NURS 3021 Weekly Nursing Care Plan

Things to think about

● During your first and second shifts complete 2-6, remembering to compare and contrast subjective and objective assessment findings to look
for trends, improvement, worsening condition, etc. Note these in your care plan (perhaps in a different color) and communicate changes to
your CI and the responsible nurse.
● Develop greater knowledge by reviewing the patient’s chart for information (remember to think about the laws that govern patient privacy).
● Continue to collect data and add to it (when permitted to do so) during the clinical shifts.
● Reflect on 9&10, providing specific examples before you submit the final work to your clinical instructor 48 hours after your second shift
EACH CLINICAL WEEK.

Significant Medical Diagnoses: __Cellulitis

Safety Considerations: __limited movement in her left leg because of the cellulitis and lymph node fluid accumulation
Activity level and restrictions: Up independently
Activities of Daily Living: _Independent_
Data/Information

(1) Provide the etiology and Cellulitis is a bacterial skin infection that is introduced into the skin surface, thus leading to an acute
pathophysiology (the primary superficial infection that affects the deep dermis and subcutaneous tissue. This infection comes from group
disease or condition the patient A beta-hemolytic streptococcus. Whenever there is a skin break, injuries, surgical incision, fissures between
is admitted with). *If you have toes, insects or animal bites, this allows for the entrance of bacteria that eventually leads to cellulitis.
already prepared for this Patients who have lymphedema, venous insufficiency, diabetes mellitus and peripheral arterial disease are at
medical diagnosis, then pick higher risk for developing cellulitis. This condition is characterized mainly by erythema, warmth, edema
another so as to grow your and tenderness to palpation, which is a result of cytokine and neutrophil response after being recruited
because of the bacteria breaching the epidermis- their response includes the production of antimicrobial
collection/knowledge.
peptides and keratinocyte proliferation. As mentioned, the bacteria causing this is the group streptococci.
However, they also produce virulence factors such as pyrogenic exotoxins (A, B, C and f0 and also
streptococcal super antigens that can lead to more pronounced and invasive diseases.
(2) Assessment data (from health health history:
history/interview, vital signs - Anemia
and physical examination).
- cholelithiasis
Provide your analysis after you
 collect the data. - GERD
- hyperlipidemia
- hypertension
- hypoalbuminemia
- irritable bowel syndrome
- metastatic malignant melanoma
- osteoarthritis
- vitamin D deficiency
vital signs and physical assessment:
Her BP was 119/67; upon assessment, I noticed that she had a lump on her groin area (left side of her leg-
upper region). Additionally, I noticed that I could not get a pedal, femoral or popliteal pulse for her left leg
because of the wound dressing. Also, she had bruises bilaterally because of her primary diagnosis and she
has been admitted to the hospital more than 2 occasion for cellulitis and so, the nurse (clinical instructor)
educated her on the preventative measures of repeated admission for cellulites and how to properly clean
and dress her injury site to ensure that there is no bacterial breakdown which can lead to cellulitis. Finally,
Patient had limited movement in her left leg which is the location of the dressing.

(3) One priority physiological and Physiology:

one priority psychosocial Risk for infection related to open wounds and decreased knowledge as evidenced by readmission to the
nursing diagnosis (must be hospital for cellulitis, immune response to treatments for melanoma and altered skin integrity.
NANDA approved).
Rationale: the patient has an open wound and has been admitted because of cellulitis; the patient lacked
Provide the rationale for why understanding of preventive measures; however, suitable interventions - education about the health
you determined as priority. conditions and its risk factors will help reduce future readmission.

Psychosocial nursing diagnosis:

Readiness for enhanced learning related to risk for infection as evidenced by a patient's understanding of
their health condition and preventative measures to prevent reinfection.
 Rationale: the patient is ready to learn how to prevent this medical condition from occurring again. The
patient was given education and was eager to know more before being discharged from the hospital.

(4) Planning: create in Short term: By the end of the shift, the patient understands how to care for her open wound to prevent
collaboration with the bacterial breakdown, which leads to cellulitis.
patient/family two SMART
Long-term goal: By the end of the month, the patient will demonstrate a reduction in readmission rate for
goals for each nursing infection-rated complication - cellulitis compared to the previous year, evidenced by her medical record.
diagnosis (one short, one long-
term) The patient will go for a biopsy; proper wound care understanding and treatment are necessary for
cellulitis. Hence, patient understanding of these preventative measures and treatment plans is
Provide the rationale for each essential.
goal.
Short term: Before Friday, May 26th, the patient will verbalize an understanding of her medical condition,
risk factors for re-infection and how to implement appropriate preventative methods after the one-on-one
education session with the nurse.
Long-term goal: By the end of the week, the patient will demonstrate an increased understanding of her
medical diagnosis and treatment plan and can elaborate on her understanding upon her next consultation
with the physician.
The patient needs to understand her health conditions, and since the patient shows readiness for
growth and learning, empowering her with this knowledge and getting her actively involved in any
prevention measures. Self-care is essential and can prevent readmission. Additionally, scheduling
more follow-up sessions to reinforce and assess the patient's understanding of her health condition
and infection prevention measures is essential.

(5) Three to four nursing - education about the health condition and how to prevent further reinfection
interventions to implement
- Teaching patients the importance of taking their prescriptions according to the physician's orders -
(must relate to the primary
scheduling more education sessions over the phone to increase patient understanding about her
nursing diagnoses and condition and preventative measures for reinfection.
determined goals).
- Promoting hand hygiene and sterile field- showing the patient how this is done while dressing her
Provide the rationale for each
wound.
nursing intervention.
 - Encourage vaccinations up to date- this will prevent infection
- Encourage good nutrition enhancement- to support the immune system and promote wound healing.

(6) Evaluation/result of the - Assessing the patient's understanding of her health condition, infection risk and preventative
intervention (can be expected measures through verbal and open-ended questions and a teach-back session with the nurse.
results if long-term)
- Reviewing healing progress- monitoring for signs of re-infection or delayed healing.
- Follow-up consultation with the patient in person or via phone to address any future concerns,
reinforce education, and evaluate their understanding.

(7) Medications see below

(use drug card template)

(8) Relevant laboratory and Erythrocytes (4.0), hemoglobin (112), hematocrit (0.344), MPV (6.6), absolute lymphocytes (1.1) and
diagnostic tests (why is the test EGFR (55) is low while her platelets (476) and CRP (103.8) is high other than those results, everything else
being done, what are the is normal.
findings, are there any special Looking at her hemoglobin levels it is concerning her anemia medical history.
considerations needed
MRI test is conducted to verify if the cancer has metastasized into the brain and spinal cord. The result came
before/during/after the test?) out good, and no evidence of the spread was found.
Biopsy has been planned for this Monday to determine if the current growth on the left upper region of her
leg-groin area is cancer-related.
(9) Client Experience (what ● education about her condition and how to prevent another readmission to the hospital for cellulitis
techniques and strategies
● Dressing for the pretibial and upper region of the left leg with the correct ordered dressing tools-
can/did you use to improve on
provided education and showed patient on how to maintain sterile field and also steps on how to
the patient’s lived experience treat and dress her wound.
of their chronic condition)
● Allowed for space to communicate with myself and also spend time with family
Provide specific examples.
● Patient finished all her meals- made ensure that patient had all her meals by encouraging her on the
importance of improved nutrition.
● Patient spends time outside in the morning to receive natural Vitamin D since she has vitamin D
 deficiency- this information for her deficiency was gotten from her notes (personal physician notes
after running test on her- this diagnosis is part of her medical history the patient verbally gave during
admission).
(10) Ethical considerations There wasn't any ethical dilemma or considerations; however, here a list of potential ones that might occur.
(what ethical situations/ - language or communication barriers that can affect patient understanding- can be linked to age
dilemmas developed as part of
providing care). - Cultural sensitivity- certain beliefs, values and practices of patients that can influence patient
perception of infection and prevent learning.
Provide specific examples.
- Informed consent for treatment options to discuss available options for the patient.
- Patient shows a lack of interest or motivation to engage in learning and preventing measures;
however, for this patient, none was shown as the patient is ready to learn.
- The patient has the right to refuse this education but discharging her earlier without proper
education can lead to readmission to the hospital with the same primary diagnosis.

Drug cards
Generic & Trade Name of Drug: Cholecalciferol (Vitamin D 3)
Brand name (Fosamax plus D), trade name is Vitamin D3 and the Generic name is Cholecalciferol), Calderol.
CLASSIFICATION OF DRUG: Bisphophnates (nutritional supplement) Hormone and synthetic substitute; Vitamin D analog

Indications/ This medication is used to treat and prevent Vitamin D deficiency and also helps the body absorb Calcium, Phosphorus as well
Therapeutic as help in the promotion of healthy bones and teeth. In addition, this medication can be used to treat medical conditions such as
Effects: refractory rickets, hypoparathyroidism, familial hypophosphatemia, osteoporosis and Chronic kidney disease. Furthermore, the
function of Vitamin D is to help maintain normal levels of serum calcium and phosphorus in the bloodstream.

Dosage varies depending on the patient's need and their level of Vitamin D. However, according to the US recommended
Dosage Range: dietary allowance for Vitamin D, patients who are 70 years and older are to take 20mvg daily and a tolerable upper intake level
of 100mcg. Note- patient is 84 years
Routes of
This medication is commonly administered orally through table to liquid form
Administration:

This medication is converted into its active form calcifediol (25-hydroxycholecalciferol) in the liver and then kidney to be used
Pharmacokinetics:
by the body to maintain calcium and phosphorus metabolism levels.

Nursing
Implications/ Upon giving the medication, the nurse needs to assess the patient's Vitamin D level, dietary intake and should monitor if there
Assessments: will be any excess or deficiency of Vitamin D.

Excessive intake of this medication can lead to Vitamin D toxicity which can cause symptoms such as nausea, vomiting,
Side/ Adverse
weakness, and increased thirst. - For CN: irritability and headache - pruritus, Polydipsia, pancreatitis, metallic taste, anorexia,
Effects:
bone pain, myalgia, polyuria and conjunctivitis
Contraindications: Hypercalcemia and malabsorption syndrome
Client Teaching: Teach the patient to take this medication as directed by their healthcare provider. They should be educated on the importance of
getting appropriate sun exposure.

Other: drug interaction are: Thiazide diuretics, cholestyramine, cholesterol, corticosteroids, mineral oil, phenytoin, barbiturates,
digitalis glycosides, antacids (magnesium) Since the patient is on antacids which interact with this medication, best to take them
at different times of the day
 Inspiring Nursing as if EVERY Person matters…

Generic & Trade Name of Drug: Multivitamin with mineral (Centrum tablet)
brand name: ABDEK, Calcifol, Contain

CLASSIFICATION OF DRUG: Vitamin and mineral combination

Indications/ This medication is used to help with growth and good health. It is known to be a multivitamin and iron product that is used to
Therapeutic prevent or treat vitamin deficiency associated with poor dieting, pregnancy or certain illness. Additionally, this medication
Effects: helps to support the immune system, cognitive function, maintain bone health, healthy skin and the body's ability to metabolize
nutrients.

Once a day. the required dose for adult females is 8 mg/day for Zinc and 75 mg/day for Vitamin C while for adult males is 11
Dosage Range:
mg/day for Zinc and 90 mg/day for Vitamin C
Oral but should be taken with or without food. However, you can take the medication on an empty stomach at least 1 hour
Routes of before or 2 hours after a meal with a full glass of water unless your physician directs you otherwise. Don't crush the delayed
Administration: release or extended release capsule as it can release all the drugs at once and lead to an increased risk of the side effects and a
decrease in the absorption of the medication. Furthermore, don't split the delayed release capsule unless there is a score line.

Pharmacokinetics
Once they are administered orally, they are absorbed in the gastrointestinal tract and are then distributed to the rest of the body.
:

Nursing Assessment of the nutritional and what deficiencies the patient has before administering the medication also, as they take the
Implications/ medication, the nurse needs to assess if there was an improvement in their nutritional status.
Assessments:
Furthermore, the nurse needs to assess if the patient is having any allergic reaction to the medication.
 Side/ Adverse Change in color of the stool- green, diarrhea, belly pain, constipation, muscle weakness, numbness and tingling and severe
Effects: reaction.
Contraindications
Wilson’s disease, Hemochromatosis, treatment of pernicious or other megaloblastic anemia.
:
Teaching patients the importance of following the direction of the product package and the physician guide- only taking the
Client Teaching:
recommended dosage.
Teach patient to take this medication should be taken as prescribed and regularly to receive its benefits
Other:

Inspiring Nursing as if EVERY Person matters…

Generic & Trade Name of Drug: Cephalexin

brand name is Keflex, APO-Cephalexin; AURO-Cephalexin; DOM-Cephalexin [DSC]; JAMP-Cephalexin; LUPIN-Cephalexin; TEVA-Cephalexin; Biocef;
Novo-Lexin; TEVA-Cephalexin 125; TEVA-Cephalexin 250

CLASSIFICATION OF DRUG: Cephalosporin antibiotics

Indications/ This medication is used for treating bacterial infection such as bone infection caused by staphylococcus aureus and / or proteus
Therapeutic Effects: mirabilis, otitis media caused by streptococcus pneumoniae, hemophilic influenza, Streptococcus pyogenes and Moraxella catarrhal
is, respiratory tract infection, skin and soft tissue infection and urinary tract infections.

Dosage Range: Oral: 250 mg to 1 g every 6 hours or 500 mg every 12 hours (maximum: 4 g/day).
Routes of
oral
Administration:
This medication inhibits the bacterial wall synthesis from binding to penicillin-binding proteins leading to the stop of their final
transpeptidation step of peptidoglycan synthesis in the bacterial cell wall and the biosynthesis of the cell walls. The medication is
Pharmacokinetics: absorbed rapidly but often delayed in young children and neonates, it is then distributed to most of the body's tissues and fluids such
as gallbladder, liver, kidney, bone, bile and the pleural and synovial fluids. In addition, this medication peaks within one hour and is
then excreted through urine (renal mechanism).
The nurse needs to monitor for allergic reaction, and pulmonary symptoms such as tightening of the throat and chest, wheezing, and
Nursing Implications/ cough dyspnea.
Assessments: The nurse needs to monitor the patient for diarrhea, abdominal pain, fever, pus or mucus on stools and other GI problems such as
nausea, heartburn and vomiting.
The nurse needs to assess for any history of reaction to penicillin and if the patient is pregnant or lactating.

● Dermatologic: Erythema multiform, genital pruritus

● Gastrointestinal: Abdominal pain, diarrhea, dyspepsia, gastritis, nausea, pruritus any, vomiting
● Genitourinary: Genital candidiasis, vaginal discharge, vaginitis
● Hematologic & oncologic: Eosinophilia, neutropenia, thrombocytopenia
Side/ Adverse Effects: ● Hepatic: Cholestatic jaundice, increased serum alanine aminotransferase, increased serum aspartate aminotransferase
● Hypersensitivity: Anaphylaxis
● Nervous system: Agitation, confusion, dizziness, fatigue, hallucination, headache
● Neuromuscular & skeletal: Arthralgia, arthritis, arthropathy
● Renal: Interstitial nephritis
Contraindications: - antimicrobial resistance, viral infections such as the common cold-
- hypersensitivity especially to penicillin
- Renal failure or impairment because this medication is eliminated via renal mechanism.
- C.difficile- associated diarrhea and pseudomembranous colitis- alters the normal flora of the colon
- pregnancy
- breastfeeding
- coagulopathy and vitamin K deficiency
 - diabetes mellitus
- geriatric
teach the patient the importance of taking this medication with food
teach the patient the importance of taking this medication as prescribed ( for that specific bacteria) and must be completed to
Client Teaching: prevent bacteria resistance
teach the patient to look out for side effects and communicate with the physician if they worsen
teach the patient to avoid taking alcohol while taking this medication

Other:

Inspiring Nursing as if EVERY Person matters…

Generic & Trade Name of Drug: Diltiazem brand name- Cardizem

CLASSIFICATION OF DRUG: calcium channel blocking agents, Group IV antiarrhythmic

Indications/
Therapeutic Effects: This medication is a calcium channel blocker that works by relaxing the muscles of the heart and blood vessels. It is used to
treat hypertension, angina and some heart rhythm disorders.

Dosage Range: the maximum dose is about 540 mg/day

Routes of
oral or standard IV push
Administration:
This medication is absorbed from the GIT and undergoes an extensive first pass metabolism and then about 70 - 80% bounds to
the plasma protein. In addition, this medication is metabolized by the cytochrome P450 system and is an inhibitor of CYP3A4
Pharmacokinetics:
which can lead to drug to drug interactions.

Nursing Implications/ - check blood pressure, heart rate

Assessments: - assess baseline renal and liver function
- Monitor for any heart failure, dyspnea or pulmonary edema.
- slow heartbeats, pounding heartbeats or fluttering in the chest
- light headed feeling
- shortness of breath
Side/ Adverse Effects: - nausea, upper stomach pain, itching, loss of appetite, dark urine, clay colored stools
- jaundice
- severe skin reaction
- swelling
Contraindications: hypersensitivity
- Don't take this medication if you have low blood pressure, sick sinus syndrome or 2nd or 3rd degree AV block (unless
Client Teaching: you have a pacemaker)
- Don’t take this medication if you have recently had a heart attack or have a buildup of fluid in your lungs.
- Follow the direction of the physician orders.
Other:

Inspiring Nursing as if EVERY Person matters…

Generic & Trade Name of Drug: Piperacillin Tazobactam; brand name- Zosyn

CLASSIFICATION OF DRUG: Beta-lactamase inhibitors

Indications/ This medication are two different medication that has a combination of penicillin antibiotic that is used to treat any bacterial
Therapeutic Effects: infections such as stomach, skin and uterine infections and also for pneumonia. Piperacillin-tazobactam is a β-lactam-β-
lactamase inhibitor combination with a broad spectrum of antibacterial activity against gram-positive as well as gram-negative
pathogens
Applies to the following strengths: 2 g-0.25 g; 3 g-0.375 g; 4 g-0.5 g; 2 g-0.25 g/50 mL; 3 g-0.375 g/50 mL; 4 g-0.5 g/100 mL;
Dosage Range:
36 g-4.5 g; 12 g-1.5 g
Routes of
IV- 4g/0.5g is administered over 30 mins
Administration:

Within 30 min of infusion, piperacillin/tazobactam achieves 16-85% of plasma concentrations in skin, muscle, lung,
Pharmacokinetics:
gallbladder, and intestinal mucosa

Nursing
Implications/ monitor for any allergic reaction and anaphylaxis
Assessments:
Monitor for pulmonary symptoms such as tightness in the throat, chest, wheezing, cough dyspnea or skin reaction.

diarrhea, constipation
Side/ Adverse nausea, headache and insomnia,
Effects:
Seizure, confusion, severe stomach pain, low potassium level- leg cramps and muscle twitching - report to the doctor
immediately.
Hypersensitivity, will not work if you have colds, flu or other viral infection.
Contraindications:
Patient who are allergic to any penicillin or beta-lactamase inhibitors.
Client Teaching: teach client to ensure that they follow the direction of the physician
They should not take this medication to treat any diarrhea without communicating with their physician.
Other:

Inspiring Nursing as if EVERY Person matters…

References

Medscape. (n.d.). Zosyn (piperacillin-tazobactam) - dosing. Retrieved from https://reference.medscape.com/drug/zosyn-piperacillin-tazobactam-

342485

Drugs.com. (n.d.). Piperacillin/tazobactam dosage. Retrieved from https://www.drugs.com/dosage/piperacillin-tazobactam.html