QuestionAnswered step-by-stepGENERAL INFORMATION (30 points) Primary Medical Diagnosis 15 points…GENERAL INFORMATION (30 points)Primary Medical Diagnosis15 points Provide a detailed description of the primary medical diagnosis that will be used for this assignment. Include all symptoms, treatments, risk factors, medications, therapies, labs, and diet. Glucose checks one time a day related to type 2 diabetesAcetaminophen tablet related to pain not to exceed 3000 mg in 24 hoursAricept tablet- cognitive-communication deficitCyanocobalamin solution acute kidney failureVitamin B12 injectionDebrox solution prophylactic care right earEliquis tablet (apixaban) venous thrombosis and embolismFurosemide tablet edema or increase in weightHydralazine HCL hypertension hold for SBP<110Levothyroxine sodium hypothyroidism Metoprolol succinate ER tablet for hypertension Metformin HCL type 2 diabeticMultiple vitamin-minerals tablets supplementOmeprazole capsules delayed-release (esophageal reflux disease with esophagitis) Simvastatin tablet hypercholesterolemiaSimethicone tablet bloating/gasVitamin D3 tablet supplement Cryptosporidium- negativeGiardia- negativeCalprotectinper OT place a 3-inch towel roll in the right hand at bedtimeReferences: Potential Secondary Medical Complications5 points Identify two potential medical complications associated with the primary medical diagnosis. Explain why each is a potential complication.NOTE: These are NOT nursing diagnoses.1 Pneumonia- occurs because of not being able to move because of the stroke 2 Swallowing problems- after a stroke can sometimes result in things 'going down References: Nursing Care10 points Describe in detail all the appropriate nursing care for the primary medical diagnosis.NOTE: This is what you, as the nurse, will be doing to care for a patient with this diagnosis. For example: encourage, monitor, assess, teach, etc. Nursing care often does not require a provider order. reposition to prevent contractures, relieve pressure, attain good body alignment, and prevent compressive neuropathies. Elevate the affected arm to avoid edema and fibrosis. Provide a full range of motion four or five times a day to maintain joint mobility. Change position every 2 hours; place the patient in a prone position for 15 to 30 minutes several times a day. Encourage personal hygiene activities as soon as the patient can sit up. Select appropriate self-care activities that can be carried out with one hand. Help the patient to set realistic goals; add a new task daily.As a ?rst step, encourage the patient to carry out all self-care activities on the unaffected side. Ensure the patient does not neglect the affected side; provide assistive devices. Improve morale by making sure patient is fully dressed during ambulatory activities. Assist with dressing activities (e.g., clothing with Velcro closures; put a garment on the affected side ?rst); keep environment uncluttered and organized. Provide emotional support and encouragement to prevent fatigue. Frequently assess skin for signs of breakdown, emphasizing bony areas and dependent body parts. Increase natural or arti?cial lighting in the room; provide eyeglasses to improve vision. Voiding pattern and offer urinal or bedpan on patient's voiding schedule. Have occupational therapists make a home assessment and recommendations to help the patient become more independent. Encourage patients to attend community-based stroke clubs to feel belonging and fellowship to others. Encourage the patient to continue with hobbies, recreational and leisure interests, and contact friends to prevent social isolation. Encourage the family to support the patient and give positive reinforcement. Remind spouse and family to attend to personal health and wellbeing. References: PATIENT SPECIFIC INFORMATION (38 points)Primary Medical Diagnosis Findings10 points List patient specific assessment information and findings directly related to the primary medical diagnosis. Include all symptoms, medications, treatments, therapies, labs, and diet.incontinence of bowel, supper pubic catheter output 275cc 2/2/2022, per OT place 3-inch towel roll in the right hand at bedtime, (allergies Aspirin celecoxib) advance directive ( DO NOT RESUSCITATION), height 62 ft tall, wt. 160.2 lbs. cognitive-communication deficiency, speaks clearly but slow, type 2 diabetes mellitus, other intervertebral diseases, hyperlipidemia unspecified, hypothyroidism-unspecified, hypomagnesemia, vascular dementia without betta, hypokalemia, muscle weakness (generalized), aphasia, personal history of transient, neuromuscular dysfunction, regular diet, independence with self-feeding when assisting with setup, ate 65% of her breakfast intake 240ml 2/2/2022, electric wheelchair for ambulation, Hoyer lift to transfer from bed to w/c, bed, toilet every 2 hours or as needed, barriers cream to prevent skins breakdown, large bowel movement 2/2/2022,118/58 mm Hg left arm sitting, 93% room air, Apical 62 bpm, wt. 160.2 pounds, respiration 12 RR, radial 60 bpm. cleared lungs sounds. Temporal, carotid, brachial, femoral, popliteal are equal, posterior tibialis and dorsal pedis weak. Edema was noted in the lower extremities. Homans sign negative in left lower extremities. Homans sign positive right lower extremities. 6 gaze intact. Pupils are round, reactive to light, and accommodating. Eyelids, no drainage, redness, or swelling noted. Conjunvitas pink with moist mucosa. Natural teeth. Wears glasses. Acetaminophen tablet related to pain not to exceed 3000 mg in 24 hoursAricept tablet- cognitive-communication deficitCyanocobalamin solution acute kidney failureVitamin B12 injectionDebrox solution prophylactic care right earEliquis tablet (apixaban) venous thrombosis and embolismFurosemide tablet edema or increase in weightHydralazine HCL hypertension hold for SBP<110Levothyroxine sodium hypothyroidism Metoprolol succinate ER tablet for hypertension Metformin HCL type 2 diabeticMultiple vitamin-minerals tablets supplementOmeprazole capsules delayed-release (esophageal reflux disease with esophagitis) Simvastatin tablet hypercholesterolemiaSimethicone tablet bloating/gasVitamin D3 tablet supplement Secondary Medical Diagnoses3 points List and define all the patient's secondary medical diagnoses (maximum of 10). Gastro-esophageal- when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus) this backwash (acid flux) can irritate the lining of your esophagus. Gastric ulcer- A hole in the lining of the stomach corroded by the acidic digestive juices which are secreted by the stomach cells References: Surgical Procedures3 points List and describe all the patient's surgical procedures. Include the approximate date of the procedure.NOTE: Usually found in the chart under History & Physical. If there is no date listed, your patient may be able to provide a relative date. If not, state "no date available". References: Allergies1 point List all the patient's allergies to food, medication, latex.NOTE: Usually found in the provider orders. If the patient is allergy free from all of these, state "no known allergies to food, medication or latex". The allergic reaction does not need to be listed. Aspirin celecoxib Diet1 point Identify and describe the patient's prescribed diet. Explain why this diet is appropriate for the patient. Regular texture, regular fluidReferences: Medications5 points List all the patient's prescribed medications, excluding PRNs. Identify the medication purpose and medical diagnosis (if applicable) associated with each medication. Glucose checks one time a day related to type 2 diabetesAcetaminophen tablet related to pain not to exceed 3000 mg in 24 hoursAricept tablet- cognitive-communication deficitCyanocobalamin solution acute kidney failureVitamin B12 injectionDebrox solution prophylactic care right earEliquis tablet (apixaban) venous thrombosis and embolismFurosemide tablet edema or increase in weightHydralazine HCL hypertension hold for SBP<110Levothyroxine sodium hypothyroidism Metoprolol succinate ER tablet for hypertension Metformin HCL type 2 diabeticMultiple vitamin-minerals tablets supplementOmeprazole capsules delayed-release (esophageal reflux disease with esophagitis) Simvastatin tablet hypercholesterolemiaSimethicone tablet bloating/gasVitamin D3 tablet supplement References: Labs3 points List three labs that are the most appropriate for the patient's primary/secondary diagnosis. Include the name of the lab test, the patient's value in comparison to the standard reference range and identify which medical diagnosis is associated with each lab.NOTE: If the patient does not have any listed or current labs, research labs that are pertinent to the primary/secondary diagnosis. This will require approval from the clinical instructor.Name of Lab Test Patient's Value (Reference Range) Associated Medical Diagnosis/Condition Cryptosporidium negative Giardia negative calprotectin 1,010.0 <50.0 mcg/a References: Flowsheet10 points List, label and describe each of the following for your patient at every clinical day.NOTE: If the patient does not have any ordered therapies, state "no ordered therapies".NOTE: If a clinical day is cancelled or the student is absent, state "cancelled" or "absent" accordingly in all boxes of that column. If the clinical rotation does not extend 4 days, state "no clinical" in all boxes of the last column. Examples Clinical Day 1 Clinical Day 2 Clinical Day 3 Clinical Day 4Height/Weight 52 inches / 160 pounds 62 inches / 160.2 pounds Canceled Different patient143 pounds with w/c Vital Signs(include position, site, label, location, etc.) T 98.7 F oralP 84 bpm apicalR 16 breaths/minBP 125/70 right arm sittingO2 Sat 98% on room airPain 2/10 left knee aches T 97.3 temporal02 Sat 93% room airBP 118/58 mm Hg left arm sittingPain 0/10R 12 breaths/minP 62 bpm apical Canceled T 97.5 oralP 78 bpm right radialApical 66 bpmR 14 breaths/minBP 124/78 mm Hg left arm siting02 Sat 95% room air Intake/Output Breakfast 50% 120ccLunch 75% 120 ccVoided x 1 continentBM x 1 formed, soft, brown Breakfast 65% 240ccVoided x1 incontinence bowel soft Canceled Breakfast 100% 300ccLunch 45% 180ccVoided 1 continentBM x1 formed brown Transfer Status(including assistive devices) Transfers with 1-assist, gait belt, and front-wheeled walker Transfers with Hoyer lift Canceled Transfers with easy stand sling Therapy Program(Restorative, PT, OT, ST) NuStep 30 minHand bicycle 10 minWorked on saying numbers due to aphasia with ST Per OT placed a 3-inch towel roll in RT's hand at bedtime.Rehab level: poor Canceled Group exercise at the chapel for 30 mins Psychosocial Needs2 points Identify two psychosocial needs for the patient. Explain why each are appropriate for the patient.1 Anxiety- is a common side effect experienced by many stroke patients. These effects can be heightened due to worries surrounding reintegrating back into everyday life when physical or mental abilities have changed. For these patients, it can be extremely beneficial to remember to attend to their mental health needs 2 The psychological issues may affect rehabilitation outcomes through a reduction in follow-through with practice and home exercise program, reduced energy level, increase fatigue, reduced frustration tolerance, and potentially less motivation and hope about the future. For example, depression can cause many of the symptoms, yet these symptoms may be mistaken for medical or personality issues. Depression- is a significant complication of stroke that may impede rehabilitation, recovery, quality of life, and caregiver health. References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883408/ Stromberg, Holly. (2021). DeWitt's Medical-Surgical Nursing: Concepts and Practice, ed. 4, Pg 507Stroke - Symptoms and causes - Mayo Clinic Nursing Careplan 1 (16 Points)Nursing Diagnosis (2 Points)No more than 1 potential diagnosis may be used Actual or Potential (1 Point)Highlight actual or potential. Expected Outcome(2 Points)Identify 1 outcome that will show maintenance or improvement of the selected nursing diagnosis.Ensure outcome is SMART:Specific - Measurable - Attainable - Relevant - Timebound Nursing Interventions (3 Points)Identify 3 patient specific interventions that will directly assist in meeting the expected outcome.At least 2 must be action-driven interventions. Rationales (3 Points)Provide 3 rationales that validate why the intervention will assist in meeting the expected outcome.One rationale per intervention. Evaluation(1 Point)Restate the original expected outcome. Identify if the outcome was met or not met.Impaired physical mobility The patient will not have any pressure sores/skin breakdown within 2-4 weeks The patient will be repositioned and have a passive range of motion exercises 2-3 times daily or as tolerated. Relief pressure and increased circulations Related To (R/T) (2 Points)Describe the patient's specific situation and/or medical diagnosis that is directly linked to and causing the chosen nursing diagnosis. DO NOT state a medical diagnosis, but a description is appropriate.temporary disruption of blood flow to the right side of the brain incoordination, imbalanced gait, difficulty in movement, generalized weakness, and verbalization of overwhelming tiredness/fatigue Clean dry and moisture skin necessitate Maintenance of skin integrity and prevent skin breakdownAs Evidenced By (AEB) (2 Points)List all necessary supportive patient data to support the chosen nursing diagnosis (assessment findings, history, medications, labs, therapies, diet). This information proves your nursing diagnosis is appropriate. Utilize special mattresses, such as gel mattresses. Reduce pressure on bony prominences, heels, elbow, and sacrum. Hemiparesis of the right sideReferences: Stromberg, Holly. (2021). DeWitt's Medical-Surgical Nursing: Concepts and Practice, ed. 4, Pg 507Stroke - Symptoms and causes - Mayo ClinicKhaku AS, Tadi P. Cerebrovascular Disease. [Updated 2021 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430927/ Nursing Careplan 2 (16 Points)Nursing Diagnosis (2 Points)No more than 1 potential diagnosis may be used Actual or Potential (1 Point)Highlight actual or potential. Expected Outcome (2 Points)Identify 1 outcome that will show maintenance or improvement of the selected nursing diagnosis.Ensure outcome is SMART:Specific - Measurable - Attainable - Relevant - Timebound Nursing Interventions (3 Points)Identify 3 patient specific interventions that will directly assist in meeting the expected outcome.At least 2 must be action-driven interventions. Rationales (3 Points)Provide 3 rationales that validate why the intervention will assist in meeting the expected outcome.One rationale per intervention. Evaluation(1 Point)Restate the original expected outcome. Identify if the outcome was met or not met.self-Care Deficit The patient will demonstrate the maximum performance of ADLs in at least four weeks. Assess barriers that prevent self-care To identify areas that would need aid, such as toilet hygiene, brushing, teeth, combing air, and putting on clothes, makeup, and jewelry. Related To (R/T) (2 Points)Describe the patient's specific situation and/or medical diagnosis that is directly linked to and causing the chosen nursing diagnosis. DO NOT state a medical diagnosis, but a description is appropriate.Inability to perform activities of daily living (ADLs); grooming, bathing, dressing, elimination, and diminished levels of strength/endurance Encourage participation in care as their ability to. To promote patient self-esteem and encourage independence. As Evidenced By (AEB) (2 Points)List all necessary supportive patient data to support the chosen nursing diagnosis (assessment findings, history, medications, labs, therapies, diet). This information proves your nursing diagnosis is appropriate. Establish a toilet schedule and habit training for every 2 hours. Prevent skin breakdown, clean incontinent episodes, and preserve patient dignity. Stroke sequalae incontinence of bowel, supper pubic catheter output 275cc 2/2/2022, per OT place 3-inch towel roll in the right hand at bedtime, (allergies Aspirin celecoxib) advance directive ( DO NOT RESUSCITATION), height 62 ft tall, wt. 160.2 lbs. cognitive-communication deficiency, speaks clearly but slow, type 2 diabetes mellitus without, other intervertebral diseases, hyperlipidemia unspecified, hypothyroidism-unspecified, hypomagnesemia, vascular dementia without betta, hypokalemia, muscle weakness (generalized), aphasia, personal history of transient, neuromuscular dysfunction, regular diet, independence with self-feeding when assisting with setup, ate 65% of her breakfast intake 240ml 2/2/2022, electric wheelchair for ambulation, Hoyer lift to transfer from bed to w/c, bed, toilet every 2 hours or as needed, barriers cream to prevent skins breakdown, large bowel movement 2/2/2022,References: Stromberg, Holly. (2021). DeWitt's Medical-Surgical Nursing: Concepts and Practice, ed. 4, Pg 507Stroke - Symptoms and causes - Mayo ClinicKhaku AS, Tadi P. Cerebrovascular Disease. [Updated 2021 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430927/ Health ScienceScienceNursingLPN 104Share Question