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NURSING ASSESSMENT FORM Student: Patient: Maila Carl M.

Morantte GV Age: 78 Marital Status: Widow Date: 22 October 2011 Admission Date: 17/10/2011

Reason for Admission: Shortness of Breath (SOB) upon minimal exertion, Severe Sinus Bradycardia with HR of 26 beats per minute (bpm) Current Medical Diagnosis: Paroxysmal Atrial Fibrillation (PAF), Chronic Heart Failure (CHF), Type II Diabetes Mellitus(DM), Transient Ischemic Attack (TIA), Hypertension (HTN), Chronic Renal Failure (CRF), depression, gout, osteoarthritis (OA) Bradycardia probably from overdose of Amiodarone Surgical Procedure and Date Fracture (#) Neck of Femur (NOF)Right on 05/06/2011 Left femoral embolectomy on 02/07/2011 Past Medical History Three months prior to admission, patient had a hip replacement surgery and had a degree of cardiac failure during the operation. Subsequently the patient was prescribed with Amiodarone 200 mg daily, Digoxin 62.5 micrograms daily, and Metoprolol 95 mg daily. On the 13th of September, a chest x-ray showed increasing congestive heart failure with a large heart shadow. Four days prior to admission patient went to a specialist physician for follow-up and complained of SOB. Electrocardiogram (ECG) was done and showed a sinus rhythm of 26 bpm indicating sever sinus bradycardia. Blood pressure was also 180/40 mm Hg at that time. Patient was then instructed to stop taking Digoxin, Metorprolol, and Amiodarone. During that time patient also agreed to come to Oamaru Hospital on Monday, 17th of October 2011 for further management.

“ Taking the medicines “Although. the patient verbalized. “My health before was pretty good. Ability / willingness to participate in care / compliance with prescribed medicines/ treatment: The patient verbalized willingness to participate in care and treatment. Health Perception / Health Maintenance Pattern Patient’s perception of past general health Patient verbalized. Readiness for enhanced therapeutic regimen management as evidenced by an expressed desire to participate in care and treatment. Noncompliance to treatment in reducing risk factors contributing to illness as evidenced by declining smoking cessation treatment Smoking / Tobacco / Alcohol / Drug History Smokes 4 sticks a day . FUNCTIONAL HEALTH PATTERNS or NURSING DIAGNOSIS (using NANDA format) 1. Nursing Needs  Therapeutic communication to encourage client towards health improvement  Health Education on Proper Nutrition.”.Declined smoking cessation treatment Drinks 3 shots of Gin a day . It is really awful when you feel crook.Allergies: None known. the patient said. “I can’t exercise because I can’t do anything anymore nowadays. my life was still normal ” Patient’s perception of current health status “My health is not really very great nowadays. Someone even comes here every week just to help me shower. ROM Exercises (may coordinate with physiotherapist). so I did. I had no problems at all. yes I had already Type II Diabetes. I feel helpless”. and proper treatment regimen  Encouragement towards smoking cessation treatment  Health Education on the adequate amount of alcohol taken each day Possible Nursing Diagnoses Powerlessness (low) related to inability to perform activities of daily living as evidenced by verbal expressions of frustration. The patient also takes the prescribed medicines. I think the doctor said that I must have overmedicated some stuff that’s why he told me stop taking those. Health management/ practices Eating proper food The patient verbalized. This time you are not able to do the normal stuff that you usually do. Although.

toasted hard bread) Dentures: Upper set of teeth Oral Cavity Assessment: No pain in the mouth or gums reported.5L (oral) Nausea: None Vomiting: None Weight: 59. and hypertrophy noted. . Nursing Needs  Regular Monitoring of BGL  Health Education on Diet – referral to dietician  Inform kitchen regarding food preparation – soft foods must be available for the client  Daily Weighing  Encourage frequent position changes Possible Nursing Diagnoses Potential for Altered Body Temperature related to aging as evidenced by frequent complaints of being cold. no edema. Nutritional / Metabolic Pattern Diet Type: Diabetic Diet BGL: 5.Didn’t take any illicit drugs 2. Lower teeth is natural. No lesions. Gag reflex is intact. Halitosis not noted. exudates.7 kg Food Intolerance: Hard Foods (e. Imbalanced Nutrition: Less than body requirements related to perceived inability to ingest food due to the presence of dentures as evidenced by a steady decrease in weight. swelling. Risk for Impaired Skin Integrity related to altered fluid status as evidenced by presence of edema. Skin Integrity: Dryness noted Bilateral edema (grade 2) on lower extremities noted. ulcers. cracking. bleeding.3 mmol Appetite: Average % of food eaten at mealtime: 75% Mini nutritional assessment for older adults: Fluid intake in 24 hours: 6 glasses of water or approximately 1.g. discoloration and redness noted No coating on tongue noted. Fluid Volume Excess related to compromised function of the kidneys as evidenced by bilateral edema on the lower extremities. Gingiva is pink in color.

Elimination Pattern Bowel Pattern (Usual): Everyday in the morning Constipation: None Diarrhea: None.200mL Urine: clear and pale yellow in color Catheter: None Nursing Needs:  Record incontinence time  Schedule voiding 30 minutes before incontinence times  Schedule fluid intake  Health education on exercises to strengthen anterior perineal muscles  Teach patient the importance of maintaining a daily routine  Collaborate with dietician regarding foods and fluids to acidify urine Possible Nursing Diagnoses: Urinary Urge Incontinence related to overdistention of bladder and aging as evidenced by nocturia. getting in or out of the shower. Dressing or Grooming: Gets clothes from the closets and drawers and puts on clothes and outer garments with fasteners. Activity / Exercise Pattern (Self-care Ability & ADLs Katz Tool) Bathing: Needs help with bathing more than one part of the body.Pressure Sore Risk Score (Braden): 20 Pressure Prevention Strategies: Encourage frequent position change Keep the skin dry Encourage adequate intake of fluids and proper diet 3. Needs help in putting on the shoes Toileting: Needs help in transferring to the toilet and Nursing Needs  Needs help in showering and toileting  Needs assistive devices  In need of family and social support system Possible Nursing Diagnoses Self Care Deficit in bathing and . generally distended Bowel Sounds: 5-20 bowel sounds per minute Bladder: has urge incontinence usually at night Urine Output in 24 hours: 5 times. approximately 1. 4. but stools are usually very soft Stool Type: Type 4 in the Bristol Scale Elimination Aids: Loperamide Ostomy: None Abdomen: soft.

6. Nursing Needs  Health education on medication regimen and its effects  Probable referral to physical or occupational therapist  Referral to social worker before discharge for home modification Possible Nursing Diagnoses Risk for Falls as evidenced by history of falls. Activity / Exercise Pattern (Mobility) Ambulating independently : Yes Exercise / physio: None Assistive Devices: Walking Frame Range of Motion: Reduced Balance / Gait: Unsteady Hand Grasp: Equal / strong Leg Muscles: Equal/ weak Lifting Transferring Plan: Can ambulate on her own Falls Risk Score: 10 Falls Prevention Strategies: Review medication regimen and how it affects the client Discuss importance of monitoring conditions that contribute to occurrence of injury Discuss the need for and sources of supervision Refer to physical or occupational therapist to obtain appropriate assistive devices for mobility. Activity / Exercise Pattern (respiratory/ circulatory status) Baseline Vital Signs: T:36. Preparation of food is done by another person. KATZ Dependency Score: 3 toileting related to weakness and tiredness as evidenced by a score of 3 in the Katz Tool 5. or home modification before discharge.5 degrees Celsius P: 26 bpm R: 18cpm BP: 180/70 mm Hg Current Vital Signs: Nursing Needs  Monitor vital signs every 4 hours  Monitor patient’s telemetry  Encourage rest as needed between activities  Provide a quiet nonstimulating environment  Teach relaxation techniques . age.cleaning self Transferring: Moves in and out of bed or chair with the help of a frame Continence: Partially incontinent of bowel. and the intake of medications that may cause drowsiness. (Nocturia) Feeding: Gets food from plate into mouth without help. bathroom safety.

warm. shin CRT (lower) <3 sec: Yes CRT (upper) <3 sec: Yes Peripheral Pulses: Radial 42 bpm Pedal: 42 bpm Apical Pulse Rate: irregular Heart Sounds (S1 and S2): Audible though irregular Pulse Rate Deficit: No  Refer to social worker for assistance at home prior to discharge Possible Nursing Diagnoses: Activity Intolerance related to imbalance of oxygen demand and supply as evidenced by a severely low heart rate and shortness of breath upon minimal exertion. Decreased Cardiac Output related to an altered heart rate and rhythm as evidenced by a severely low and irregular heart rate accompanied by fatigue and shortness of breath upon minimal exertion 7. whispery almost quiet sounds on both sides Chest Pain with resp: No Oxygen Therapy: None SaO2: 98% Cough: None Sputum: None Finger Nail Clubbing: None Facial Color: Pale Facial Skin: Warm and Dry Extremities: Pale. Sleep / Rest Patterns Times usually go to bed and get up?: 10:00 PM and 8:00AM How long does it take to fall asleep? 30 minutes Actual Sleep Hours: 8 hours Naps: Yes Wakes up in the middle of night or early morning?: Yes Usually for toileting What wakes you or keeps you awake? Toileting. and dry Peripheral Edema: Yes Pitting (location): bilateral on both legs. Loud Noise. Pattern: Eupnea Breath Sounds: clear. Cognitive / Perceptual Pattern Nursing Needs .T: 36. 8. no adventitious breath sounds.7 degrees Celsius P: 43 bpm R: 17 cpm BP: 220/80 mm Hg Resp. Being Cold Sleep Aids Clonazepam Generally feels rested and ready for daily activities after sleep? Yes Nursing Needs  Create an environment conducive for sleeping  Encourage going to the toilet 30 minutes before sleeping  Maintain room temperature  Teach relaxation techniques  Administer required medication  Suggest sleep preparatory activities such as quiet music Possible Nursing Diagnosis Sleep Pattern Disturbance related to urinary urgency or incontinence. Quality: Dyspnea: None SOB: Yes upon minimal exertion Use of accessory muscles: Yes Resp.

Self Perception / Self Concept Pattern What changes has the patient noted that affects what he/she is able to do? She emphasized that the weakening of her heart has caused her to lead a sedentary lifestyle. assist. self care. Role / Relationship Pattern Occupation (Past): Social Worker Employment Status: Retired Support Systems: Present. neighbors see her often times but there is really no one who is at home to help. How have these changes affected the way the patient feels about himself or herself? She feels helpless and unable to do a lot of things compared to what she can do before. or even just keep her company. Nursing Needs  Encourage verbalization of feelings  Use therapeutic communication Possible Nursing Diagnosis Powerlessness related to dependency lifestyle as evidenced by expressions of hopelessness. Nursing Needs:  Encourage to verbalize her feelings  Use therapeutic communication  Encourage to participate in activities and to talk with the other ladies in the room  Encourage the family to visit her more often  Coordinate with the occupational therapist . Any major concerns about hospitalization / LTC or illness / disability? (transition. financial. 10. future) The client’s perception about her situation. doing groceries for her Observations of family / friend interactions The son visits her about 3 times a week.LOC: alert Oriented: to time place and person Speech: WNL Hearing: WNL Hearing Aids: None Vision: Impaired R & L Eyeglasses: Yes Pupils: ERL Taste: Normal Highest Level of Education: College Degree MMSE Score: 24 Cognitive Status: normal Ability to make decisions: Herself Pain: None  May need assistance in toileting at night 9. Family specifically his son and daughter in law Family concerns/ participation in patient care: Provision of a home help.

spiritual. easily laughs and makes jokes Is patient on medications to assist coping? Antidepressants Nursing Needs: Administer prescribed meds as ordered 13. Coping / Stress Tolerance Pattern Major loss / change in the past year? The loss of her husband and moving into a new house What problem/s is the patient trying to deal with now? The need for more home help How does the patient usually deal with these situations? The patient verbalized. “Nothing. cultural beliefs which help to give the patient / resident inner strength? Presbyterian Religious/ spiritual/ cultural practices during hospitalization? Keeps a bible Nursing Needs: Encourage religious beliefs. I couldn’t talk much with my son because he doesn’t go home very often. 11. . dysmenorrhea Last Pap Smear: can’t remember Mammogram: None Sexual concerns RT illness/ disability? None Nursing Needs 12. with no feeling of remorse.Possible Nursing Diagnosis Impaired Social Interaction related to absence of available significant others or peers as evidenced by verbalization of the client with her situation at home. Sexuality / Reproductive Pattern LMP: 50’s Postmenopausal: 50’s Use of contraceptives/ HRT: Yes. Show her the chapel in the ward. Pills Menstrual Problems: Yes. Value/ Belief Pattern Religious.” Emotional State of the patient: Patient looks fine.

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