Patient:85 yr old female in hospice care, Hx of ischemic cardiomyopathy, A fib, dyslipidemia, CHF, history of CVA, CKD, aortic aneurysm, UTI, CAD, valvular heart disease.
2.CHRONIC KIDNEY DISEASE
Pathophysiology: CKD is defined as kidney damage or a GFR less than 60 mL that is consistent for a period over 3 months .CKD is a result of a number of conditions that lead to a loss of functioning kidney nephrons with progressive deterioration of glomerular filtration, tubular resorptive capacity, and endocrine functions of the kidneys that can be permanent.(Norris et al., 2020)
Risk factors;(Norris et al., 2020)
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3.HYPERTENSION
Pathophysiology : hypertension is a common condition that affects the body's arteries. If you have high blood pressure, the force of the blood pushing against the artery walls is consistently too high. The heart has to work harder to pump blood.Untreated, high blood pressure increases the risk of heart attack, stroke and other serious health problems.(Mayo Clinic, 2022)
Risk factors(Mayo Clinic, 2022)
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Factors impacting discharge: lack of suitable support system at home,terminal health condition,lack of transportation arrangements , safety of the living environment ,financial considerations , patients beliefs and wishes,low functional status .
NURSING PROBLEMS
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3.Activity intolerance
Client will mantain their desired level of activity during hospice care (Flynn & Martinez-Kratz, 2023)
interventions
Nurse will reduce reposition times to decrease patient discomfort (Flynn & Martinez-Kratz, 2023)
Nurse will allow for periods of rest before and after physical activity as needed(Flynn & Martinez-Kratz, 2023)
Nurse will provide increased attention to comfort and dignity of the terminally ill patient(Flynn & Martinez-Kratz, 2023)
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7 SYSTEMS
Cardiac: Bradycardic, Heart is S1,S2.Patient has a history of CHF
Integumentary: Skin cool and clammy, risk for skin impairment , pale but no rashes. Non pitting edema in the extremities.
Respiratory: crackles to auscultation, normal respiratory excursion, no wheezing and no use of accessory muscles
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Musculoskeletal: Patient has limited mobility ,very weak strength in both upper extremities and lower extremities. At risk for falls due to fatigue and impaired mobility.
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Neuro/psych: Patient not alert, not oriented to place, time .Patient has limited mobility and response ,responds to physical stimuli. Unable to asses response to ROS questions.
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GI: Bowel sounds active to auscultation ,soft on palpation, non distended, Passing flatus. Recent bowel movement , inadequate nutrition, takes bites and drinks.difficulty swallowing
GU: Patient voided, patient incontinent to urine and stool, uses briefs,no pain ,frequency or urgency,Decreased urine output.
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