UNIVERSITY OF SOUTH FLORIDA

COLLEGE OF NURSING

FUNDAMENTAL PATIENT ASSESSMENT TOOL Student: Stacy Dunham #U81247943

Assignment Date: 06/26/2015

.
Agency: SMH
1 PATIENT INFORMATION
Patient Initials: AW Age: 81 Admission Date: 06/18/2015

Gender: F Marital Status: Widowed Primary Medical Diagnosis: atrial fibrillation

Primary Language: English Secondary Diagnosis: COPD

Level of Education: High school graduate Other Medical Diagnoses: (new on this
admission)
Occupation (if retired, what from?): Bank Teller Angina

Number/ages children/siblings: 2 sisters: 1 age 86, 1 deceased Shortness of breath

3 Sons: Kevin 53, Kent 56, Mark 57
Served/Veteran: Never If yes: Ever deployed? N/A Code Status: Full Code

Living Arrangements: lives alone Advanced Directives: Yes

If no, do they want to fill them out? Already did
Culture/ Ethnicity /Nationality: German SX Date: 6/19/2015 Procedure: cardiac ablation

Religion: Baptist Type of Insurance: Medicare , AARP

1 CHIEF COMPLAINT: palpitations, chest pressure, and generalized weakness

3 HISTORY OF PRESENT ILLNESS: (Be sure to OLDCART the symptoms)

The patient stated she had dealt with symptoms of a dry cough and palpitations for weeks, which she stated is generally a
sign of her being in a-fib. She stated she didnt call or go see her physician for it because other than the cough and
palpitations, she felt fine. She then went to see her PCP for cellulitis on her right leg. While there, they placed her on
ECG and she was in a-fib. Symptoms progressed during the day. On 06/17/2015 the patient woke up feeling weak,
lethargic, was diaphoretic, and had palpitations. She stated she felt throughout the day. She finally decided to call 911
and went to the ED by ambulance. Her initial HR was in the 170s, when taken by EMS. Once at the ED, the hospital
began a Cardizem drip and her HR decreased to the 100s.
Onset: gradual, began with a cough Onset: comes on suddenly while in the hospital
Location: right side chest Location: right side chest
Duration: o/o for weeks Duration: comes and goes
Characteristics: pressure, dizzy Characteristics: pressure, dull ache
Aggravating: walking and any exertion Aggravating: walking and exertion
Relieving: rest Relieving: Cardizem and rest
Treatment: prescribed medication Treatment: ablation and medication

University of South Florida College of Nursing Revision September 2014 1

 2 PAST MEDICAL HISTORY/PAST SURGICAL HISTORY
Date Operation or Illness
06/19/2015 ECHO - transesophageal
06/19/2015 Cardiac ablation SCT CTA Pulmonary Vein Isolation, due to a-fib
05/2013, Kyphoplasty for thoracic fxs due to osteoporosis
12/2012,
12/2010
2001 Left lumpectomy x 2 w/ radiation for self-contained, unk stage breast cancer
2001 Optic nerve sheath after occlusion
08/2000 Right cataract SX
09/1999 Appendectomy post rupture of appendix
11/1999 Abdominal hernia repair w/ MESH
12/1997 Left cataract SX
11/1995 Total hysterectomy after diagnosis of cervical cancer and continued abdominal problems
1976 Rhinoplasty - cosmetic
1973 Varicose veins left leg
1946 Tonsillectomy
Age (in years)

2 FAMILY MEDICAL HISTORY

Environmental

Cardiac, MI, DVT

Bleeds Easily

Hypertension
Alcoholism

Glaucoma
Diabetes
Arthritis

Seizures
Anemia

Asthma

Cancer

Tumor
Ulcers
Stroke
Psych
Allergies

Renal
Gout
Cause
of
Death

Father 84 AAA X X X
Failure
Mother 93 to thrive
N/
Brother N/A
A
Sister 77CVA X
Livin
Sister 86 X
g
Son Livin
53 X X
g
Grandma 64 Train X
Comments: The patient isnt sure of the onset of any of the diseases for any of her relatives.

1 IMMUNIZATION HISTORY
(May state U for unknown, except for Tetanus, Flu, and Pna) YES NO
Routine childhood vaccinations X-U
Routine adult vaccinations for military or federal service X
Adult Diphtheria (Date) X-U
Adult Tetanus (Date) Is within 10 years? X
Influenza (flu) (Date) Is within 1 years? X 01/14
Pneumococcal (pneumonia) (Date) Is within 5 years? X 01/13
Other vaccines given for international travel or occupational purposes? Please List X

University of South Florida College of Nursing Revision September 2014 2

 1 ALLERGIES OR ADVERSE REACTIONS
NAME of
Type of Reaction (describe explicitly)
Causative Agent
Flecainide Increased liver enzymes

Medications ACE inhibitors Pruritus and urticaria

Norvasc Edema in ankles and feet

Other (food, tape,

NONE
latex, dye, etc.)

5 PATHOPHYSIOLOGY: (Mechanics of disease, risk factors, how to diagnose, how to treat, prognosis, and include any
genetic factors impacting the diagnosis, prognosis or treatment). Include APA reference and in text citations.
Atrial fibrillation: This is an irregular, rapid, and disorganized atrial rhythm. It is where the electrical impulse stimulated
to contract the heart is disturbed. An electrical impulse generates in the SA node of the atrium. As it is traveling to the AV
node in the atrium, a premature beat arises and blocks the impulse from traveling to the ventricles. That impulse then
takes an alternate route back to the AV node and reenters into atrium. This continual reentry is what will cause the
disorganized atrial rhythm and multiple P (sinus) waves. This can be a result of primary cardiac disorder, a response to a
systemic condition, or the result of an electrolyte imbalance or drug toxicity. Risk factors of this disease are hypertension,
HF, cardiac hypertrophy, COPD, ETOH, electrolyte imbalances, drug toxicity, nicotine, caffeine, hyperthyroidism, as well
as being part of the normal aging process. There are some genetic factors as it has been found to run in families.
Potassium channel gene mutations can also cause familiar atrial fibrillation. Diagnosing a-fib can be done a variety of
ways. Auscultating the patients HR and rhythm and notating any adventitious sounds by listening to the first and second
heart sounds. A-fib is also recognizable and viewable by examining an ECG. On an ECG, a-fib is recognizable by no
discernible P waves and it they are irregularly spaced. There is a decreased amount of QRS complexes. Treatment will
depend on the severity of the condition and whether the patient is being hemodynamically affected, as well as how fast the
rhythm is. Various treatments include: 1) Oxygen 2) Fluids if it is related to electrolyte imbalances 3) Medications for
rate control, including: beta blockers, calcium channel blockers, antiarrhythmics. Medications, such as: diltiazem,
digoxin, verapamil, amiodarone. 4) Anticoagulants. 5) Cardioversion. 6) Catheter ablation. 7) Pacemaker. This rhythm
can be deadly. If this is a chronic and untreated problem, it can lead to heart failure or a stroke. The Framingham Heart
Study has shown that people with a-fib have a risk of death 1.5 to 1.9 times as high as people without a-fib but with other
conditions. (Case-Lo, 2013, para,1, page 11). People with a-fib are five times more likely to suffer a stroke, than those
who dont have it.
If this rhythm is secondary to causes such as drug toxicity, alcohol, caffeine, nicotine, etc., it can likely be reversed by the
patient changing their habits. If the condition cannot be reversed by a change in habits, then medications is the next best
choice. Medications can then reset the rhythm back to a normal sinus rhythm. People generally will have to go on a
blood thinner simultaneously to prevent clots from forming. If medications arent successful, a patient may either need
ablation or a pacemaker placed. Ultimately, many people with this condition are able to lead long and healthy lives.
However, whether the treatment is medication, ablation, or surgery, they will still have to make lifestyle changes in order
to not aggravate or worsen their condition. (Case-Lo, 2013)

University of South Florida College of Nursing Revision September 2014 3

 5 MEDICATIONS:
Name: Cardizem (diltiazem) Concentration: 125mg in 125mL 1:1 Dosage Amount: 10mg per hr
Route: IV Frequency: continuous until rhythm converts to sinus rhythm
Pharmaceutical class: Calcium Channel Blocker Ther
Hospital only
Class: antianginal / antiarrhythmic / antihypertensive
Indication: a-fib
Side effects: abnormal dreams, anxiety, confusion, dizziness, drowsiness, h/a, nervousness, psychiatric disturbances, weakness, blurred
vision, disturbed equilibrium, epistaxis, tinnitus, cough, dyspnea, edema, braycardia, chest pain, hypotension, palpitations, syncope,
tachycardia, increased liver enzymes, anorexia, constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, nausea, vomiting, dysuria,
nocturia, polyuria, sexual dysfunction, urinary frequency, dermatitis, erythema multiforme, flushing, sweating, photosensitivity, pruritus,
urticarial, rash, gynecomastia, hyperglycemia, anemia, leukopenia, thrombocytopenia, weight gain, joint stiffness, muscle cramps,
parethesia, tremor, gingival hyperplasia Adverse: arrhythmias, HF, Stevens-Johnson Syndrome
Patient Teaching: Take the medication as prescribed and at the same time daily. Take missed doses as soon as possible, unless close to
the time for the next dose. Dont double dose. Teach the patient how to take their own pulse and have them monitor it. If the HR drops
below 50, they should report it to their physician. The patient should be careful getting up or changing positions, as this can cause
orthostatic hypotension. They should maintain good oral hygiene and wear sunblock. Advise it could cause dizziness and drowsiness.
They shouldnt operate machinery until they know how they react to the medication. The patient should increase water and fiber intake,
as this can cause increased constipation. Lastly, report any side effects / adverse reactions to the medication. Nursing considerations:
It shouldnt be prescribed to someone who is already hypotensive or has bradycardia. If they have a liver or renal disease, consider side
effects and consider a different medication. If they are a diabetic, they should check their BS daily, as this can cause hyperglycemia. If
the patient has renal, hepatic, respiratory disease, bleeding disorder, or are immune compromised, consider the side effects of this
medication and the potential to worsen symptoms. They should weight themselves regularly. Know interactions between the patients
current medications and this medication, including OTC and herbals. Find out if they are taking any OTC or herbals.
Name: Rythmol (propafenone) Concentration: 150mg in 1 tablet Dosage Amount: 150mg
Route: oral Frequency: every 8 hours
Pharmaceutical class: Sodium Channel Blocker IC Ther
Home only
Class: antiarrhythmic
Indication: a-fib
Side effects: dizziness, shaking, weakness, blurred vision, angina, braycardia, hypotension, altered taste, constipation, nausea, vomiting,
diarrhea, dry mouth, rash, joint pain. AVERSE: SVT, VTach, agranulocytosis
Patient Teaching: They should take the medication as prescribed and at the same times daily. If they forget a dose they should take it
as soon as possible, if it is within 4 hours, otherwise dont take that dose. Advise this medication can cause dizziness, so they should
avoid operating machinery before they know how this medication with affect them. The patient should make all f/u appointments with
their physician. They should advise any physician they are taking this medication prior to having any surgeries. Advise the patient they
should increase their water and fiber intake with this medication, as it can cause increased constipation. Lastly, report any side effects /
adverse reactions to the medication. Nursing considerations: If this patient has bradycardia prior to taking this medication, consider
prescribing a different one. If this patient is immune compromised, has leukemia, or is receiving chemo or radiation, consider the side
effects of this medication and possibly prescribing a different medication. Know the interactions between the patients current
medications and this medication, including OTC and herbals. Find out if they are taking any OTC or herbals.

Name: Lanoxin/Toloxin (digoxin) Concentration: 125mg in 1 tablet Dosage Amount: 125mg

Route: oral Frequency: once daily
Pharmaceutical class: digitalis glycoside Ther Class:
Both
antiarrhythmic
Indication: for this patient its to treat a-fib. Other indications: HF, A-fib and flutter, atrial tach
Side effects: fatigue, h/a, weakness, blurred vision, yellow or green vision, bradycardia, ECG changes, AV or SA block, anorexia,
nausea, vomiting, diarrhea, thrombocytopenia, electrolyte imbalances with acute digitalis toxicity Adverse: Arrhythmias
Patient Teaching: Take this medication daily, as prescribed, and at the same time. If they miss a dose, they should take it as soon as
possible if within 12 hours, otherwise they should skip the dose and never double dose. Teach the patient how to take their own pulse
and to report if they become bradycardic. The patient should follow up with physician regularly. They should report any side effects /
adverse effects. Nursing considerations: If the patient already has an AV, SA block or bradycardia, this medication should not be
prescribed. If they are already anorexic, consider a different medication. If they are immune compromised, receiving chemo or
radiation, consider side effects of medication. If the patient is prone to dehydration and/or has a failure to thrive, consider a different
University of South Florida College of Nursing Revision September 2014 4
medication. Know the interactions between the patients current medications and this medication, including OTC and herbals. Find out
if they are taking any OTC or herbals.
5 MEDICATIONS:
Name: Primsol (trimethoprim) Concentration: 100mg in 1 tablet Dosage Amount: 100mg
Route: oral Frequency: once daily
Pharmaceutical class: folate antagonist Ther Class: anti-
Home only
infective
Indication: for this patient its to treat recurrent UTIs. Other indications: and otitis media.
Side effects: altered taste, epigastric discomfort, glossitis, nausea, vomiting, drug-induced hepatitis, pruritus, rash, megaloblastic
anemia, neutropenia, thrombocytopenia Adverse: none
Patient Teaching: Once the patient begins the medications, they need to finish it completely and as directed, even if they are feeling
better. If they forget a dose they should take it as soon as possible, without double dosing. They should space out the following doses
appropriately. Notify physician of any side effects / adverse reactions including: rash, sore throat, fever, mouth sores, bleeding or
bruising. Lastly, report any side effects / adverse reactions to the medication. Nursing considerations: If the patient has ulcers, GERD,
bleeding disorder, are receiving chemo / radiation or are immune compromised, have a liver disease or are an alcoholic consider side
effects of this medication. Possibly consider prescribing a different medication. Know the interactions between the patients current
medications and this medication, including OTC and herbals. Find out if they are taking any OTC/herbal.

Name: Prilosec / OTC (omeprazole) Concentration: 20mg in 1 capsule Dosage Amount: 20mg
Route: oral Frequency: twice daily
Pharmaceutical class: Proton pump inhibitor Ther Class:
Home only
antiulcer
Indication: for this patient its to treat heartburn, GERD. Other indications: healing erosive esophagitis, duodenal ulcers, benign gastric
ulcer, Zollinger-Ellison syndrome, decrease risk of GI bleed in critical patients
Side effects: dizziness, drowsiness, fatigue, h/a, weakness, chest pain, abdominal pain, acid regurgitation, constipation, diarrhea,
flatulence, nausea, vomiting, hypomagnesemia, itching, rash, bone fracture, allergic reactions Adverse: pseudomembranous colitis
Patient Teaching: Take the medication as directed, and if they miss a dose take it as soon as possible, without double dosing. Use
caution when operating machinery until they know how they react on this medication, as it can cause dizziness and drowsiness. Avoid
taking NSAIDS, ASA, and aspirin while on this medication, as it can cause increased GI irritation. They should report any changes in
stool, or any appearance of blood or a dark tarry substance in it. Report if stool has any pus or mucus type appearance. Report any
vomiting with the appearance of blood, or coffee ground appearance. If a female and planning on getting pregnant, they should notify
their physician. Lastly, report any side effects / adverse reactions to the medication. Nursing considerations: If the patient is an
alcoholic, has a hepatic or liver disease, consider side effects. If the patient already suffers from chronic diarrhea, has ulcerative colitis,
or Chrons, consider a different medication. If the patients labs show hypomagnesemia, do not prescribe. If the patient has a known
history of a GI bleed, consider not prescribing. Know the interactions between the patients current medications and this medication,
including OTC and herbals. Find out if they are taking any OTC or herbals.

Name: Bayer, Ecotrin (aspirin) Concentration: 81mg in 1 tablet Dosage Amount: 81mg
Route: oral Frequency: once daily
Pharmaceutical class: salicylate Ther class: antipyretic,
Both
non-opioid analgesic, antiplatelet aggregator
Indication: for this patient its to decrease platelet aggregation. Other indications: analgesic, decrease inflammation or fever
Side effects: tinnitus, dyspepsia, eigastric distress, nausea, abdominal pain, anorexia, hepatotoxicity, vomiting, anemia, hemolysis, rash,
urticarial. Adverse: anaphylaxis and laryngeal edema, GI bleed.
Patient Teaching: Take medication with a full glass of water and to be in an upright position for up to 30 min after taking. The patient
should report any side effects / adverse reactions such as unusual bleeding of the gums, bruising, blood or tarry substance in stool,
haematemesis, or coffee ground appearance. The patient should limit alcohol, Tylenol, and other NSAIDS. Report to any physician
they are taking it prior to having any surgery. Nursing considerations: If the patient is on blood thinners, do not prescribe, as it can
cause increased bleeding. If the patient is an alcoholic, has a hepatic or liver disease, consider side effects. If the patient already suffers
from chronic diarrhea, has ulcerative colitis, or Chrons consider a different medication. If the patient has a known history of a GI
bleed, consider not prescribing. Know the interactions between the patients current medications and this medication, including OTC
and herbals. Find out if they are taking any OTC or herbals.

University of South Florida College of Nursing Revision September 2014 5

 5 MEDICATIONS:
Name: Pravachol (pravastatin) Concentration: 10mg in 1 tablet Dosage Amount:10mg
Route: oral Frequency: once daily at bedtime
Pharmaceutical class: hmg coa reductase inhibitor (statin)
Both
Ther Class: lipid lowering agent
Indication: hypercholesterolemia, prevention of: CHD, MI, CVA
Side effects: amnesia, confusion, dizziness, h/a, insomnia, memory loss, weakness, rhinitis, bronchitis, chest pain, edema, abdominal
cramps, constipation, flatus, heartburn, altered taste, drug induced hepatitis, dyspepsia, increased liver enzymes, nausea, pancreatitis,
erectile dysfunction, rash, pruritus, hyperglycemia, arthralgia, arthritis, immune-mediated necrotizing myopathy, myalgia, myositis,
hypersensitivity Adverse: rhabdomyolysis
Patient Teaching: Take the medication as directed and do not skip a dose. If miss a dose, take as soon as possible, but do not double
dose. Avoid drinking grapefruit juice. Restrict fats from diet, and they should exercise and quit smoking. This medication doesnt cure
hyperlipidemia, and should still lead a healthier diet. Wear sunscreen. Females should notify physician prior to getting pregnant, as this
is pregnancy category X. They should notify their physician immediately if they begin having muscle pain, tenderness, weakness, and
fever, as this could indicate a life threatening problem. Report any other side effects / adverse reactions. They should use caution when
operating machinery, as it can cause dizziness and confusion. They should limit alcohol while on this. They should increase water and
fiber in their diet as it can cause constipation. They should follow-up with their doctor regularly for labs. If they are a diabetic, they
need to check their BS regularly. Nursing considerations: Medication shouldnt be prescribed if the patient already has myositis,
IMNM, or a muscle degenerative disease. Consider alternative medication if the patient has a hepatic disease, or pancreatitis. LFTs
should be monitored regularly on this patient. Fi the patient is taking antibiotics then consider lowering the dosage on this medication,
as those can cause myopathy as well. Use caution if the patient is on warfarin, as it can increase the effects of it.
Name: Coumadin / Jantoven (warfarin) Concentration: 5mg in 1 tablet Dosage Amount: 7.5mg
Route: oral Frequency: every Monday, Wednesday, and Friday
Pharmaceutical class: coumarin Ther class:
Home only
anticoagulant
Indication: for this patient: due to a-fib. Other indications: prophylaxis treatment of DVT, PE, management of MI.
Side effects: cramps, nausea, dermal necrosis, fever Adverse: bleeding
Patient Teaching: Take the medication as directed. If they miss a dose, take it as soon as possible that day, but dont double dose.
Inform their physician at their f/u for labs if they missed a dose. Do not abruptly stop this medication. Avoid foods high in vitamin K.
Tell the patient what these medications are. Avoid cranberry juice. Avoid IM injections, use a soft toothbrush and dont floss to help
prevent oral bleeding. Shave with an electric razor. Avoid alcohol and NSAIDS as it increases risk of bleeding. If its a female patient
and they are planning on getting pregnant, they should advise their physician, as it is a pregnancy category X. They should advise any
physician they are taking it prior to having any surgery. Notify their physician immediately if they have haematemesesis, or notice any
coffee ground appearance in emesis. Also notify immediately if they have any blood or tarry substance in their stool. They should get
regular labs and f/u with their physician regularly. Notify doctor of any other side effects /adverse reactions. Nursing considerations:
If the patient is an alcoholic, has a hepatic or liver disease, consider side effects. If the patient already suffers from chronic diarrhea, has
ulcerative colitis, or Chrons consider a different medication. If the patient has a known history of a GI bleed, consider not prescribing.
Know the interactions between the patients current medications and this medication, including OTC and herbals. Find out if they are
taking any OTC or herbals.

Name: Zofran (ondansetron) Concentration: 4mg in 2 mL Dosage Amount: 4mg

Route: IV Frequency: every 4 hours as needed
Pharmaceutical class: five ht3 antagonist Ther class:
Hospital only
antiemetic
Indication: nausea and vomiting
Side effects: h/a, dizziness, drowsiness, fatigue, weakness, QT interval prolongation, constipation, diarrhea, abdominal pain, dry
mouth, increased liver enzymes, EPS Adverse: Torsades
Patient Teaching: Take medication as directed and as needed. They should tell their physician if they notice any palpitations or
irregular heartbeat, involuntary movement of the eyes, face, or limbs. They should increase fiber and water intake as it can cause
constipation and diarrhea. They should limit alcohol while on this medication. Nursing considerations: Be aware of all the y-site
incompatibilities with this medication. If the patient has hepatic disease, or is an alcoholic, use with caution. If the patient has a history
of Torsades or prolonged QT, do not prescribe. Monitor for EPS, arrhythmias, and check labs for hypokalemia and hypomagnesemia, as
they can cause arrhythmias. Know the interactions between the patients current medications and this medication, including OTC and
herbals. Find out if they are taking any OTC or herbals.

University of South Florida College of Nursing Revision September 2014 6

 Allmedicationscitedby:(UnboundMedicine,Inc,2015).

5 NUTRITION: Include type of diet, 24 HR average home diet, and your nutritional analysis with recommendations.
Diet ordered in hospital? 2g NA+, plus nutritional Analysis (Consider co-morbidities and cultural
supplements Mighty Shake Plus and Boost. considerations): Lives alone, no one to help monitor her
diet. She doesnt cook and lives on fast food. Has CHF, a-
Diet patient follows at home? NONE fib, valvulopathy, colon polyps, GERD, diverticulosis,
hypercholesterolemia, and osteoporosis. Reports decreased
appetite.
HOME DIET Recommendations: Having a consultation with a dietician
Breakfast: Doesnt eat breakfast and receive paperwork on the types of food to eat, and what
Lunch: Olive Garden: lasagna piece / Red Lobster: foods fit into what category. Stop eating fast food, and
coconut shrimp / KFC or Publix rotisserie chicken can get begin cooking or getting meals packaged and easy to
6 servings out of chicken prepare from the grocery store. I recommend she greatly
Dinner: Leftovers from lunch / Some kind of vegetable: 1 decrease the amount of sodium she is consuming. She
serving. carrots, green beens, corn, asparagus, potatoes needs to decrease it by 1.5g daily. She needs to increase the
Snacks: whole milk cottage cheese, 4 club crackers, 2 amount of water she is consuming. A-fib can be greatly
cookies: PB, sugar, or white chocolate macadamia affected by electrolyte imbalances, and contributes to HTN.
Liquids (include alcohol): 2 glasses water daily, 1 glass tea She is likely retaining too much water as well, which can
w/sweetener daily, doesnt drink alcohol. affect her CHF and cause fluid accumulation in the lungs.
She needs to increase the amount of grains, dairy, and
24 HR average home diet: 1225 calories protein she consumes. She needs to begin eating fruit. She
Grains Vegetables Fruits Dairy
Protein can try and eat fruit that is less acidic. She doesnt have
Foods any ulcers, but suffers from GERD. If her medication isnt
Target 6 oz. 2 cup(s) 2 cup(s) 3 cup(s) 5 oz.
Eaten 4 oz. 2 cup(s) 0 cup(s) 1 cup(s) 1 oz.
controlling the GERD, then she should consult physician
for an alternative one. Increase the amount of fiber, which
Status Under OK - Under Under
will help with constipation. Start eating breakfast. A poor
Daily limits: 2000 calories diet will contribute to lethargy and weakness and slow
Eaten: 1225 / Empty calories eaten: 361 healing time if she isnt consuming enough protein and
Oils limit: 6 tsp., Eaten: 0 tsp. carbs. Improving her diet by eating the right types of food,
Sat Fat limit: 22 g, Eaten: 19g cooking vs. going out will likely improve her cholesterol
Sodium limit: 2300mg, Eaten: 3488mg levels, HTN, GERD, colon polyps, diverticulosis,
valvulopathy, osteoporosis, and symptoms of CHF. Her
She is not consuming enough calories on the right types of decreased appetite may be due to depression or worsening
food. She is consuming too much NA+ per day. She isnt health, but her health could be improved with a better diet.
consuming any good fats or fruit. She is also not She may need to continue on supplements which may make
consuming enough water. NOTE: She states she doesnt it easier for her to get the nutrients she needs.
eat fruit due to gastric problems. (ChooseMyPlate.gov. 2011).
Use this link for the nutritional analysis by
comparing the patients 24 HR average home diet to
the recommended portions, and use My Plate as
a reference.

1 COPING ASSESSMENT/SUPPORT SYSTEM:

Who helps you when you are ill? Son Mark in Cape Coral (1st call), neighbor Rose (2nd call), church members (3 rd).
How do you generally cope with stress? Eats and increases sugar intake. She will also pray for relief.
Recent difficulties (MH, social, financial): She has been feeling depressed and alone. Her closest son is in Cape Coral.
She states she doesnt like to burden or impose on the neighbors, and one of them is having medical problems of her own.
University of South Florida College of Nursing Revision September 2014 7
She stated, what else is there? She believes she no longer has good quality of life.

+2 DOMESTIC VIOLENCE ASSESSMENT

Have you ever felt unsafe in a close relationship? NO
Have you ever been talked down to? When she had disagreements with spouse.
Have you ever been hit punched or slapped? NO
Have you been emotionally or physically harmed in other ways by a person in a close relationship with you? NO
If yes, have you sought help for this? N/A
4 DEVELOPMENTAL CONSIDERATIONS: Eriksons stage of psychosocial development
Check one box. Give the textbook definition (citation and reference) of both parts of Ericksons
developmental stage in the patients age group: Ego Integrity vs. Despair Age: 65+ years
Textbook definition of Stage 8: The task of this stage is the acceptance of ones life, worth, and eventual death.
Ego integrity reflects a satisfaction with life and an understanding of ones place in the life cycle. A sense of
loss, discomfort with life and aging, and a fear of death are seen in despair. (Treas & Wilkinson, 2014)
Describe the stage and give the characteristics that the patient exhibits: The patient realizes life has to come
to an end at some point and she understands she is nearing the end. She is not fully accepting of it, but she
understands it. She is sad and depressed over the end nearing and her failing health. She has had feelings of
nostalgia and is reflecting upon good memories she has had. She is exhibiting sadness and fear. She is longing
for companionship and doesnt want to be alone. She desires to spend more time with family.
Describe what impact of disease/condition or hospitalization has had on your patients developmental
stage of life: The patient states from 1999-2002 she began to get sick and became depressed. The patient would
have been 65 in 1999, placing her at the beginning of Stage 8. Since then, she has had repeated hospitalizations
and her health is continuing to fail her. As the patients diseases continued to progress and she had decreased
health and mobility, she began to see the end of her life nearing. She became depressed and wasnt ready for it
to come to an end. At the same time, she has made several statements, reflecting on her past, how she lived a
good life and has been blessed. While the patient may not be ready for death, she understands its coming and it
is part of life. At the same time she has no desire to make any life modifications, as she believes there is
nothing she can do to change the inevitability of death.
+3 CULTURAL ASSESSMENT:
What do you think is the cause of your illness? She stated she is aware smoking for 40 years is what caused her
illness.
What does your illness mean to you? Im feeling like Im nearing the end. She stated she is feeling the decline.
+3 SEXUALITY ASSESSMENT:
Have you ever been sexually active? YES
Do you prefer women, men or both genders? Men
Are you aware of ever having a sexually transmitted infection? NO
Have you or a partner ever had an abnormal pap smear? Yes, 1994
Have you or your partner received the Gardasil (HPV) vaccination? NO
Are you currently sexually active? NO If yes, are you in a monogamous relationship? N/A
When sexually active, what measures do you take to prevent acquiring a sexually transmitted disease or
an unintended pregnancy? Ages 19-21 used condoms and oral contraceptives off and on in-between having
children.
How long have you been with your current partner? Spouse deceased for 15 years, married for 42 years.
Have any medical or surgical conditions changed your ability to have sexual activity? NO
Do you have any concerns about sexual health or how to prevent sexually transmitted disease or
unintended pregnancy? NO, states Im too old and Im not having sex anymore.

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1 SPIRITUALITY ASSESSMENT:
What importance does religion or spirituality have in your life? The patient places the highest priority on
this and goes to church on Sundays, but wishes she could go more often. She goes as often as she can.
Do your religious beliefs influence your current condition? She states she doesnt know where she would be
or how she would cope without her religion. She states she prays to help get her through it, and relies on the positivity of her spiritual
community.

+3 SMOKING, CHEMICAL USE, OCCUPATIONAL/ENVIRONMENTAL EXPOSURES:

1. Does the patient currently, or has he/she ever smoked or used chewing tobacco? YES

How much? 10 cigarettes x 35 yrs,

If so, what? Cigarettes For how many years? 40 years
20 cigarettes x 5 yrs

If applicable, quit when?

age 19 thru 60 Pack Years: 23 years
Approx. 23 years ago
Does anyone in the patients household smoke tobacco? If
Has the patient ever tried to quit? She did quit.
so, what, and how much?
No one now. She was married for 42 years and husband
If yes, what did they use to try to quit? Cold turkey
smoked 3 packs of cigarettes daily.

2. Does the patient drink alcohol or has he/she ever drank alcohol? Not now, but she use to drink.

For how many years? 59 years

What? Bourbon and 7UP How much? 2 drinks at a time

Frequency: every 3 months Volume: 8 oz age: 19 thru: 78

If applicable, when did the patient quit?
2012

3. Has the patient ever used street drugs such as marijuana, cocaine, heroin, or other? NO
If so, what? N/A

How much? N/A

For how many years? N/A age N/A thru N/A
If not, when did he/she quit?
Is the patient currently using them? N/A
N/A

4. Have you ever, or are you currently exposed to any occupational or environmental Hazards/Risks?
NONE

5. For Veterans: Have you had any kind of service related exposure?
N/A

University of South Florida College of Nursing Revision September 2014 9

 10 REVIEW OF SYSTEMS NARRATIVE
How do you view your overall health? Poor. She feels as though she will die soon.
Integumentary: History of cellulitis, thin skin and prone to bruising due to blood thinners.
HEENT: headaches, decreased vision, decreased hearing
Pulmonary: COPD, O2 dependent, history of smoking
Cardiovascular: CHF, Right sided HF, atrial fibrillation, PVCs, valvulopathy,
GI: GERD, diverticulosis, colon polyps
GU: incontinence, frequent UTIs, vaginal dryness and itching
Musculoskeletal: Osteoporosis, osteoarthritis, history of vertebral compression fxs, thoracic kyphoplasty.
Ambulates with a walker. Overweight.
Immunologic: Decreased due to poor health. Susceptible to illness and is on constant O2 and history of COPD.
No active infection, but is on prednisone due to COPD exacerbation.
Hematologic/Oncologic: PT INR high, hypercholesterolemia. Abnormal labs: RBC low at 3.79. No current
cancer, but has a history of breast cancer, and abnormal pap.
Metabolic/Endocrine: None
Central Nervous System: neuropathy
Mental Illness: Depression, anxiety
Childhood Diseases: Walking pneumonia
Is there any problem that is not mentioned that your patient sought medical attention for with anyone?
NONE.
Any other questions or comments that your patient would like you to know? She stated there isnt anything
she would like to know, but theres something she would like me to know. She stated she has had a blessed life.
She states she has great family relationships, and her children are wonderful. She has very fond memories of her
marriage and thinks her husband was great. She states she had a charmed life.
10 PHYSICAL EXAMINATION: General survey:
Height: 56 Weight: 157.6 lbs. BMI: 25.4, on the low side of overweight. Pain (rating, location): 1/10 Rt
side of chest.
Pulse: 116 Blood Pressure (location): 157/90 Right upper arm Temperature (route taken): Oral 98.3
Respirations: 24 BPM SpO2: 95% Room Air or O2: 95% Overall Appearance: Good
Mood/Affect: Broad affect, happy to sad depending on what we were discussing. Overall Behavior: Lonely
and sad Speech: Clear, understandable
Integumentary: Skin warm, pink, and dry. Cap refill < 3 seconds. Residual cellulitis lower right leg, anterior.
Skin red, warm to the touch, and 1+ edema. Spots of ecchymosis on arms from IV sticks. Skin is thin. Skin
turgor slightly tented. No edema on the rest of the body. Hair and nails all normal quality with no abnormalities.
Coccyx area is red due to incontinence.
IV Access: Left wrist 22 ga placed 06/25/2015. It was dry and intact.
HEENT: Eyes PERRL, sclera white, lens clear. Decreased vision right eye. Decreased hearing, worse in left ear.
Skull, face, nose, throat normal in appearance. Tongue and gums pink. No dentures. Good oral hygiene.
Lymphnodes nl in size.
Pulmonary/Thorax: Lungs are clear. RR tachypneic and shallow, equal chest rise and fall.
Cardiovascular: Tachycardia w/ occ PVCs, distal pulses equal 2+, nl heart tones. Palpable carotid with no
bruits. No JVD.
GI: Abdomen slightly rounded. NL bowel sounds heard all 4 quadrants. Non-tender, soft, no masses felt.
Tympanic sounds.
GU: No external exam. The patient reports vaginal itch and dryness.
Musculoskeletal: Pulse motor sensory x 4. Moves all extremities without assistance. NL active ROM. Good
strength and muscle tone. No atrophy or wasting. Gait is slightly unbalanced and slow.
Neurological: A&O x 4. Decreased sensation all toes bilateral feet.

University of South Florida College of Nursing Revision September 2014 10

10 PERTINENT LAB VALUES AND DIAGNOSTIC TEST RESULTS
(include pertinent normals as well as abnormals, include rationale and analysis. List dates with all labs and diagnostic tests):
LAB DATES TREND ANALYSIS
WBC (4.5-11): 11.3 H 6/17/15 N/A PT / INR: Low intensity, all
RBC (4-5.2) 4.73
indications except mechanical
HGB (10.9-15.5) 14.5
Platelet (150-400) 283 heart valve or risk of cardiac
PT (11.7-15) 23.4 H embolus.
INR (0.81-1.20) 2.08 H
Glucose (60-100): 115 H
NA+ (131-145) 134
K+ (3.7-5.4) 3.8
CO2 (22-29) 24
BUN (8-23) 8
GFR (>60) >60
Creatinine (0.4-1.1) 0.7
Troponin (0 0.8) 0
WBC (4.5-11): 9.7 6/19/15 N/A PT / INR: High intensity, at
RBC (4-5.2) 4.44
risk with mechanical heart
HGB (10.9-15.5) 13.8
Platelet (150-400) 285 valve or at high risk of cardiac
PT (11.7-15) 33.1 H embolus.
INR (0.81-1.20) 3.27 H
Glucose (60-100): 96
NA+ (131-145) 136
K+ (3.7-5.4) 4.4
BUN (8-23) 21
Creatinine (0.4-1.1) 1.2 H
GFR (>60) 46 L
PT (11.7-15) 30.7 H 6/21/15 N/A Medium intensity, average risk
INR (0.81-1.20) 2.96 H
with mechanical heart valve or
moderate risk of cardiac
embolus.
WBC (4.5-11): 10.2 6/23/15 N/A PT / INR: Low intensity, all
RBC (4-5.2) 3.5 L
indications except mechanical
HGB (10.9-15.5) 10.5 L
Platelet (150-400) 307 heart valve or risk of cardiac
PT (11.7-15) 26.6 H embolus.
INR (0.81-1.20) 2.46 H
Glucose (60-100): 89
NA+ (131-145) 139
K+ (3.7-5.4) 4.2
CO2 (22-29) 28
BUN (8-23) 17
GFR (>60) >60
Creatinine (0.4-1.1) 0.9
WBC (4.5-11): 10.5 6/25/15 Glucose fluctuating while at PT / INR: High intensity, at
RBC (4-5.2) 3.79
hospital. It could be due to risk with mechanical heart
HGB (10.9-15.5) 11.4
Platelet (150-400) 338 time it was taken, i.e., after a valve or at high risk of cardiac
PT (11.7-15) 31.5 H meal. embolus.
INR (0.81-1.20) 3.06 H
Glucose (60-100): 156 H
NA+ (131-145) 137
Other than PT INR, all other
K+ (3.7-5.4) 3.8 labs showing no trend and are
CO2 (22-29) 25 near NL and not at a treatable
BUN (8-23) 9 level or WNL.
GFR (>60) >60
Creatinine (0.4-1.1) 0.9

PT (11.7-15) 31.05 H 6/26/15 PT INR continues to fluctuate High intensity, at risk with
INR (0.81-1.20) 3.06 H
and not at therapeutic levels. mechanical heart valve or at
Warfarin needs to be adjusted. high risk of cardiac embolus.

University of South Florida College of Nursing Revision September 2014 11

10 PERTINENT LAB VALUES AND DIAGNOSTIC TEST RESULTS
(include pertinent normals as well as abnormals, include rationale and analysis. List dates with all labs and diagnostic tests):
DIAGNOSTIC DATES TREND ANALYSIS
Chest X-ray 6/17/15 N/A Fibrosis, lungs hyperinflated,
calcified left hilar lymph
nodes, mid kyphoplasty noted.
Stationary ECG Study 6/18/15 N/A Atrial fibrillation
ECHO-Transesophageal 6/18/15 N/A Mild-mod lt atrial enlargement.
Mild-mod mitral regurgitation.
Mod tricuspid regurgitation w/
bilateral enlargement. Aortic
valve is trileaflet and mildly
calcified with mild aortic
incompetence. Lt ventricular
systolic function approx. 55-
60%. Mild atherosclerotic
changes in descending aorta.
SCT CTA Pulmonary Vein 6/26/15 N/A Severe centrilobular
Isolation emphysematous disease with
upper lobe predominance.
Linear and nodular airspace
opacity within the superior
segment of the rt lower lobe
5mm in greatest diameter.

+2 CURRENT HEALTHCARE TREATMENTS AND PROCEDURES:

(Diet, vitals, activity, scheduled diagnostic tests, consults, Accucheck, etc. Also provide rationale and frequency if applicable.)
Continue on the cardiac monitor to monitor for arrhythmias. She has been in and out of a-fib with occ
PVCs.
Monitor vitals every 4 hours to assess for changes.
Cardizem drip to treat a-fib, as needed. 10mg/hr IV infusion.
Continue with Nitro 0.4mg SL prn for chest pain can repeat q5 min x 3, Zofran 4mg IV q4h prn for
nausea, Morphine IV 2mg q2h severe pain prn / Oxycodone 5/325mg q4h moderate pain prn, Dilaudid
0.5mg IV q2h prn pn, Tylenol 650mg q4h prn mild pain, Demerol 6.25mg IV prn for shivering, Xanax
0.25mg prn anxiety. Peri-colace twice daily for constipation prn, Halcion 0.125mg qhs prn insomnia,
Cepacol prn sore throat, Maalox Plus 30 mL four times daily for indigestion.
Continue with regular meds treating chronic conditions.
2g NA+ diet plus supplementation with Mighty Shake Plus three times daily, and Boost once daily. Due
to patients significant cardiac history, this is the diet best for her. Encourage her to eat > 50%.
Continue getting PT INR, due to Warfarin. Levels are currently high.
Continue with Accucheck prior to every meal to assess for BS >100.
Taper off the prednisone. Placed on to treat exacerbation of COPD.
Duo Neb 3ml three times daily prn for COPD and dyspnea.
Fall precautions; continue with yellow armband and socks, bed alarm, and calling for assistance as
needed.
Activity AD LIB. / PT.
Rotate in bed every 2 hours and get up regularly to sit in the chair.
Moisture management for incontinence.
Apply Aloe Vesta twice a day and as needed for skin due to incontinence. Consider placing Aquacel.

University of South Florida College of Nursing Revision September 2014 12

 8 NURSING DIAGNOSES (actual and potential - listed in order of priority)
1. Decreased cardiac output r/t cardiac disorder EB palpitations and arrhythmia
2. Activity intolerance r/t acute pain, dysrhythmias EB EKG changes reflecting arrhythmias, exertional
discomfort, and verbal report of fatigue and weakness.
3. Activity intolerance r/t imbalance between oxygen supply and demand EB exertional dyspnea, and verbal
report of fatigue and weakness.
4. Risk for impaired skin integrity r/t mechanical factors, and physical immobilization EB destruction of skin
layers.
5. Ineffective self-health management r/t perceived benefits, and powerlessness EB failure to reduce risk
factors; ineffective choices in daily living for meeting health goals.
6. Risk for powerlessness: risk factor: actual or perceived loss r/t depression over physical deterioration,
nonparticipation in care, and reports lack of control.

University of South Florida College of Nursing Revision September 2014 13

 15 CARE PLAN Nursing Diagnosis: See previous page. Listed in order below.
Patient Goals/Outcomes Nursing Interventions to Achieve
Goal
The patient will demonstrate adequate
cardiac output as evidenced by blood
pressure, pulse rate and rhythm within
normal parameters for client; strong
peripheral pulses; maintained level of
mentation, lack of chest discomfort or
dyspnea; an ability to tolerate activity
without symptoms of dyspnea, syncope, or
chest pain before the end of this shift.
Long term goal: The patients HR will
maintain a NL sinus rhythm on oral meds
and she will remain pain free.
The patient will participate in prescribed
physical activity with appropriate changes
in heart rate, blood pressure, and breathing
rate: maintain monitor patters within
normal limits. Verbalize an understanding
of the need to gradually increase activity
based on testing, tolerance, and symptoms.
Demonstrate increased tolerance to
activity. Long term: the patient will have
increased strength and will be able to
tolerate walking around the grocery store
to do her own shopping and will remain
pain free.
The patient will participate in prescribed
physical activity with appropriate changes
in heart rate, blood pressure, and breathing
rate: maintain monitor patters within
normal limits. Maintain normal skin
color, and skin is warm and dry with
activity. Verbalize an understanding of the
need to gradually increase activity based
on testing, tolerance, and symptoms.
Demonstrate increased tolerance to
activity. Long term: the patient will be
able to tolerate walking around the
grocery store to do her shopping and will
not get winded when doing so.
University of South Florida College of Nursing Revision September 2014
Rationale for Interventions
Provide References
Continue to monitor the patients heart
rhythm and adjust medications as needed
to control the rate and rhythm. Evaluate
patient's pain, treat if necessary, and
continue with the present treatment
regimen.
Reduce or eliminate contributing factors
by allowing for periods of rest before and
after planned exertion periods and
physical activity. Check pulse rates
resting and after activity to avoid danger
of too great an increase. Assess skin color
(hands, nails) before and after activity.
Monitor the patients response to activity
by observing for symptoms of respiratory
intolerance. Instruct and assist a COPD
client in using conscious, controlled
breathing techniques during exercise,
including pursed-lip breathing, and
inspiratory muscle use. Encourage
coughing, deep breathing, and inspiration
spirometer. Progress the patients activity
gradually. Refer the COPD client to a
pulmonary rehabilitation program.
Evaluation of Goal on Day of
Care is Provided
EB: A nursing study to validate The patient had normal cardiac output as
characteristics of the nursing diagnosis evidenced by her vitals. Her BP, HR was
decreased cardiac output in a clinical both within NL limits. Her HR was in NL
environment identified and categorized sinus prior to me leaving.
related and client characteristics that were
present as primary or secondary. (Martins,
Alita, & Rabelo, 2010).
EB: Exercise-based cardiac rehabilitation The patient never performed any physical
is effective in reducing total and activity before I left. Her pain however
cardiovascular mortality and hospital was at a tolerable level.
admissions. (Du et al, 2009).
EB: The 6-minute walk test predicted The patients RR did drop under 20 BPM
mortality in COPD clients. (Celli, 2010). after receiving breathing treatments. The
EB: A systematic review found pursed-lip patient never did perform any physical
breathing effective in decreasing dyspnea. activity. By the time I left, the patient
(Carrieri-Kohlman & Donesky-Cuenco, reported breathing much better and having
2008). EB: A systematic review found only minimal discomfort while breathing.
that inspiratory muscle training was
effective in increasing endurance of the
client and decreasing dyspnea. (Langer et
al, 2009). EB: Pulmonary rehabilitation is
a highly effective and safe intervention to
reduce hospital admissions and mortality
to improve health-related quality of life in
COPD clients who have recently suffered
an exacerbation of COPD. (Puhan et al,
2011).
14
 Patient Goals/Outcomes
The patient will regain integrity of skin
surface; report any altered sensation or
pain at the site of skin impairment;
demonstrate understanding of plan to heal
skin and prevent reinjury; describe
measures to protect and heal the skin and
to care for any skin lesions. Long term:
the patient will be mobile and not be bed
bound, therefore will not be at risk of skin
breakdown.
The patient will describe daily food and
fluid intake that meets therapeutic goals.
Describe activity/exercise patterns that
meet therapeutic goals. Collaborate with
health providers to decide on the
therapeutic regimen that is congruent with
health goals and lifestyle.
Long term: the patient will continue to
exercising and maintain a healthy lifestyle.
The patient will state feelings of
powerlessness and other feelings related to
powerlessness. They will identify factors
that are uncontrollable and participate in
planning and implementing care; making
decisions regarding care and treatment
when possible. Long term: the patient will
have a more positive outlook on life and
will seek help when she feels
overwhelmed.
University of South Florida College of Nursing Revision September 2014
Nursing Interventions to Achieve
Goal
Use a risk assessment tool to
systematically assess immobility-related
risk factors. Inspect and chart skin
integrity q4h. Provide measurements to
decrease pressure/irritation to skin by
keeping the skin clean, dry and intact.
Turn and rotate the patient q2h. Expose
skin to air if needed, or apply Aloe Vesta
or Aquacel.
Assist the patient self-manage his or her
own health through teaching about
strategies for changing habits such as
overeating, and sedentary lifestyle.
Provide the patient with information on
how to eat a healthier and more balanced
meal. Encourage the patient to eat >50%
of her meals while in the hospital.
Observe for factors contributing to
powerlessness. Establish a therapeutic
relationship with the client by spending
one-on-one time with them. Encourage
the patient to share his or her beliefs,
thoughts, and expectations about his or her
illness.
Rationale for Interventions Evaluation of Goal on Day of
Provide References Care is Provided
EB: Targeting variables can focus The patients skin will remained intact and
assessment on particular risk factors and showed no degradation. Coccyx Aquacel
help guide the plan of prevention and care. pad placed to prevent breakdown.
(EPUAP/NPUAP, 2009).
EB: Self-management education helps They patient showed more interest in
achieve positive health outcomes such as eating. The patient has a better
reductions in systolic blood pressure as understanding on how to eat a more
well as fewer exacerbations of COPD. balanced diet.
(Govil et al, 2009).
EB: Many studies identify factors The patient demonstrated the ability to
contributing to feelings of powerlessness express her feelings and seek help for
are related to loss of person, place, health, them.
or social relationships. (Braam, 2010).
EB: In a study of successful adaptation of
women with chronic illness, establishment
of a therapeutic relationship contributed to
positive outcomes. These relationships
were enhanced by careful listening on the
part of the health care provider. (Cudney,
Weinert, & Kinion, 2011). The Health
Belief Model identifies perceived barriers
and perceived susceptibility to disease as
powerful predictors of clients motivation
in taking action to prevent disease and
participate in self-care management.
(Pender, Murdaugh, & Parsons, 2010)
15
 DISCHARGE PLANNING: (Put a * in front of any patient education in above care plan that you would include for discharge teaching)
SS Consult: None
Dietary Consult: Cardiac diet. Discuss healthier eating options and how to reduce NA+.
PT/ OT: Will need PT/OT for weakness, decreased activity, COPD
Pastoral Care: She stated she didnt have any spiritual needs.
Durable Medical Needs: Declined TED hose. Already has a walker at home.
F/U appointments: Cardiologist: Dr. John Culp, Internist: Dr. Bonnie Gabriel, PCP: Dr. Ryan Baker
Med Instruction/Prescription: Prednisone instructions, tapering. Unknown if there will be any medication changes.
Are any of the patients medications available at a discount pharmacy? Insurance doesnt cover sending away for 3 month prescriptions. All of
the prescriptions are available as generics and can be found at Walmart. She can sign up for a free program app on cellphone for GoodRX. It offers
discount coupons and price compares all prescriptions at all local pharmacies.
Rehab/ HH: May benefit from this, as she seems to be declining and have less interest in taking active role in health. The patient lives alone.
Palliative Care: While in hospital, provide comfort measures for anxiety and manage her pain.

University of South Florida College of Nursing Revision September 2014 16

 References

Ackley, B., & Ladwig, G., (2014). Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (10th ed.). Maryland Heights,

MO: Mosby.

Case-Lo, C. (2013). Atrial Fibrillation: Whats My Prognosis. Healthline. Retrieved from http://www.healthline.com/health-slideshow/atrial-

fibrillation-prognosis#1

ChooseMyPlate.gov. (2011). Retrieved July 14, 2015, from http://www.choosemyplate.gov/

Treas, L., & Wilkinson, J., (2014). Basic Nursing: Concepts, Skills & Reasoning. Philadelphia, PA: F.A. Davis Company.

Unbound Medicine, Inc. (2015). Daviss drug guide (Version 1.17) [Mobile application software]. Retrieved from

https://itunes.apple.com/us/app/daviss-drug-guide-updates/id301427093?mt=8

University of South Florida College of Nursing Revision September 2014 17