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Acid-Base imbalance from Aspirin OD - Coggle Diagram
Acid-Base imbalance from Aspirin OD
Nursing Diagnosis
Risk for fall
Environment
Rugs
Stairs
Cat
Side effects of medications
Orthostatic Hypotension
Making sure that the patient is changing positions slowly
Dizziness
Making sure patient has something to hold on to or gets oriented before moving
Support system
Physical therapy
Strength patient
Have family/friend look in or help with certain things
Adrenal insufficiency
Nutrition and fluids
Nausea and vomiting can occur
Monitor patient for fluid or electrolyte imbalance
If needed increase sodium and decrease potassium intake
Medication
To help with S/S of the disease
Take only as directed
Report side effects of medication so prescriber can consider adjusting
Labs
PCO2 (Normal 35-45mmHg) respiratory factors
06/15-2310
36
06/16-0615
40
06/15-1245
32L
HOC3 (Normal 22-26 mEq/L) Metabolic factors
6/15-2310
21L
6/16-0615
21L
6/15-1245
19L
PO2 (Normal 80-100mmHg) Oxygen dissolved in plasma
06/15-2310
85
06/16-0615
89
06/15-1245
88
SaO2 (Normal 95-100) Saturation of Oxygen
6/15-2310
96
6/16-0615
97
6/15-1245
97
pH (Normal 7.35-7.45) Acidity or Alkalinity
06/15-2310
7.32L
06/16-0615
7.36
06/15-1245
7.28L
Salicylate Level (Normal 15-30mg/dL)Toxicity
6/15-2310
43H
6/16-0615
20
6/15-1245
63H
ABG- to find if patient is Metabolic Alkalosis/ Acidosis or Respiratory Alkalosis/Acidosis (patient is in metabolic acidosis with partial compensation
Physical Assessment
Not aware
Time
Day
Sick to stomach
Worsening pain
Mornings
Bedtime
Skin bronze in color
Ringing in ears
Dizziness when standing
Incision is almost healed
Medical History
Osteoarthritis (associated with DX)
Cataracts (not associated with DX
Rheumatoid arthritis (associated with DX)
adrenal insufficiency/Addison's disease (no associated with DX)
Medications
Furosemide PO 20mg
Patient teaching
Take as directed
Consult doctor about diet high in potassium
Monitor side effects
Caution when changing position (orthostatic hypotension)
Monitor labs
Glucose
electrolytes
renal and hepatic functions
calcium
Potassium
Sodium
Magnesium
BUN
ASA/Oxycodone Hydrochloride
Patient teaching :
Instruct patient how and when to ask for medication
Advise that medication has potential for abuse
Monitor labs for toxicity
Monitor for Side effects
Make sure patient isn't pregnant or plan on becoming pregnant
Prednisone PO 5mg
Patient teaching
Causes immunosuppression
Long term
Eat a diet high in protein, calcium, and potassium/ Low in sodium and carbohydrates
Take as directed
Avoid vaccinations until talking to the doctor
Monitor labs
glucose
electrolytes
potassium
calcium
cholesterol/lipids
thyroid
Monitor Intake and Output
Monitor side effects
Aspirin extra strength
Patient teaching
avoid alcohol
Sodium-restricted diet
Take with full glass of water and remain upright for 15-30 minutes
Monitor side effects
Monitor for Toxicity overdose
Monitor salicylate levels
Vital signs
Temp 99.4F
HR 98
Resp. 26
BP Lying 99/47
BP Standing 78/40
Misc. Nursing Notes
3/28/2021 2200 M. Houston, SVN TCC
Patient was readmitted to the hospital after having surgery on her hip. After a nurse visit at home the patient was found confused with an elevated temp, high HR, high RR and low BP.
Patient has adrenal insufficiency, is at risk for falling and was in metabolic acidosis with partial compensation.
Patient teaching was preformed for safety and for medication administration and side effects
Patient is stable and will be returning home