Impaired bed mobility due to environmental constraints related to fracture closed femur shaft and CELECOXIB drug study

Nursing Care Plan  

ASSESSMENT NURSING PLANNING IMPLEMENTATION EVALUATION
DIAGNOSIS
OBJECTIVE OF INTERVENTION RATIONALE
CARE

Subjective Cues:  Impaired bed After 8 hours of nursing Determine functional 1 = requires use Determined functional After 8 hours of nursing
“Nahihirapan ako mobility due to intervention the patient will level classification 1 to level classification 1 to 4 intervention the patient was
gumalaw or environmental be able to: of equipment or be able to:
4
iposisyon sarili ko sa constraints device, 2 = requires
kama, like magturn related to  Verbalize willingness help from another  Verbalize willingness
side to side.” as fracture closed to/and participate in person to/and participate in
verbalized by the femur shaft repositioning program. repositioning program.
 Demonstrate for assistance, 3 =  Demonstrate
client
techniques/behaviors requires help from techniques/behaviors
Objective Cues: that enable safe another person and that enable safe
 Dependence on repositioning. equipment repositioning.
mechanical lift  Maintain or increase  Maintain or increase
device, 4 =
devices to transfer strength and function strength and function
and ambulate of affected and/or dependent, does not of affected and/or
 Limited range compensatory body participate in compensatory body
of motion (ROM)  part. activity part.
 The patient will perform  The patient will perform
activities with the least activities with the least
amount of assistance, amount of assistance,
considering their disease considering their disease
and condition. and condition.

    Ascertain that to promote mobility Ascertain that dependent

 dependent client is and enhance client is placed in best
placed in best bed for environmental bed for situation
situation safety.
(e.g., correct size,
(e.g., correct size, support surface, and
support surface, and mobility functions)
mobility functions)

    Turn dependent client reposition in good Turned dependent client

frequently, utilizing bed frequently, utilizing bed
body alignment,
and mattress and mattress
using appropriate
positioning settings to supports helps keep positioning settings to
assist movements blood flowing assist movements

    Instruct client and Instructed client and

caregivers in methods of Family and caregivers in methods of
moving client relative to caregivers need to moving client relative
specific situations and know about the
proper usage of to specific situations and
mobility needs.
equipment at home mobility needs.
and the appropriate
handling of the
patient. Clear
instructions keep
the caregivers safe
as well as the
patient. 

Observe skin for To reduce friction, Observed skin for

reddened areas/shearing. maintain safe reddened areas/shearing.
Provide appropriate skin/tissue Provide appropriate
pressure relief/surface pressures, and wick pressure relief/surface
support mattress away moisture support mattress

Reposition the patient at Frequent position Repositioned the patient

least every two hours changes help reduce at least every two hours
and as needed.  burdening pressure and as needed. 
points for an
extended period and
reduce break down. 

Promote independence Assisting only in Promote independence

during exercises and necessary steps during exercises and
activities.  prevents the patient activities. 
from becoming
dependent. The goal
is to further
independence and
maximize the
patient’s
capabilities. 

Provide bowel Lack of exercise, Provided bowel

stimulation.  bed rest, and pain stimulation. 
medication often
 lead to constipation.
Stool softeners and
laxatives help
alleviate
constipation. 

Provide extremity To avoid or prevent Provided extremity

protection (padding, pressure sores protection (padding,
exercises, etc.) exercises, etc.)

Include Working with PT Included

physical/occupational and OT ensures the physical/occupational
therapists and patient engaging in therapists and
rehabilitation exercises regularly. rehabilitation
Daily exercise helps
providers in creating providers in creating
the patient maintain
movement program and movement program and
and also gain
identifying identifying
muscle strength
assistive devices. over time.  assistive devices.

Refence/s:
Doenges, M. E., et al. (2017). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales 11th Ed. Pg 454-457. F.A Davis Co.
Drug Study 
GENERIC NAME:  MECHANISM OF ACTION:
NSAID that exhibits antiinflammatory,
analgesic, and antipyretic activities. Unlike
CELECOXIB ibuprofen, inhibits prostaglandin synthesis by
inhibiting cyclooxygenase-2 (COX-2), but
does not inhibit cyclooxygenase-1 (COX-1).
BRAND NAME: INDICATION:
Relief of S&S of osteoarthritis and rheumatoid
arthritis. Treatment of acute pain and primary
Celebrex dysmenorrhea. Reduction of polyp formation
in familial adenomatous polyposis (FAP),
ankylosing spondylitis
DRUG ILLUSTRATION:
SIDE EFFECTS/ADVERSE
REACTION
Body as a Whole: Back pain,
peripheral edema. Increased risk
of cardiovascular events.  
GI: Abdominal pain, diarrhea,
dyspepsia, flatulence, nausea. 
CNS: Dizziness, headache,
insomnia. 
Respiratory: Pharyngitis,
rhinitis, sinusitis, URI.  
Skin: Rash
NURSING RESPONSIBILITY
Assessment & Drug Effects
Therapeutic effectiveness is indicated by
relief of joint pain.
 Lab tests: Periodically monitor Hct and Hgb,
liver functions, BUN and creatinine, and
serum electrolytes.
Monitor closely lithium levels when the two
drugs are given concurrently.
 Monitor closely PT/INR when used
concurrently with warfarin.
 Monitor for fluid retention and edema
especially in those with a history of
hypertension or CHF.
Patient & Family Education
 Avoid using celecoxib during the third
trimester of pregnancy.
 Promptly report any of the following:
 unexplained weight gain, edema, skin rash.
 Stop taking celecoxib and promptly report to
physician if any of the following occurs: S&S
of liver dysfunction including nausea, fatigue,
lethargy, itching, jaundice, abdominal pain, and
flulike symptoms; S&S of GI ulceration
including black, tarry stools and upper GI
distress.
 Do not breast feed while taking this drug.

CLASSIFICATION CONTRAINDICATION:
Severe hepatic impairment; hypersensitivity to
celecoxib; asthmatic patients with aspirin triad;
 CENTRAL NERVOUS SYSTEM advanced renal disease; concurrent use of
AGENT diuretics and ACE inhibitors; anemia;
 ANALGESIC pregnancy (category D) in third trimester;
 NSAID lactation.
 CYCLOOXYGENASE-2 INHIBITOR
 ANTIPYRETIC
DOSAGE/FREQUENCY/ROUTE:

Acute Pain, Dysmenorrhea

Adult: PO 400 mg 1st dose, then 200 mg same
day if needed, then 200 mg b.i.d. prn

Actual:
 200mg caps 2x a day for 5 days

Reference/s: Wilson, et al. (2015). Drug Guide. Retrieved from http://www.robholland.com/Nursing/Drug_Guide/data/monographs/monoframe.html?vfile=C052.html