littletown

thanks helpsothersinlife!

thanks a lot muscadinewine! any other inputs, friends

Hi friends: I am working on my client care map. I need help with it, two many concerns, i don't know if the following is right or not. i did not use up all my abnornal data that i have assessed. any input are appreciated. My client: John is 85 years old male. He is admitted on: fracture ankle (with cast on left ankle, and dressing on left ankle) and delirium (very mild, can not keep tract of time), the medications he is taking: potassium chloride; vitamin D; thyroxine; resedronate sodium; irbesartan; hydrochlorothiazide; fluticasone; Acetaminophen; dabigatran, ventolin (puffer) and atrovent My assessment is as follows: - Used to smoke and exposure to pollute environment and drink* - RLL -crackles, - Lost 7 lb at the first week of admission* - Needs extra blanket when he sleeps - One of his granddaughter visits and helps him every day, his son and step daughter have not shown up since he is in hospitial - Joint between humerus and clavicle was hurt in the past* - Unable to keep track of time, date and month and has mild short memory* - He cannot function critical thinking, such as he cannot calculate simple addition and subtraction - A little difficulty related to hearing (he uses hearing aid)*; unable to hear well if more than 2 persons at the same time to communicate; dentures - Pain on left ankle, pain level is 5 out of 10 for half an hour with movement - Left ankle unable to move due to the cast and fracture* - Left ankle: swelling and stiff, the pain level is 2-3 out of 10 at rest and 5-6 out 10 with movement* - Left lower limb does not move well because of a cast and fracture, one small incision on ankle with no swelling, no discharge and it is dry, no redness - Muscle weakness and sore with movement on left ankle* - Edema found on left foot* - Toes on left foot are purple and cold* he can wiggle and feel them; feels tired after exercise; SOB on exertion* - Needs one person to transfer, with commode or wheelchair*; cannot bath his back; needs moderate help in dressing pants; upper extremities move well, with minor assistant in feeding I need to identify four priority nursing diagnosis, for each diagnosis, identify client short term and one long term goal; identify interventions that address these four nursing diagnosis, and provide rationale to support the interventions, evaluate the impact these interventions Nursing diagnosis: 1. Impaired physical mobility r/t fracture left ankle AEB: report pain on movement; left ankle unable to move due to the cast and fracture Left foot is stiff and swelling, the toes of foot are purple, cold and swelling ; muscle Weakness Client short-term goal: client will participate in ADLS and desired activities every day Long-term goal: client will increase strength and function of left ankle in two weeks Intervention: - Teach the client appropriate wheelchair use and techniques Rationale: - Instruct client regarding fracture healing process, diagnostic procedures, treatment and its complications, home care, daily activities, diet, restrictions and follow-up Rationale: 2. Risk for falls R/T wheelchair use, 85years old, fracture ankle with cast on it, delirium Goals: Short-term: client will understand of risk factors and free of injury in hospital Long-term: client will be able to protect him from injuring. Interventions: - I will do pain assessment regularly and observe his gross motor coordination Rationale: - Make sure environment hazards in care setting Rationale: - Assess client's cognitive status, coping abilities. Rationale: 3. Anxiety R/T: stress, sick role function, change health status, AEB: lost 7 lb since in hospital, impaired attention, and diminished ability to problem solve, Goals: Short-term: client will appear relaxed in two weeks Long-term: client will find sound ways to deal with anxiety Interventions: - Identify client's anxiety factors and observe client's behaviours - Help client identify feelings and begin to deal with problems, isten and talk to the client Rationale: - Provide comfort measures, such as, quiet environment, lighting, warm environment. Rationale: - Provide emotional support to client, explain all procedures to decrease anxiety and to obtain cooperation. Rationale: - 4. Impaired memory R/T: delirium AEB: cannot keep track of time, experience of forgetting (he said 'did I have my medication?' after he took half an hour, but not always forgetting); always asked 'what do we do next?; I don't know, ask nurses'; cannot do simple calculations Goals: Short-terms: client will maintain orientation to time in short period of time Long-term: client will demonstrate accurate what he did Interventions: - Decrease the amount of stimuli in client's environment, such as, low noise level, few people. rationale: this decreases the possibility of forming inaccurate sensory perception. - Correct client's description of inaccurate perception. Rationale: participation in real situation interferes with ability to respond to reality. - Provide a feeling of safety in client's environment by asking same personnel on a regular basis to provide cares any input are appreciated. thanks

Hi friends: I am working on my client care map. I need help with it, two many concerns, i don't know if the following is right or not. i did not use up all my abnornal data that i have assessed. any input are appreciated. My client: John is 85 years old male. He is admitted on: fracture ankle (with cast on left ankle, and dressing on left ankle) and delirium (very mild, can not keep tract of time), the medications he is taking: potassium chloride; vitamin D; thyroxine; resedronate sodium; irbesartan; hydrochlorothiazide; fluticasone; Acetaminophen; dabigatran, ventolin (puffer) and atrovent My assessment is as follows: - Used to smoke and exposure to pollute environment and drink* - RLL -crackles, - Lost 7 lb at the first week of admission* - Needs extra blanket when he sleeps - One of his granddaughter visits and helps him every day, his son and step daughter have not shown up since he is in hospitial - Joint between humerus and clavicle was hurt in the past* - Unable to keep track of time, date and month and has mild short memory* - He cannot function critical thinking, such as he cannot calculate simple addition and subtraction - A little difficulty related to hearing (he uses hearing aid)*; unable to hear well if more than 2 persons at the same time to communicate; dentures - Pain on left ankle, pain level is 5 out of 10 for half an hour with movement - Left ankle unable to move due to the cast and fracture* - Left ankle: swelling and stiff, the pain level is 2-3 out of 10 at rest and 5-6 out 10 with movement* - Left lower limb does not move well because of a cast and fracture, one small incision on ankle with no swelling, no discharge and it is dry, no redness - Muscle weakness and sore with movement on left ankle* - Edema found on left foot* - Toes on left foot are purple and cold* he can wiggle and feel them; feels tired after exercise; SOB on exertion* - Needs one person to transfer, with commode or wheelchair*; cannot bath his back; needs moderate help in dressing pants; upper extremities move well, with minor assistant in feeding I need to identify four priority nursing diagnosis, for each diagnosis, identify client short term and one long term goal; identify interventions that address these four nursing diagnosis, and provide rationale to support the interventions, evaluate the impact these interventions Nursing diagnosis: 1. Impaired physical mobility r/t fracture left ankle AEB: report pain on movement; left ankle unable to move due to the cast and fracture Left foot is stiff and swelling, the toes of foot are purple, cold and swelling ; muscle Weakness Client short-term goal: client will participate in ADLS and desired activities every day Long-term goal: client will increase strength and function of left ankle in two weeks Intervention: - Teach the client appropriate wheelchair use and techniques Rationale: - Instruct client regarding fracture healing process, diagnostic procedures, treatment and its complications, home care, daily activities, diet, restrictions and follow-up Rationale: 2. Risk for falls R/T wheelchair use, 85years old, fracture ankle with cast on it, delirium Goals: Short-term: client will understand of risk factors and free of injury in hospital Long-term: client will be able to protect him from injuring. Interventions: - I will do pain assessment regularly and observe his gross motor coordination Rationale: - Make sure environment hazards in care setting Rationale: - Assess client's cognitive status, coping abilities. Rationale: 3. Anxiety R/T: stress, sick role function, change health status, AEB: lost 7 lb since in hospital, impaired attention, and diminished ability to problem solve, Goals: Short-term: client will appear relaxed in two weeks Long-term: client will find sound ways to deal with anxiety Interventions: - Identify client's anxiety factors and observe client's behaviours - Help client identify feelings and begin to deal with problems, isten and talk to the client Rationale: - Provide comfort measures, such as, quiet environment, lighting, warm environment. Rationale: - Provide emotional support to client, explain all procedures to decrease anxiety and to obtain cooperation. Rationale: - 4. Impaired memory R/T: delirium AEB: cannot keep track of time, experience of forgetting (he said 'did I have my medication?' after he took half an hour, but not always forgetting); always asked 'what do we do next?; I don't know, ask nurses'; cannot do simple calculations Goals: Short-terms: client will maintain orientation to time in short period of time Long-term: client will demonstrate accurate what he did Interventions: - Decrease the amount of stimuli in client's environment, such as, low noise level, few people. rationale: this decreases the possibility of forming inaccurate sensory perception. - Correct client's description of inaccurate perception. Rationale: participation in real situation interferes with ability to respond to reality. - Provide a feeling of safety in client's environment by asking same personnel on a regular basis to provide cares

hello everyone: here is the assessment i did for my client: -toileting: needs one person transfer, commode or wheelchair, needs assistancet to get in and out -dressing: needs little help for the upper and lots help with the pants due to his broken ankle with cast -groming: he can wash him front, but needs help for the back, he can shave himself - he is unable to write check or balance financial affair, unable to do simple caculations, he is short memory very mild delirium my question is : how should i interpret my findings with rationale and critical thinking, using current literature and understanding their impact on the client's concept map? here is my writting, i need do some interpretation on my findings in depth, but i stuck in here, any one can help me, i appreciate any advice introduction functional assessment measures the patient's level of independence in performing activities of daily living (adls). this information is important to help understand patient limitations and rehabilitation needs; thus help to create a practical rehabilitation plan. assessment of adls can be processed by meeting basic requirements, such as toileting, feeding, dressing, grooming, physical ambulation and bathing. functional assessment that identifying disabilities and impairments can help to identify areas of functioning that could improve by intervention (eliopoulos, 2005). two functional assessment tools,physical self-maintenance scale (psms) activities of daily living developed by pfizer canada inc. (1999a) and functional activities questionnaire (faq) developed by pfizer canada inc. (1999b) are used in my functional assessment. based on the data collected and tool scores, the functional status and level of independence of my client are assessed. assessment my client is, xx (for the confidential purpose, i use his initial here), 85- year old. according to my assessment tools, psms, i found my client, xx, is unable to go to toilet independently; and he needs one person transfer with commode or wheelchair because of his muscle weakness. the only assistance in his meal is to open the milk for him. he does not need feeding, he needs minor assistance in wearing upper clothes, but needs moderate assistance in putting on pants because his upper limbs moves well and lower limbs cannot move well. he can wash his front but unable to wash his back. he needs help getting in and out of wheelchair.

Hi everyone: I am a new RPN studnet, I am working on a assignment- functional assessment using two tools, one is Physical self maintenace scale activities of daily living and one is functional activities questionnaire. I finished my assessment and filled the two tools. the requirement is to use essay format to discuss your findings and determine the level of independence and functional status of the client based on teh toll scores, include the rational for your judgements. i am not sure what rational provided to support assessemnt findings and critical thinking. the instructor asks for : compete interpretation well presented with good use of literature from a variety of resources, clear signs of critical thinking and understanding of the ramificaions of the results of the tests and their impact on the client's concept map can anybody help me, am i on right track and how can i use my critical thinking and rational, and resource, books:no:? thanks in advance my client's assessment is follows: Score A. Toileting Cares for self at toilet completely, no incontinence. Needs to be reminded or needs help in cleaning self, or has rare (weekly at most) accidents. Soiling or wetting while asleep more than once a week. Soiling or wetting while awake more than once a week. No control of bowels or bladder. 3 _______ B. Feeding Eats without assistance. Eats with minor assistance at mealtimes and/or with special preparation food, or helps in cleaning up after meals. Feeds self with moderate assistance and is untidy. Requires extensive assistance for all meals. Does not feel self at all and resists efforts of others to feel him/her. 2 _______ C. Dressing Dresses, undresses, and selects clothes from own wardrobe. Dresses and undresses self with minor assistance. Needs moderate assistance in dressing or selection of clothes. Needs major assistance in dressing, but cooperates with efforts of others help. Completely unable to dress self and resists efforts of others help. ____3___ D. Grooming (neatness, hair, nails, hands, face, clothing) Always neatly dressed, well groomed, without assistance. Grooms self adequately with occasional minor assistance, eg., shaving. Needs moderate and regular assistance or supervision in grooming. Needs total grooming care, but can remain well groomed after help from others. Actively negates all efforts of others to maintain grooming. ____3___ E. Physical Ambulation Goes around grounds or city. Ambulates within residence or about one block distance. Ambulates with assistance of (check one) a () another person b ( ) railing c ( ) cane d ( ) walker e ( ) wheelchair - gets in and out without help f (√) wheelchair - needs help getting in, out. Sits unsupported in chair or wheelchair, but cannot propel self without help. Bedridden more than half the time. ___3____ F. Bathing Bathes self (tub, shower, sponge bath) without help. Bathes self with help on getting in and out of tub. Washes face and hands only, but cannot bathe rest of body. Does not wash self but is cooperative with those who bathe him/her. Does not try to wash self, and resists efforts to keep him/her clean. _____3__ Total Score ____17__ Functional Activities Questionnaire (FAQ) Functional scale recommended when MMSE is ≥ 15) 0,1,2,3 is the score Normal* (0) Has difficulty but manages† (1) Requires assistance (2) Dependant (3) 1. Writing cheques, paying bills, balancing a cheque book. r r r r√ 2. Assembling tax records, business affairs, or papers. r r r r√ 3. Shopping alone for clothes, household necessities, or groceries. r r r r√ 4. Playing a game of skill, working on a hobby. r r√ r r 5. Heating water, making a cup of coffee, turning off the stove. r r r r√ 6. Preparing a balanced meal. r r r r√ 7. Keeping track of current events. r r r√ r 8. Paying attention to, understanding, discussing a TV show, book, or magazine. r r r√ r 9. Remembering appointments, family occasions, holidays, medications. r r r√ r 10. Travelling out of the neighbourhood, driving, arranging to take buses. r r r r√ Total Score ____25______ and my essay (i have not finish yet, just need some advices, see i am on righ track) Assessment My client is, xx (for the confidential purpose, I use his initial here), 85- year old. According to my assessment tools, PSMS, I found my client, xx, is unable to go to toilet independently; and he needs one person transfer with commode or wheelchair because of his muscle weakness. The only assistance in his meal is to open the milk for him. He does not need feeding, He needs minor assistance in wearing upper clothes, but needs moderate assistance in putting on pants because his upper limbs moves well and lower limbs cannot move well. He can wash his front but unable to wash his back. He needs help getting in and out of wheelchair. what should I interpret in depth with rational?