History of Present Illness:Hip Fracture – patient fell in her home and broke her hip (admitting diagnosis). Vascular Dementia brought on by several TIA’s (Etiology/Pathology) Pts. progressive cognitive deficits led to her fall, and inabilility to perform normal ADL’s and self care. Since being admitted to Thompson, pt. has had consults with oncology in regards to her breast cancer diagnosis, with a GI specialist in regards to her dysphagia, and with a social worker in regards to her mental acuity and appropriate social activities related to her cognitive level.
PMH (Past Medical History)/Co-Morbidities: Breast Cancer, Rheumatoid Arthritis, anhedonia, depression, gout, anemia, hypertension, dysphagia Psychosocial HistoryPt. was married for a long time, husband deceased. Pt. worked on a farm and as a customer service clerk at several stores. Has 4 children, 3 that live in the area and are involved. Pt. has a high school diploma and worked on a farm and as a customer service employee at several stores.
Nursing Care and Treatments:Pt.was assessed using the Braden Pressure Ulcer Risk Assessment scale due to immobility – pt. requires a full mechanical lift and spends the time she is not in bed in a wheelchair. Clinical pathways – monitor pt. for changes in level of cognitive impairment by conducting mental assessments. Oncologist has recommended pt. have periodic evaluations for spread of breast cancer that is currently being treated palliatively. Pts. functional capabilities allow her to be verbal and is able to speak and make her needs known
Therapies prescribed: Pt. has also seen an Occupational Therapist to determine the best way to incorporate pt. on the floor and in her surroundings related to her baseline. They have recommended that pt. spend time among the residents to keep her actively involved in the floor and engaged with others. Medical Tests:Pt. received a Cat Scan to assess level of damage in regards to her TIA’s. Pt. also received an EKG to further indicate further damage to the heart. Pt.
also underwent several MRI’s to ascertain the stage of cancer that she was experiencing in her left breast. Medications LETRAZOLEANTINEOPLASTIC Femara Pt. takes 25 mg daily Treatment of postmenopausal women with breast cancer Nausea, musculoskeletal pain Assess patient for pain and other side effects periodically throughout therapy Caution women who are perimenopausal or who recently became menopausal to use adequate contraception during therapy; letrozole may cause fetal harm LORAZEPAMANTI-ANXIETY
AtivanSEDATIVE/HYPNOTIC ANALGESIC ADJUNCTS Pt. takes . 5 mg daily and is also ordered PRN Used to treat anxiety disorder, seizures, and for pre-operative sedation Dizziness, drowsiness, lethargy APNEA, CARDIAC ARREST Assess degree and manifestations of anxiety and mental status (orientation, mood, behavior) prior to and periodically throughout therapy Patients on high-dose therapy should receive routine evaluation of renal, hepatic, and hematologic function Advise patient to taper lorazepam by 0.05 mg q 3 days to decrease withdrawal symptoms.
Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication SERTALINEANTI-DEPRESSANT Zoloft Pt. takes 100 mg daily Used for major depressive disorder, panic disorder, OCD, PTSD, generalized anxiety disorder NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL THOUGHTS, dizziness, drowsiness, fatigue, headache, insomnia, diarrhea, dry mouth, nausea, sexual dysfunction, sweating, tremor, SERATONIN SYNDROME Assess for suicidal tendencies, especially during early therapy.
Restrict amount of drug available to patient. Assess for serotonin syndrome (mental changes [agitation, hallucinations, coma], autonomic instability [tachycardia, labile blood pressure, hyperthermia], neuromuscular aberrations [hyper-reflexia, incoordination], and/or GI symptoms [nausea, vomiting, diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, triptans) Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide; new or worse depression or anxiety.
CLOPIDOGRELANTI-PLATLET AGENT Plavix Pt. takes 75 mg daily Reduction of atherosclerotic events (MI, stroke, vascular death) BLEEDING, GI BLEEDING, NEUTROPENIA, THROMBOTIC THROMBOCYTOPENIC PURPURA Monitor patient for signs of thrombotic thrombocytic purpura (thrombocytopenia, microangiopathic hemolytic anemia, neurologic findings, renal dysfunction, fever). May rarely occur, even after short exposure.