NUR 212: Concepts of Nursing Care of the Adult I

Pre class assignment: Week 5

Mobility and Sensory Perception

NOTE TO STUDENTS: Syllabus reading for this assignment Giddens: Chapter 25, and
27, Lewis: pp. 1366-1379, 1424-1425

Task
Clustering related information
Predicting and managing potential complications
Giddens describes physiologic consequences (potential complications) of immobility.
List these below. Identify nursing interventions specific to each complication.

Potential complication Nursing interventions

Keep patient skin clean and dry, Ensure the patient is on well-
Possible skin balanced diet and also promoting hygiene.
breakdown

Use incentive spirometer, deep breathing exercise and encourage

Risk of pneumonia ambulation.

Monitor for DVT, cap refill, skin assessment for warmth, redness, and
Blood clot tenderness.

Constipation Monitor bowel schedule, give stool softer, provide diet high in fibers
and encourage fluid intake.

Ensure safety precaution by monitoring for falls and providing safety

Bone demineralization barriers like alarms, fall pad, call light in reach

Muscle wasting Proper diet, assist with ROM. Safety measures in place.

Mood change/ Encourage the patient to attend activities and socialize with others.
depression Allow the patient to voice their concerns and monitor for mood
change.
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Task
Clustering related information
For the each of the 6 interrelated concepts below, describe how it can have an impact
on sensory perception, or how it can be impacted by problems with sensory perception.
Add other interrelated concepts and describe similarly.

Concept Impact
Interpersonal Significantly influence the psychological health of adolescents.
relationships

Intracranial regulation Brain disturbances

Nutrition Inability to sense smell or taste can cause a patient to not want to eat
therefore their nutrition status decline.

Pain Necessary to provide brain with pain signal to be able to remove pain
source

Development Significantly affected among children with limitations in hearing and

vision. Adaption may be required.

Mobility Body awareness and balance

Task
Identifying signs and symptoms
Comparing and contrasting data

Compare and contrast pathophysiology of Multiple Sclerosis, Myasthenia Gravis, and

Parkinson’s disease.
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Multiple Sclerosis Myasthenia Gravis Parkinson’s disease

 Neuromuscular  Progressive
 Multifocal regions of disorder neurodegenerative
inflammation disorder.
 Fluctuating muscle
 Myelin destruction in weakness
the CNS  Loss of dopaminergic
neurons.
 Inflammation injuries  Predisposition of
underlying axon and rapid fatigue  Neurotransmission
damage disruption
oligodendrocytes

Task
Identifying signs and symptoms
Comparing and contrasting data

Compare and contrast manifestations of Multiple Sclerosis, Myasthenia Gravis, and

Parkinson’s disease.
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Multiple Sclerosis Myasthenia Gravis Parkinson’s disease

 Paresthesias  Ptosis  Tremor

 Numbness  Difficulty swallowing  Rigidity
 Tingling  Skeletal muscle  Slowed movement.
 Muscle weakness weakness  Depression
 Blurred vision  Difficulty breathing  Dementia
 Depression  Psychosis
 Dizziness  Sleep disturbance
 Vertigo
 Cramps

Task
Predicting and managing potential complications

You are caring for a patient newly diagnosed with multiple sclerosis. What should be
included in your teaching about preventing exacerbations?
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Teaching the patient the importance of taking any prescribed medication, to avoid
smoking, proper diet with a lot of fluids, taking plenty of rest and avoiding too much
stress and not to stop medication without notifying the doctor could help to avid
exacerbation.

Task
Predicting and managing potential complications
You are caring for a patient newly diagnosed with myasthenia gravis. What should be
included in your teaching about preventing exacerbations?
Teach the patient to avoid anyone who is showing the signs and symptoms. Encourage
rest periods, avoid becoming overheated or getting to
cold.__________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
____

Task
Clustering related information
Identifying signs and symptoms
Predicting and managing potential complications
Review the case study on page 92 in the Giddens book. Develop a nursing care plan from this
patient from a concept perspective. Use the concept map care plan format from your clinical
documents as shown below and used in previous weeks.
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Conceptual Care Plan

Tissue
intergrity
Pain

Reduction in tissue
prefusion, Pressure
ulcers and skin
Mobility breakdown.

Increased vs immobility

Assess pain, Decreased

ADL ability

Elimination
Nutrition

Constipation Encourage the

patient to take
plenty of water
to help in
avoiding
Loss of appetite constipation

Encourage
ambulation

Provide stool
softener

Medications
Dimethyl fumarate
B-interferon
ACTH
Bethanechol
Pyridostigmine
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Azathioprine
Carbidopa/levodopa
bromocriptine
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Medication Map

Classification/Group Name: _________________________________

General Purpose: Dimethyl Fumarate is used to treat the releasing forms of multiple sclerosis including clinically isolated
syndrome, relapsing-remitting disease, and active secondary progressive disease.
___________________________________________________________________________________________________

___________________________________________________________________________________________________________
___________________________________________________________________________________________________________

Action/System: Exert neuroprotective effects in patients with multiple sclerosis by activating the nuclear erythroid 2- related
factor 2 transcriptional
pathway.___________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
______________________________________________________________________________________________________

3 Medications from this classification: INTERACTIONS

1._ : Dimethyl Fumarate
___________________ (generic)
____Tecfidera__________________ (brand)
2._____________________ (generic)
______________________ (brand)
3._____________________ (generic)
_______________________ (brand)
TIPS for recognizing this class:
______________________________
_________________________
Patient/Family Teaching
(what should they know about this medication to get the best benefit from it & to
prevent adverse reactions?)
_It may not cure but slow some disabling effects and decrease the
SIDE EFFECTS ADVERSE EFFECTS
(with Medications, OTC, Herbals, Foods)
Vomiting Flushing
 Interact with drugs that weaken
Abdominal pain Redness the immune system or increase
Nausea Itching the risk of infection.
Diarrhea_________________________________ ____________________________
_________________________________________ ____________________________
_________________________________________  Do not change the medication
_________________________________________ without doctor’s approval.
_________________________________________ ____________________________
____________________________
_________________________________________
_________________________________________
NURSING CONSIDERATIONS:
(MONITORING & INTERVENTIONS)
_Monitor for pregnancy outcomes in women exposed to this drug
during pregnancy.
Monitor for complete blood counting before starting treatment.
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Bethanechol is used to relieve difficulties in urinating caused by surgery or drugs or othersfactor

Action/system: It increases the tone of the detrusor urinae muscle usually producing a contraction sufficiently strong to initiate micturition and
empty the bladder. Stimulates gastric motility, increases gastric tone and often restores impaired rhythmic peristalsis.

Brand Names: Urecholine

Side effects: Belching, Flushing, Diarrhea, Salivation
Adverse effects: Headache, Sweating, Urinary urgency, hypotension, bronchoconstriction
Interaction: Bethanechol has moderate interaction with at least 74 different drugs like donepezil, trazodone, galantamine

Patient teaching: Take the drug on an empty stomach 1 hr before or 2 hrs after the meal to prevent nausea and vomiting.
It can cause dizziness especially when you rise from a sitting or lying position rise slowly to avoid hurting yourself.

Monitoring and intervention: Abdominal discomfort, increased salivation, flushing or hot feeling of the skin.
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Medication Map

Classification/Group Name: _________________________________

General Purpose: ACTH controls the production of another hormone called cortisol. This medication is used to treat
certain type of seizures in children and treat conditions such as MS, arthritis, lupus.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
__

Action/System: Binds to its receptor MC2R located on adrenocortical cell membranes activating a Gs- protein resulting in
an increase of intracellular cyclic adenosine monophosphate.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
____________________________________________________________________________________________________

3 Medications from this classification: SIDE EFFECTS ADVERSE EFFECTS INTERACTIONS

1.____ACTH________________ (generic)
______H.P Acthar________________ (brand)
2._____________________ (generic)
______________________ (brand)
3._____________________ (generic)
_______________________ (brand)
TIPS for recognizing this class:
______________________________
_________________________
Hallucination Increased thirst (with Medications, OTC, Herbals, Foods)
 Diuretics, Ritodrine, vaccines
Muscle cramps Confusion
____________________________
Nausea and vomiting Stomach pain
____________________________
_________________________________________
_________________________________________  Mifepristone_________________
____________________________
_________________________________________
___________
_________________________________________  Alcohol or smoking may interact
_________________________________________ with this
_________________________________________ medication___________________

NURSING CONSIDERATIONS:
Patient/Family Teaching (MONITORING & INTERVENTIONS)
(what should they know about this medication to get the best benefit from it & _________________________________________________________
to
prevent adverse reactions?) _Kidney disease
__________________________________________________________
Osteoporosis
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Medication Map

Classification/Group Name: _________________________________

General Purpose: Azathioprine is used to prevent organ rejection in people who have received a kidney transplant. It is
usually taken along with other medication to allow the new kidney to function normally.

________________________________________________________________________________________________________
________________________________________________________________________________________________________
_____________________________________________________________________________________________

Action/System: Inhibits purine synthesis this leads to less DNA and RNA produced for the synthesis of WBC thus
immunosuppression

________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
SIDE EFFECTS ADVERSE EFFECTS
___________________________________________________________________________________________
Fever
3 Medications from this classification: Pale skin INTERACTIONS
1.___Azathioprine_________________ Short of breath (with Medications, OTC, Herbals, Foods)
(generic) Hair loss  Some of the products that
___Azasan___________________ (brand) Skin rash interact with this drug include
2._____________________ (generic) Nausae febuxostat.___________________
_______Imuran_______________ (brand) Do not receive vaccination
_________________________________________
3._____________________ (generic) ____________________________
_________________________________________
_______________________ (brand) _________
_________________________________________
 Other drugs that weaken the
TIPS for recognizing this class: immune system such as
______________________________ rituximab____________________
_________________________
NURSING CONSIDERATIONS:
Patient/Family Teaching
(MONITORING & INTERVENTIONS)
(what should they know about this medication to get the best benefit from it & to
prevent adverse reactions?)
_________________________________________________________
_Monitor for full blood count
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Medication Map

Classification/Group Name: _________________________________

General Purpose: Carbidopa levodopa is used to treat the symptoms of Parkinson’s disease and symptoms that may
develop after encephalitis( swelling of the brain) or injury to the nervous system caused by carbon monoxide
poisoning.____________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
___________

Action/System: It works by being converted into dopamine in the brain. It also prevent levodopa from being broken
down before it reaches the brain.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
____________________________________________________________________________________________________

3 Medications from this classification: SIDE EFFECTS ADVERSE EFFECTS

1.Carbidopa
levodopa____________________ (generic)
______________________ (brand)
2.____Sinemet_________________ (generic)
______________________ (brand)
3._____________________ (generic)
_______________________ (brand)
TIPS for recognizing this class:
______________________________
_________________________
Diarrhea Confusion INTERACTIONS
(with Medications, OTC, Herbals, Foods)
Severe vomiting Depression
 Use of Sinemet and iron salts or
High fever Tremors and sweating
multivitamins should be administered
_________________________________________
with caution.
_________________________________________ _________________________________
_________________________________________ _______________________
_________________________________________ Use of Sinemet with dopamine-
_________________________________________ depleting agent to deplete monoamine
_________________________________________ stores is not
recommended._____________________

Patient/Family Teaching
(what should they know about this medication to get the best benefit from it & to
prevent adverse reactions?)
As with levodopa periodic evaluation of hepatic, hematopoietic, NURSING CONSIDERATIONS:
 NUR 212: Concepts of Nursing Care of the Adult I
Pre class assignment: Week 5

Pyridostigmine is used to improve muscle strength in patients with a certain muscle disease. It works by preventing breakdown of certain natural
substances in your body
Action/system: Inhibits acetylcholinesterase in the synaptic cleft thus slowing down the hydrolysis of acetylcholine in the neuromuscular junction,
they increase the signaling and relieve symptoms.

Brand name: Mestinon

Side effects: Upset stomach, Diarrhea, Vomiting.

Adverse effects: Pale skin, Cold sweats, Blurred vision.

Interaction: It is safe to drink alcohol in moderation whilst taking this drug.

Take this medication with food or milk if it upsets your stomach.

Patient teaching: Take exactly as directed do not take more or less of it or take it more often than prescribed by the doctor.
Swallow the extended-release tablet whole do not chew or crush them. Continue to take even if you feel well.