Case study help

diana2520 · May 12, 2012

Hey, i just wanted to tell you that if you have the prioritization, Delegation by la charity book, it will help you with some of the answers you are looking for. it has case studies in the back and some symptoms of your study case may be similar..check it out

Esme12, ASN, BSN, RN · May 12, 2012

so i have this case study and i'm kind of unsure of how this is all related i put some answers but would just like some feedback please :) [color=#c3260c]
[color=#c3260c]*[color=#404040]t.c. is an 80 year-old farmer who is diabetic. his history includes smoking for 50 years (but not in the past 10 years), angina, hypertension, and atrial fibrillation. t.c. has been on nifedipine (procardia) 20 mg qid and digoxin (lanoxin) 0.375 mg qd. he adjusts his insulin (regular and nph) depending on his activity (he occasionally helps his sons with livestock and field work). t.c. underwent triple coronary bypass surgery yesterday.
[color=#404040]the postoperative course was uncomplicated until it was determined in the post anesthesia[color=#404040] reco[color=#404040]very area that he was bleeding. t.c. was returned to surgery and five units of blood were administered during the second operation. today, t.c.’s urine output is less than 5 ml/hr and he is diagnosed with acute tubular necrosis (atn).[color=#404040]
since t.c.’s blood pressure never dropped below 80/50 in the recovery area and surgery, what contributed to the poor kidney perfusion that led to acute tubular necrosis? consider his original medical problems.
these are my answers any feedback would be greatly appreciated!!!!
cvd(cardiovascular disease), htn (increase pressure
welcome to an! the largest online nursing community!
ok...first......let the patient drive your diagnosis, not try to fit the patient to the diagnosis you found first. you need to know the pathophysiology of your disease process. you need to assess your patient, collect data then find a diagnosis. let the patient data drive the diagnosis.
what is your assessment? is the the patient having pain? are they having difficulty with adls? what teaching do they need? what does the patient need? what is the most important to them now?
the medical diagnosis is the disease itself. it is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first.

care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. it is trying to teach you how to think like a nurse.
think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. what would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.
from a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.
every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the nanda taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. you need to have access to these books when you are working on care plans. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is get this information to help you in writing care plans so you diagnose your patients correctly.
don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. these will become their symptoms, or what nanda calls defining characteristics.
here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:
assessment (collect data from medical record, do a physical assessment of the patient, assess adls, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)
a dear an contributor daytonite always had the best advice.......check out this link.
https://allnurses.com/nursing-student...is-290260.html
nursing care plan | nursing crib
nursing care plan
nursing resources - care plans
nursing care plans, care maps and nursing diagnosis
http://www.delmarlearning.com/compan.../apps/appa.pdf
understanding the essentials of critical care nursing

Esme12, ASN, BSN, RN · May 12, 2012

[color=#404040]you said you are doing a case study.......what is it that you are looking for?

[color=#404040]t.c. history, angina, hypertension, and atrial fibrillation diabetic t.c. underwent triple coronary bypass surgery yesterday.

[color=#404040]this patient has a previous medical history of htn. what is hypertension? how would htn affect the kidney's? how does the diabetes affect the kidneys? this patient has afib. how would the irregular heart rate affect the kidneys? could there be clot formation that developed and got "thrown" to the kidneys? is cabg (coronary artery bypass graft) a risk factor itself? who stated that the 80/50 b/p couldn't cause atn...in along standing htn patient 80/50 is pretty low. how does the blood transfusions affect this scenario? can a pt develop atn from transfusions?

[color=#404040]

so this patient has atn. acute tubular necrosis. (medscape: medscape access) requires registration but it is free and is a great resource.

what is atn? what causes atn? what contributing factors could have contributed to this patient developing atn.

acute tubular necrosis (atn) is usually caused by lack of oxygen to the kidney tissues (ischemia of the kidneys). it may also occur if the kidney cells are damaged by a poison or harmful substance

atn is one of the most common causes of kidney failure in hospitalized patients. risks for acute tubular necrosis include:

blood transfusion reaction
injury or trauma that damages the muscles
low blood pressure (hypotension) that lasts longer than 30 minutes
recent major surgery
septic shock due to severe infection

liver disease and kidney damage caused by diabetes (diabetic nephropathy) may make a person more susceptible to the condition.

atn can also be caused by:

dye (contrast) used for x-ray (radiology) studies
medications that are toxic to the kidneys (such as aminoglycoside antibiotics or amphotericin)
acute tubular necrosis - pubmed health

care plans/care maps must be chosen from the "approved" script....nanda. i think the biggest mistake students make is that the need to let what the patient says, does and feels (the assessment) dictate what you do next. not the medical diagnosis and try to fit the patient into diagnosis. some other helpful links.

nurseprnRN, BSN, RN · May 13, 2012

it's also not true that you cannot use the medical diagnosis in your assessment. there are many, many nanda-i nursing diagnoses that include a medical diagnosis in the defining characteristics. you just can't start with a medical diagnosis and derive a nursing diagnosis from that alone. that would not be....nursing.

I will be a nurse · May 14, 2012

Thank you so much this was exactly what I was looking for!!!

Esme12, ASN, BSN, RN · May 14, 2012

You are welcome!!!! We aim to help.