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Jane Dodge - Coggle Diagram

- - - - Concern for blood loss and not enough oxygen to cells. (Tyerman & Cobbett, 2019, p. 572).
    - - Concern for infection related to bowel resection surgery. (Tyerman & Cobbett, 2019, p. 696).
    - - Surgical stress or nutritionally related.
    - - Concern for hyperkalemia
- - - - Transient Ischemic Attack (TIA)
        
        Jane's smoking history, alcohol use, weight, age, family history is what could have lead to her Transient Ischemic Attack (Tyerman & Cobbett, 2019, p. 1515).
- - - - Cerebrovascular Accident
        
        Complicatioons include right-sided hemiplegia (right-sided paralysis), dysphagia (difficulty swallowing), aphasia (speaking and language difficulties post stroke), and immobility.
        
        Managed immediately with Thromobolytic Therapy, and will be prevented long term with ASA 160mg (used as an antiplatelet medication in this case) QD to prevent clotting.
        
        Left-sided (that is why loss of mobility is seen on the right side of the body), ischemic (not enough blood flow to the brain), affected the middle cerebral artery (occlusion of this results in lack of oxygen to the cerebrum). (Tyerman & Cobbett, 2019, p. 1510).
        
        Jane has many modifiable risk factors that can be changed to prevent another stroke, such as obesity, dyslipidemia, alcohol use, and physical inactivity. Her non-modifiable risk factor includes diabetes. (Tyerman & Cobbett, 2019, p. 1509).
    - - Managed by monitoring blood glucose levels and keeping them between 6-10 mol/L, and with the use of Metformin 1000mg BID (most likely with breakfast and supper). Metformin decreases production and absorption of glucose
    - - Managed long-term with the use of Ramipril 5mg QD, which is a antihypertensive that works by suppressing the RAAS pathway, and Labetalol via IV for acute management of HPT. Labetalol blocks beta receptor sites which helps to decrease peripheral vascular resistance and blood pressure.
      - Nursing assessment: monitor blood pressure, encourage physical activity, weight management. (Tyerman & Cobbett, 2019, p.797).
    - - Social isolation, minimal family contact, minimal involvement in community activities
      - Medically treated with Escitalopram 5mg QD, this is a Seratonin Reuptake Inhibitor, to allow for more Seratonin in the synapse to encourage elevated mood and feelings of bliss.
      - Depression worsened after stroke due to loss of independence, can also be related to age. (Tyerman & Cobbett, 2019, p. 105).
    - - Type 2 Diabetes is the most common cause of CKD, could be a sign of poor or insufficient management of Type 2 Diabetes. (Tyerman & Cobbett, 2019, p. 1208).
      - CKD has gastrointestinal clinical manifestations that could worsen Jane's current situation, such as GI bleeding, vomitting, gastritis. (Tyerman & Cobbett, 2019, p. 1209).
    - - Most likely caused by Jane's high cholesterol, sedentary lifestyle, hypertension, obesity, and history of smoking. (Tyerman & Cobbett, 2019, p. 815).
    - - Managed long term with Atorvastatin 80mg QD, which is an anti-hyperlipidemic, which prevents cardiovascular disease and decreases LDLs.
    - - Patient will receive specialty formulas to ensure she is meeting adequate nutritional needs. Important for nurse to check the placement of tubing so aspiration does not occur. (Tyerman & Cobbett, 2019, p. 983).
    - - Sedentary lifestyle, more at risk for development of depression due to social isolation and minimal independence due to dependance on caregivers for everyday activities.
        
        Require involvement from other health care professionals such as a physiotherapist and speech therapist to continue to work on mobility and speech and regain skills.
    - - The clinical manifestation of Paralytic Ileus presented is abdominal distention, severe abdominal pain, absent bowel sounds, vomitting, nausea, and not passing gas or stool.
      - Ongoing nursing assessments for this patient would include monitoring intake and output, measuring for abdominal distention, auscultation of bowel sounds. Bowel function is evidenced by passing stool and gas. (Tyerman & Cobbett, 2019, p.429).
    - - Bowel Resection
        
        Hydromorphone and Acetaminophen for pain relief, hydromorphone is best at first for more severe pain, and then acetaminophen as a non-opioid pain relief.
        
        Antibiotics used to help prevent infection include Ceftriaxone and Metronidazole via IV.
        
        Metoclopramide 10mg via IV, increases motility and gastric emptying, will help to prevent another bowel obstruction.
        
        Heparin 5000 units via subcutaneous BID, this is to prevent clotting post-op, and Pantoprazole 40mg via IV QD, Pantoprazole is a Proton Pump Inhibitor, reducing gastric acid production could help speed up the healing process.
        
        Electrolyte Management
        
        Imbalanced due to stress, surgery, illness, and loss of kidney function, which is the main organ for regulating electrolyte balance. (Jane's CKD diagnoses) (Tyerman & Cobbett, 2019, p. 358).
    - - Involvement of a dietician due to difficulties eating (dysphagia, right sided weakness)
      - Concern for delayed healing, good nutrition allows for faster recovery and healing. (Tyerman & Cobbett, 2019, p. 985).