I have submitted this assignment and I was graded low, I would like…

Question Answered step-by-step I have submitted this assignment and I was graded low, I would like… I have submitted this assignment and I was graded low, I would like your assistant to review this below and see what you can change. Here is the feedback from my instructor and her assessment when she graded.  “No primary nursing diagnosis given Your assessment data lists anxiety and noise, was your patient anxious and noisy?”   Patient Medical Diagnosis: Patient has a history of Insomnia, nausea, and non-Hodgkin’s lymphomaNursing Diagnosis:Ineffective Airway Clearance, Hyperthermia related to increase in metabolic rate, and Anxiety-related to a perceived threat to health Assessment Data (Include at least three-five subjective and/or objective pieces of data that lead to the nursing diagnosis)Goals & Outcome (Two statements are required for each nursing diagnosis.  Must be Patient and/or family focused; measurable; time-specific; and reasonable.) Nursing Interventions (List at least three nursing or collaborative interventions with rationale for each goal & outcome.)Rationale (Provide reason why intervention is indicated/therapeutic; provide references.)Outcome Evaluation & Replanning(Was goal met?  How would you revise the plan of care according the patient’s response to current plan ?)Persistent FatigueLack of appetiteWeight lossStatement #1Within the span of care, the patient will be able to discuss feelings of dread, anxiety, and so forth and respond to relaxation techniques with a decreased anxiety level.  Statement #2 Within the span of care, the family of the patient will be able to understand the current situation and collaborate with the plan of care of the patient.  Maintain a calm, non-threatening manner while working with the client.Establish and maintain a trusting relationship by listening to the client; displaying warmth, answering questions directly, offering unconditional acceptance; being available and respecting the client’s use of personal space.Remain with the client at all times when levels of anxiety are high (severe or panic); reassure client of his or her safety and security.Avoid asking or forcing the client to make choices.PRN medications may be indicated for high levels of anxiety. Watch out for adverse side effects.Encourage the client’s participation in relaxation exercises such as deep breathing, progressive muscle relaxation, guided imagery, meditation and so forth.Administer SSRIs as ordered.Collaborate with the family in the plan of care     Anxiety is contagious and may be transferred from health care provider to client or vice versa. Client develops feeling of security in presence of calm staff person.Therapeutic skills need to be directed toward putting the client at ease, because the nurse who is a stranger may pose a threat to the highly anxious client.The client’s safety is utmost priority. A highly anxious client should not be left alone as his anxiety will escalate.The client may not make sound and appropriate decisions or may be unable to make decisions at all.Medication may be necessary to decrease anxiety to a level at which the client can feel safe.Relaxation exercises are effective nonchemical ways to reduce anxiety.Panic attacks are caused by neuropsychiatric disorder that responds to SSRI antidepressants.This promotes bonding and gives support to uplift patient’s well-being.  Outcome #1:Goal met. Withing the span of care, patient was able to collaborate with the health care provider and discuss the feelings of anxiety with the plan to deal with the problem.Outcome #2″Goal met as the patient was able to collaborate with the family as evidenced by discussing about the problem and finding support with them. “This will be the outcome if the Intervention was fulfilled thoroughly as evidenced by the presence of patient itself” List patient mediations, indications, and nursing considerations for this patient Medication, Dose, RouteIndications for MedicationNursing Consideration for Patient/ Side EffectsMelatonin 3 mg, Oral RouteMelatonin has been used for short-term treatment of trouble sleeping (insomnia) due to sleep cycle disorders and time changes. Adverse Reactions/Side Effects:CV: hypotensionCNS: drowsiness, headache, dizzinessGI: nausea, vomiting, abdominal crampsNursing ConsiderationsInstruct patient to take at bedtime as directed.Causes drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.Caution patient to avoid concurrent use of alcohol or other CNS depressants.Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.Antihistamines 50 mg, Oral RouteAntihistamines is approved for the treatment of anxiety. It can also be used to treat difficulty sleeping, nausea, vomiting, itching, skin rash, and allergies.Adverse effects:CNS: Drowsiness and sedation.GI: Drying of the GI mucous membranes, GI upset, nausea.GU: Dysuria, urinary hesitancy.Skin: Skin eruption and itching.Nursing consideration:Proper administration. Administer drug on an empty stomach, 1 hour before or 2 hours after meals, to increase the absorption.Drug effectiveness. Note that the patient may have a poor response to one of these agents but a very effective response to another; the prescriber may need to try several different agents to find the one that is most effective.Relief from dry mouth. Because of the drying nature of antihistamines, patients often experience dry mouth, which may lead to nausea and anorexia; suggest sugarless candies or lozenges to relieve some of the discomforts.Safety measures. Provide safety measures as appropriate if CNS effects occur to prevent patient injury.Increase fluid intake. Increase humidity and push fluids to decrease the problem of thickened secretions and dry nasal mucosa.Ensure voiding. Have patient void before each dose to decrease urinary retention if this is a problem.Skin care. Provide skin care as needed if skin dryness and lesions become a problem to prevent skin breakdown.Avoid alcohol. Caution the patient to avoid alcohol while taking these drugs because serious sedation can occur.Avoid OTC drugs. Caution the patient to avoid excessive dose and to check OTC drugs for the presence of antihistamines, which are found in many OTC preparations and could cause toxicity.Health teaching. Provide thorough patient teaching, including the drug name and prescribed dosage measure to help avoid adverse effects, warning signs that may indicate problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about the drug therapy and promote compliance.Encourage patient support. Offer support and encouragement to help the patient cope with the disease and the drug regimen. Xanax 0.25-0.5 taken 3x a day, Oral RouteGeneralized anxiety disorder and panic disorderAdverse EffectsCNS: sedation, drowsiness, depression, lethargy, blurred vision, headache, apathy, light-headedness, amnesia, confusion, mild paradoxical excitatory reactions in the first two weeks of therapyCV: hypotension, hypertension, arrhythmias, palpitationsGI: dry mouth, constipation, nausea, vomiting, elevated liver enzymesGU: urinary retention and hesitancy, loss of libido, changes in sexual functioningHematological: blood dyscrasias, anemiaLocal injection sites can develop phlebitis, local reactions, and thrombosis.Withdrawal syndrome caused by abrupt cessation of drugs is characterized by nausea, headache, vertigo, malaise, and nightmares.Nursing ConsiderationAssess for the mentioned cautions and contraindications (e.g. drug allergies, hepatorenal diseases, psychosis, glaucoma, etc.) to prevent any untoward complications.Perform a thorough physical assessment to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.Monitor results of laboratory tests (e.g. renal and liver functions tests, complete blood count (CBC), etc.) to monitor effectiveness of the therapy and provide prompt treatment to developing complications.Ativan 8 mg for a day (24 hrs.)For insomnia due to anxiety or transient situational stressAdverse Effects:CNS: drowsiness, somnolence, lethargy, ataxia, vertigo, “hangover” feeling, thinking abnormalities, paradoxical excitement, anxiety, hallucinationsCV: bradycardia, hypotension, syncopeRespiratory: serious hypoventilation, respiratory depressionHypersensitivity reactions: rash, serum sickness, Steven-Johnson syndromeDevelopment of physical tolerance and psychological dependenceNursing ConsiderationsAssess for the mentioned cautions and contraindications (e.g. drug allergies, hepatorenal diseases, seizure disorders, etc.) to prevent any untoward complications.Perform a thorough physical assessment to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.Apixaban (Eliquis) 2.5 mg oral every 2 hoursThe patient is diagnosed with non-Hoggkin’s lymphoma, it is known that this disease may cause Venous Thromboembolism. Apixaban is an anticoagulant (blood thinner) that reduces blood clotting and reduces the risk of stroke and systemic embolism.Adverse EffectsAllergic reaction: hives; chest pain, wheezing, difficult breathing; feeling light-headed; swelling of your face, lips, tongue, or throat.Spinal blood clot such as tingling, numbness, or muscle weakness especially in the legs and feet.Easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding that will not stop.Headache, dizziness, weakness, syncopeurine that looks red, pink, or brown; orblack or bloody stools, coughing up blood or vomit that looks like coffee grounds.Acetaminophen 650 mg every 4 hoursIs an antipyretic drug used to reduce feverAdverse effectsNausea,Stomach pain,Loss of appetite,Itching,Rash,Headache,Dark urine,Clay-colored stoolsNursing ConsiderationsDo not exceed 4 grams of acetaminophen per day to limit risk for liver, renal, and cardiac damageOverdose will lead to hepatotoxicityAcetadote is the antidote for overdoseMay increase risk for bleed with warfarin therapyMay alter blood glucose measurements  List Patient abnormal lab values, normal ranges, and why they are altered. Abnormal Lab ValueNormal RangeCause of Abnormal Lab ValueCreatinine0.5 mg/dL and 1.05 mg/dLCreatinine is a chemical compound left over from energy-producing processes in your muscles. Healthy kidneys filter creatinine out of the blood. Creatinine exits your body as a waste product in urine.A measurement of creatinine in your blood or urine provides clues to help your doctor determine how well the kidneys are working.BUN5 – 20 mg/dLcaused by a high-protein diet, Addison’s disease, or tissue damage (such as from severe burns), or from bleeding in the gastrointestinal tract. High BUN-to-creatinine ratios occur with sudden (acute) kidney problems, which may be caused by shock or severe dehydration. List all Patients Nursing Diagnosis in priority Order and explain why. Nursing DiagnosisExplanationIneffective Airway ClearanceThis will be based on Maslow’s Hierarchy of Needs which is the Physiological so this diagnosis will come first. The need for oxygen here should be prioritize.Hyperthermia related to increase in metabolic rate.Treat the hyperthermia to improve wellness and aid with cooperationAnxiety-related to a perceived threat to healthThe anxiety should be relieved to gain cooperation of patient References:Bonnet, M.H., & Arand, D.L. (2017). Treatment of insomnia. UpToDate, Topic 7691, Version 59.0 Retrieved from https://www.uptodate.com/contents/treatment-of-insomnia-in-adults. (accessed February 13, 2022)Gellersted, L., Medin, J., & Karlsson, M. R. (2014). Patients’ experiences of sleep-in hospital: A qualitative interview study. Journal of Research in Nursing, 19(3), 176 – 188.  Health Science Science Nursing NURSING 115 Share QuestionEmailCopy link Comments (0)