 mg PO (0.05ml) IV every 4 hours PRN as per Dr.’s order
        
        To start Ibuprofen 200 mg PO q 4 to 6 hours PRN as per Dr.’s order
  - - - Lethargic
        
        REASON: It determines if the patient is underweight and DEHYDRATED DUE TO IMBALANCE NUTRITION
      - Wt. 128 lbs
      - Ht. 5’10”
      - BMI: 15.4
    - - Icteric sclera
        
        REASON: The patient presented in ER with jaundice probably related to HYPERBILIRUBINEMIA
      - Visible multiple injection sites
      - Body pierce: left ear and nose
        
        REASON: Risk factors for Hepatitis B
    - - Hepatomegaly
      - Splenomegaly
        
        REASON: Common manifestations of Viral Hepatitis.
    - - Drug test:
        
        positive for Heroin use
        
        REASONS:
        
        Screen for liver infections, such as hepatitis
        
        Monitor the progression of a disease
        
        Determine how well a treatment is working
        
        Measure the severity of a disease, particularly scarring of the liver (cirrhosis)
        
        • Monitor possible side effects of medications
      - Ultrasound:
        
        hepatomegaly and splenomegaly
      - Liver function test:
        
        Alanine aminotransferase (ALT)
        
        Aspartate aminotransferase (AST)
        
        Serum bilirubin
        
        Prothrombin time (PT) and INR
        
        Alkaline phosphatase
      - Hepatitis testing:
        
        Hepatitis A: Anti-HAV IgM
        
        Hepatitis B: HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc IgM and IgG, HBV DNA quantitation, HBV genotyping
        
        Hepatitis C: Anti-HCV, HCV RNA quantitation, HCV genotyping
        
        Hepatitis D: Anti-HDV, HDV Ag
      - Fasting blood sugar
        
        REASON:
        
        Patient presented to ER with HYPERGLYCEMIA.
        
        To assess if the patient is developing Type 2 DM related to liver damaged.
      - A1C test
- - - - Hepatitis B surface antigen (HBsAg)
        
        A "positive" or "reactive" HBsAg test result means that the person is infected with hepatitis B
        
        This test can detect the actual presence of the hepatitis B virus (called the “surface antigen”) in your blood
    - - Increase fluids and encourage this as intake was 100 mL and output 300 mL (should be 480 ml in 8 hour shift)
        
        Nausea and has no appetite give dimenhydrinate 50 mg q 4 to 6 hours I.V. to help with this
    - - Provides immediate, short-term protection against hepatitis B infection
        
        HBIg has large amounts of hepatitis B antibodies taken from donated human blood
        
        Antibodies are proteins that a person's immune system makes to fight germs, such as bacteria and viruses like hepatitis B.
        
        Early administration needs to be given 1-2 weeks after exposed
    - - The body develops antibodies against hepatitis B virus (HBV)
        
        This response is known as active immunity
        
        Will have impaired metabolic metabolism since liver is inflamed – ask about pain
  - - - After contact with affected patient or after removal of gloves
    - - Barrier precautions: - Wear gloves, aprons, lab coats and other protective clothing as needed.
      - Wear goggles or face shields to protect against splashing of blood or body fluids into eyes or mouth or onto broken skin or skin rashes.
  - - - Collaborate with the dietitian while in hospital to meet nutritional requirements, such as added protein powder in foods the patient enjoys
        
        Ask food preferences
      - Collaborate with the dietitian while in hospital to meet nutritional requirements, such as added protein powder in foods the patient enjoys
        
        Ask food preferences
      - Offer frequent small meals to enhance dietary intake
      - Allow patient to choose food items, serve high-carb and high-protein foods at time of day when pt. feels like eating to increase likelihood of adequate intake
      - Provide attractively served meals to stimulate appetite
      - Measure weight daily to monitor weight loss secondary to poor appetite
    - - Teach patient to monitor and control activities that provoke fatigue to prevent setback of activity progression
      - When possible, limit environmental stimuli (light and noise) to facilitate relaxation
      - Increase patients activity gradually, as tolerated, to allow previous activity pattern to be returned
      - Assist patient in scheduling rest periods to maximize the benefits of rest and relaxation
    - - Educate the patient about basic facts about the illness
        
        Hepatitis B is transmitted through blood, semen or other body fluids from a person who is infected with the virus and then it enters another individual who is not affected. This happens through sexual contact, sharing needles/syringes/drug injection equipment. In this case since he gets into fights, if the affected person’s bodily fluid or blood comes into contact with the patient this could also be a cause.
        
        Explain why he is jaundiced and his urine is dark yellow – because livers ability is altered to take up bilirubin from the blood and excrete it into bile. Therefore, the bilirubin is built up and that is why your skin/sclera is yellow. The bilirubin is prevented from being eliminated in stool, causing more bilirubin to be eliminated in urine. Instead of the toxins being removed by the liver, they accumulate in the bloodstream and cause jaundice and severe itching. Bilirubin is one of those toxins that cause pruritus.
      - Inadequate or improper nutritional intake
        
        The liver won’t be able to heal when becomes inflamed. When have option to choose foods, choose high protein such as lean meats, beans, poultry, eggs, nuts and seeds. Also choose, milk or yogurt.
      - Limit intake of alcohol
        
        Alcohol promotes damage to the liver and increases likelihood of developing cirrhosis. Therefore, if you are abusing alcohol and have hepatitis B, more likely to develop liver cancer as well.
        
        Each time your liver filters alcohol, some of the liver cells die.
        
        The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate.
        
        This can result in serious and permanent damage to your liver.
      - Teach patient to watch for and report any signs of disease complications
        
        Fever, Fatigue, Loss of appetite, Nausea, Vomiting, Abdominal pain, Dark urine, Clay-colored bowel movements, joint pain, jaundice.
        
        Could turn chronic so watch for bleeding gums, black stools. Worsening of symptoms will require prompt interventions.
      - Teach use of infection control precautions to reduce risk of cross-contamination
        
        Handwashing, don’t share needles (Use of disposable needles and syringes) and where to locate safe disposable containers
        
        Use of condoms if sexually active, find these addiction centers in the community.
  - - - Have them perform mental health assessment and see what they recommend, ex. Admits to depression and anxiety.
        
        Referral to addiction center will help with cognitive behavioral techniques and mindfulness before prescribing medications
    - - Provide resources in the community that are available to support and sustain a reduction in risk behaviours
        
        Provide psychosocial support
        
        Gain a referral to a methadone clinic/addiction center from physician since addicted to heroin and alcohol
    - - A place like Union Rescue Mission
        
        Not only will we give them a meal and a bed, but we can also provide them with the services and support they need to get off the streets for good
        
        Can help him obtain a job and work.
- - - - Gossipy, unprofessional, privacy issues
    - - A very dangerous, unpredictable and challenging environment
    - - Resulting from lack of access to or regular access to sanitation and fresh running water
    - - Psychologically and emotionally offensive to staff
    - - Staff feel threatened
    - - Stereotyping
  - - - Goal of the Meeting is to Establish effective client-centered therapeutic relationships with Bimmy.
      - Establish some basic ground rules for how to accomplish effective care with Biming
      - The team “must agree on the goals and mission with which they are involved”
- - - - Facial Expressions
        
        Happiness, sadness, anger, surprise, fear, and disgust
        
        Universal
      - Body Movement and Posture
        
        The way you sit, walk, stand, move and carry yourself
        
        Patients may be sensitive to certain body language
      - Gestures
        
        The way you wave, point, beckon, or use your hands when speaking
        
        Can be very different across cultures
      - Eye contact
        
        The way you look at someone can communicate many things including interest, affection, hostility, or attraction
      - Touch
        
        Weak handshake, a warm bear hug, a patronizing pat on the head, or a controlling grip on the arm
        
        Vary across cultures and with the closeness of the relationship
      - Space
        
        Physical space differs depending on the culture, the situation, and the closeness of the relationship
        
        Respect their physical and emotional space
      - Voice
        
        Timing, pace, tone, how loud you speak and sounds that convey understanding, such as “ahh” and “uh-huh”
        
        Tone of voice can indicate sarcasm, anger, affection, or confidence
      - 3. Non-verbal Communication
    - - Pay Attention
        
        Look the patient in the eyes
        
        Put aside distracting thoughts
        
        Avoid a busy environment
      - Show That You're Listening
        
        Nod occasionally
        
        Smile and use other facial expressions
        
        Make sure that your posture is open and interested
        
        Encourage the patient to continue with small verbal comments like "yes" and "uh huh."
      - Provide Feedback
        
        Periodically repeat back to the patient what you heard them say
        
        Ask questions to clarify key points
        
        Summarize the patient's main concerns
      - Respond Appropriately
        
        Be candid, open and honest in your response
        
        Assert your opinions respectfully
        
        Treat the patient in a way that you think they would want to be treated
    - - Ask open-ended questions
        
        Take the time to learn about your patient’s lives, needs, preferences, values, beliefs, past experiences, etc.
        
        Express ignorance
        
        Encourage them to expand on what they have said
  - - - Use respectful and non-stigmatizing language
        
        Avoid a rushed or hurried manner
  - - - Affects the nurse-client relationship, trust and communication
      - Results in poor quality of care
      - Leads to mismanagement and undertreatment of pain
      - Discourages patients from seek medical care in the future
      - Policies and procedures