Tamra (Tammy) Johnson 11/16/10

ASSIGNMENT GUIDELINE I
Tuesday
I. Identify Client:
Client’s initials: ___L.F.________Age ___50_____Sex ___F____

Physician (s) _Bamiro, Hasbach, Patel___________________

Occupation (if retired, what kind of work did the client do and for how long).
___Disabled States she has not worked______________________________

II. Diagnosis (es)

List your assigned patient’s medical diagnoses to include current and past history. .
(1) Define each medical diagnosis in your own words to include
pathology/physiology, your pathology and physiology need to be at least one
paragraph by itself) (2) signs and symptoms (3) list all body systems involved with
the diagnosis (4) include source(s) and page number using APA format add pages as
needed. It must be in your own words no cutting and pasting from the internet. Please
review, the school’s policy on plagiarism in your student handbook). The admission
diagnosis will be found on the admission sheet. All other diagnoses may be found on
the history & physical, nurse assessment and/or progress note. You can also identify
the patient’s diagnosis by defining and reviewing the patient’s medications.

Emphysema
A chronic obstructive pulmonary disease marked by an abnormal increase in the size of
air spaces distal to the terminal bronchiole, with destruction of the alveolar walls.
These changes cause the elasticity to decrease making it difficult to exhale. Residual
volume (volume of air remaining in the lungs after maximal expiration) increases.
Tobacco smoking is the most common cause of the tissue destruction found in
emphysema. Exposure to environmental dust, smoke, or particulate pollution can be
causes too. A small number of people with emphysema may have developed it as a result
of alpha-1-antitrypsin deficiencies, a group of genetic illnesses in which there is
inadequate protection against destructive enzyme activity in the lung.
S&S
Difficulty breathing, esp. during exertion, weight loss, chronic cough, and wheezing may
be present, prolongation of expiration, diminished breath sounds, a decrease in the
measured distance between the thyroid cartilage and the chin, and heart tones that are
audible only in the subxiphoid region of the chest.
Body Systems
Respiratory System
(Taber's cyclopedic medical, 2010, pp.755)

Lung Abscess
Acute inflammation can result in the formation of an abscess, which is a collection or
cavity of fluid as a result of necrosis. The body attempts to destroy the abscess causing
 Tamra (Tammy) Johnson 11/16/10

the infection to surround the cavity. Abscesses can be acute (present < or = to 6 weeks)
or chronic (present more than 6 weeks).
A person usually gets lung abscesses when they don’t have the ability to clear bacteria
from their pulmonary tract, usually resulting from an obstruction or tumor. The bacteria
then continue to grow and multiply in the lung tissue, leading to massive bacteria which
cause necrosis and the formation of lung abscess cavity. This cavity may be filled with
fluid or pus.
S&S
Fever, chills, night sweats, productive cough with foul sputum, dyspnea, fatigue, weight
loss, pleuritic chest pain and hemoptysis. On auscultation of the lungs, bronchial breath
sounds are heard with percussion there may be localized dullness over the involved lung.
Clubbing of fingers may also be present.
Body Systems
Respiratory System
(Daniels, R, Nosek, L, & Nicoll, L., 2007, pp.1075-1078)

Hypertension (HTN)
Hypertension is a persistant rise of the systemic arterial blood pressure. Blood pressure is
determined by the amount of blood your heart pumps and the amount of resistance to
blood flow in your arteries. The more blood your heart pumps and the narrower your
arteries, the higher your blood pressure will be. This can eventually cause health
problems such as heart disease because it initiates extra work on the heart and blood
vessels.
S&S
Hypertension is often asymptomatic but one can experience consistent headaches,
dizziness, confusion, seizure and fatigue.
Body System-
Cardiovascular, nervous and urinary.
(Daniels, R, Nosek, L, & Nicoll, L., 2007, pp.911-913)

UTI
UTI is an infection of the kidneys, ureters, bladder or urethra. The infection starts when
the sterile field becomes introduced to a foreign invader such as bacteria, fungus or a
parasite. The invaders can come from stool in the body or from the circulation urine. The
infection usually starts at the urethra with inflammation, and if not caught early the
infection will move up to the bladder. Frequent elimination can cause the infection to
leave on its own.
S&S
Dysuria, frequency, urgency, cloudy, bad smelling,or bloody urine, lower abdominal
pain, mild fever
Body Systems
Urinary system
(Daniels, R, Nosek, L, & Nicoll, L., 2007, pp.1767)

Diabetes
Diabetes Mellitus is when the body does not transport glucose either because there is very
little or possibly no insulin production. The body uses insulin to transport glucose to the
 Tamra (Tammy) Johnson 11/16/10

cells. The major abnormalities of pathophysiology in pts. with type 2 diabetes are
defective beta cell secretion with early loss of 1st phase insulin production; insulin
resistance in the peripheral tissues, esp. muscle and liver; and increased production of
glucose from the liver as the disease progresses.
S&S
Hyperglycemia, obesity, polydipsia, polyuria, skin infections, blurred vision, fatigue, not
prone to ketosis but can develop with stress, N/V, dizziness on arising, delirium, coma, or
death
Body systems
Nervous, gastrointestinal, immune, and endocrine
(Daniels, R, Nosek, L, & Nicoll, L., 2007, pp.1905)

Pneumonia
In pneumonia some or all of the alveoli, interstitial tissue and bronchioles are filled with
fluid or blood as a result of the inflammatory process of infection or chemical irritants.
In the lungs we have a defense mechanism called white blood cells. They normally fight
off infection but in pneumonia the bacteria thrive in the moist environment destroying the
white blood cells. Once this happens it will begin to affect your breathing, making it
more difficult to breath. In other words, there is an infection in your lungs. Pneumonia
can be caused by bacteria, a virus or a chemical.
S&S
Pneumonia specific symptoms include fever, chills or rigors, sweats, new cough (with or
without sputum production), pleuritic chest pain and dyspnea. Nonspecific symptoms
include malaise, fatigue, abdominal pain, headaches, anorexia, and worsening of an
underlying chronic illness. Other symptoms upon examination may include tachycardia,
crackles heard on auscultation.
Body Systems
Respiratory and cardiovascular systems.
(Daniels, Rick, Nosek, Laura, Nicoll, Leslie H., 2007 pp. 1057).

Depression
Depression occurs when intense sadness lasts more than two weeks and there appears to
be no enjoyment in living. Everyone will most likely experience depression in their
lifetime but when depression prevents a person from functioning “normally” it is deemed
a major life problem. Depressed patients have more medical illnesses and a higher risk of
self-injury and suicide than patients without mood disorders. Chemical imbalances relate
to depression branching from hormonal, neurological, or genetic factors according to
physiological theories. It is an abnormality of the neurotransmitter, specifically a
deficiency of serotonin, norepinephrine, and dopamine in the CNS.
S&S
Characteristic symptoms of the depressive disorders include persistent sadness,
hopelessness, or tearfulness; loss of energy (or persistent fatigue); persistent feelings of
guilt or self-criticism; a sense of worthlessness; irritability; inability to concentrate;
decreased interest in daily activities; changes in appetite or body weight; insomnia or
excessive sleep; and recurrent thoughts of death or suicide. These symptoms cause
pervasive deficits in social functioning.
 Tamra (Tammy) Johnson 11/16/10

Body Systems
CNS, cardiovascular system and limbic system
(Taber's cyclopedic medical, 2010, pp.610-611)

History of admitting diagnosis(s) to include client’s signs and symptoms, onset,

duration and admitting vital sign.
Pt. initially admitted at Drs. Hospital on 10/20/10 with c/o of coughing up yellow,green
sputum, chills, SOB, pain in the left lower chest for 1 week before being admitted to the
hospital. Pt. transferred to TMC on 11/9/10. Admitting V/S are BP 129/76, P 66, R 18,
T 97.8 and O2 sat 100%. Her diagnosis at that time was pus pockets in the lungs and
emphysema.

Medications: Include all routine, IV therapy and respiratory medications. Explain

the action of each medication, therapeutic effect and why your patient is
taking the medication (This needs to be completed for both the routine and
PRN medication).

Routine:
1.Zosyn .375 gr/15mL-120mL @ 30mL/hr Every 8 hrs infuse over 4 hrs in 100mL of
D5W
Action: Pipercillin-Binds to bacterial cell wall membrane, causing cell death. Spectrum
is extended compared with other penicillins. Tazobactam: Inhibits beta-lactamase, an
enzyme that can destroy penicillins.
Therapeutic Effects: Death of susceptible bacteria.
Why? As antibiotic used in nosocomial pneumonia.
2.Protonix 40 mg once a day
Action Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme
system in gastric parietal cell; characterized as gastric acid pump inhibitor, since it blocks
final step of acid production.
Therapeutic Effect Diminished accumulation of acid in the gastric lumen, with
lessened acid reflux. Healing of duodenal ulcers and esophagitis. Decreased acid
secretion in hypersecretory conditions.
Why is your patient on this medication? To decrease acid secretions which may
perpetuate vomiting.
3.Lovenox 40 mg SQ every 24 hrs
Action_Potentiate the inhibitory effect of antithrombin on factor Xa and thrombin.
Therapeutic effect Prevention of thrombus formation/Anticoagulant
Why is your patient on this medication? Prevention of DVT’s 6.
4.Folic Acid 1mg oral once a day
 Tamra (Tammy) Johnson 11/16/10

Action: Required for protein synthesis and RBC function. Stimulates the production of
RBC’s, WBC’s and platelets.
Therapeutic Effect: Restoration and maintenance of normal hematopoiesis.
Why? To restore folic acid depletion due to malnutrition and assist with rebuilding
health status.
5. Novolog 1unit/0.01mL
Action: Lowers blood glucose by: stimulating glucose uptake in skeletal muscle, and fat,
inhibiting hepatic glucose production. Other actions of insulin: inhibition of lipolysis and
proteolysis, enhanced protein synthesis. A rapid-acting insulin with more rapid onset and
shorter duration than human regular insulin; should be used with an intermediate- or
long-acting insulin.
Therapeutic Effect: Control of hyperglycemia in diabetic patients.
Why? Pt. is diabetic.
6.Vancomycin in 0.9% Sodium Cl 2GM IV every 8 hrs. infuse 1 GM per 1 hr.
Action: Binds to bacterial cell wall, resulting in cell death.
Therapeutic Effect(s): Bactericidal action against susceptible organisms.
Why? Infection of the lung(s)
7.Salicylates (Aspirin) One 81mg po with food once a day
Action: Produce analgesia and reduce inflammation and fever by inhibiting the
production of prostaglandins. Aspirin only decreases platelet aggregation.
Therapeutic effect: Antipyretics, nonopioid analgesics, anticoagulant
Why? Preventative of heart issues (possible MI).
8.Potassium Chloride 20 MEQ one every 24 hrs.po
Action: Maintain an acid base balance, isotonicity, and electrophysiologic
balance of the cell.
Therapeutic effect: Mineral and electrolyte replacements.
Why? Treatment/prevention of potassium depletion.
9. Docusate Sodium (Colace) 100mg po every 8 hrs.
Action: Docusate promotes incorporation of water into stool, resulting in softer fecal
mass.
Therapeutic Effect: Softening and Passage of Stool
Why is pt on medication? Prevent constipation.
10.Doxycycline Hyclate cap (Vibramycin) 100mg po every 12 hrs. give with full glass
of water
Action: Inhibits bacterial protein synthesis at the level of the 30S bacterial ribosome
Low-dose products used in the management of periodontitis inhibit collagenase.
Therapeutic Effect: Bacteriostatic action against susceptible bacteria
Why? Infection in lungs
11.Glipizide tab (Glucotrol) 20mg po before morning meal. Give at least 30 minutes
before meals.
 Tamra (Tammy) Johnson 11/16/10

Action: Lowers blood sugar by stimulating the release of insulin from the pancreas and
increasing the sensitivity to insulin at receptor sites. May also decrease hepatic glucose
production.
Therapeutic Effect(s): Lowering of blood sugar in diabetic patients.
Why? Pt is diabetic.
12.Risperidone tab (Risperdal) 3mg po at bedtime
Action: May act by antagonizing dopamine and serotonin in the CNS
Therapeutic Effect(s): Decreased symptoms of psychoses, bipolar mania, or autism
Why? Depression
13.Simvastatin tab 20mg po at bedtime. Give in the evening.
Action: Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, an
enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol
Therapeutic Effect(s): Lowering of total and LDL cholesterol and triglycerides. Slightly
increases HDL cholesterol. Slows the progression of coronary atherosclerosis with
resultant decrease in coronary heart disease-related events.
Why? High cholesterol
14.Norvasc 10mg po once a day
Action: Inhibits the transport of calcium into myocardial and vascular smooth muscle
cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction
Therapeutic Effect(s): Systemic vasodilation resulting in decreased blood pressure;
coronary vasodilation resulting in decreased frequency and severity of attacks of angina.
Why? Hypertension
15.Chlorpheniramine Maleate 4mg po every 12 hrs.
Action: Antagonizes the effects of histamine at H2-receptor sites; does not bind to or
inactivate histamine.
Therapeutic Effect(s): Decreased symptoms of histamine excess (sneezing, rhinorrhea,
nasal and ocular pruritus, ocular tearing, and redness).
Why? Relief of allergic symptoms caused by histamine release.
16.Citalopram Hydrobromide (Celexa) 60mg po every 24 hrs
Action: Selectively inhibits the reuptake of serotonin in the CNS
Therapeutic Effect(s): Antidepressant action
Why? Depression
17.Dextrose-Sodium Chloride 0.45% 125mL/hr for IV infusion
Action: Sodium is a major cation in extracellular fluid and helps maintain water
distribution, fluid and electrolyte balance, acid-base equilibrium, and osmotic pressure.
Chloride is the major anion in extracellular fluid and is involved in maintaining acid-base
balance. Solutions of NaCl resemble extracellular fluid; reduces corneal edema by an
osmotic effect. Dextrose provides calories.
Therapeutic Effect(s): IV, PO: Replacement in deficiency states and maintenance of
homeostasis.
Why? Hydration
 Tamra (Tammy) Johnson 11/16/10

18.Lantus 100unit/mL sc at bedtime

Action: Lowers blood glucose by; stimulating glucose uptake in skeletal muscle and fat;
inhibiting hepatic glucose production. Other actions of insulin; inhibition of lipolysis and
proteolysis; enhanced protein synthesis
Therapeutic Effect(s): Control of hyperglycemia in diabetic patients
Why? Pt is diabetic
19.Pioglitazone HCL tab (Actos) 15mg po once a day
Action: Improves sensitivity to insulin by acting as an agonist at receptor sites involved
in insulin responsiveness and subsequent glucose production and utilization; requires
insulin for activity.
Therapeutic Effect(s): Decreased insulin resistance, resulting in glycemic control without
hypoglycemia.
Why? Pt. takes insulin; diabetic.

PRN’s
1.Zofran 2mg IV prn every 6 hours
Action: Blocks the effects of serotonin at 5-HT3-receptor sites (selective antagonist)
located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS
Therapeutic Effects: Decreased incidence and severity of nausea and vomiting following
chemotherapy or surgery
Why is your patient on this medication? Nausea and vomiting
2.Morphine Sulfate Soln 2mg IV every hr
Action: Binds to opiate receptors in the CNS. Alters the perception of and response to
painful stimuli while producing generalized CNS depression.
Therapeutic Effect: Decrease in severity of pain.
Why? Pain
3.Actaminophen 650mg 2X325 mg oral prn every 6 hours
Action: Inhibits the synthesis of prostaglandins that may serve as mediators of pain and
fever, primarily in the CNS. Has no significant anti-inflammatory properties or GI
toxicity.
Therapeutic Effect: Analgesia,antipyresis.
Why? Fever or Temp greater than 100.4
4. Magnesium hydroxide (Milk of Magnesia)
Action: Osmotically active in GI tract, drawing water into the lumen and causing
peristalsis. Essential for the activity of many enzymes.
Therapeutic effect: Mineral & electrolyte replacements / supplements, laxatives.
Why? Constipation
5.Promethazine HCL Syrg 12.5mg/0.5mL IV prn every 2 hrs use furthest port & dilute
with 5-10mL NS when administering IV; ask pt. feedback on discomfort.
 Tamra (Tammy) Johnson 11/16/10

Action: Blocks the effects of histamine; has inhibitory effect on the chemoreceptor
trigger zone in the medulla, resulting in antiemetic properties; alters the effects of
dopamine in the CNS; possesses significant anticholinergic activity; produces CNS
depression by indirectly decreased stimulation of the CNS reticular system.
Therapeutic Effect(s): Relief of symptoms of histamine excess usually seen in allergic
conditions; diminished nausea or vomiting; sedation
Why? Treatment and prevention of nausea and vomiting
(Deglin, Vallerand, & Sanoski, 2011, np.)

Sliding Scale (what type of insulin to administer and write out the sliding scale with
the ranges and # units)
Glucose Novolog
Less than 180 Give 0 units
181-200 Give 2 units
201-250 Give 4units
251-300 Give 6 units
301-350 Give 8 units
351-400 Give 10 units
401-450 Give 12 units
Greater than 450 Give 14 units

Intravenous Therapy: Site (location)_Lt forearm_ Type & Gauge _22_ Site
(Dsg)_tegaderm___
Maintenance Fluid _D5W ½ NS @ 125mL/hr_ Rate ___31__ gtt/min(Base on
15gtt/min)
PCA Pump (medication, dosage, freq. lock-out) ___N/A______________

List of Care: Pick one (main) medical diagnosis and write four (4) pertinent
interventions and rationales that are applicable to your assigned patient.

One Main Medical Diagnosis

Emphysema
INTERVENTION-Observe for indicators of hypoxia.
RATIONALE-Increased restlessness, anxiety, tachycardia, and changes in mental status
are early indicators of hypoxia and can signal impending respiratory compromise, which
would necessitate prompt intervention. (Swearingen,P, 2008, p.133)
 Tamra (Tammy) Johnson 11/16/10

INTERVENTION-Monitor O2 sat continuously using pulse oximetry. Note ABG results

as available.
RATIONALE-An O2 sat of less than 90% or a partial pressure of O2 of less than
80mmHG indicates significant oxygenation problems. (Ackley, B., Ladwig, G., 2011,
p.403)

INTERVENTION-Monitor the effects of sedation and analgesics on the client’s

respiratory pattern; use judiciously.
RATIONALE-Both analgesics and meds that cause sedation can depress respiration at
times. However, these meds can be very helpful for decreasing the sympathetic nervous
system discharge that accommodates hypoxia. (Ackley, B., Ladwig, G., 2011, p.403)

INTERVENTION-Monitor respiratory rate, depth, and ease of respiration. Watch for use
of accessory muscles and nasal flaring.
RATIOANLE-A study demonstrated that when the respiratory rate exceeds 30
breaths/min, along with other physiological measures, a significant cardiovascular or
respiratory alteration exists. (Ackley, B., Ladwig, G., 2011, p.402)
 Tamra (Tammy) Johnson 11/16/10

References

Daniels, R, Nosek, L, & Nicoll, L. (2007). Contemporary medical-surgical nursing.

Clifton Park, NY: Thomson Delmar Learning.

Deglin, J, Vallerand, A, & Sanoski, C. (2011). Davis's drug guide for nurses.

Philadelphia, PA: F.A. Davis Company.

Swearingin, P. (2008). All-in-One Care Planning Guide. St. Louis, MO: Mosby Elsevier.

Taber's cyclopedic medical dictionary. (2010). Philadelphia, PA: F.A. Davis Company.