Define the secondary diagnosis of this patient.

Define the secondary diagnosis of this patient. Why is it important/affect the patient when he staying at the hospital? Patient: Male Age: 81 years old Reason for Admission: ________ Urinary Tract Infection __________ Medical Diagnoses Definition of Medical Diagnoses Admitting diagnosis: Why patient was admitted to the hospital Urinary tract infection (UTI) Secondary Diagnoses: Other diagnosis important to current stay/surgical Hx Define secondary diagnosis Anterior femoral cutaneous neuropathy Arthropathy Atrial fibrillation Bone metastasis Chemosis Chronic kidney disease, stage III(moderate) Diplopia DJD (degenerative joint disease) Dysgeusia Eczema Gout History of COVID 19 Hyperbilirubinemia Hypertension with impaired renal function Intracranial ,mass Lesion of left external ear Medication monitoring encounter Meningioma Osteonecrosis of jaw Prostate cancer metastatic to bone Proteinuria Right subscapular pain Solar purpura Thrombocytopenia Weakness Wellness examination Past Medical History Tobacco: ___Never______ Alcohol: Beer – 1-2 time/week_ Recreational Drugs: None____ Activity Level: Independent Usual Diet: Regular diet Laboratory Analysis Write down the lab results at the start of your shift for the most recent results. Provide rationale for abnormal lab values. Complete Blood Count (CBC) Lab Value Normal Value Patient’s Value Reasons for high or low values (Pagana) Nursing Implications WBC 5-10 (10×3/UL) (H) 18.0 (10×3/uL) Infection/ inflammation (UTI) Monitoring the patient’s temperature and vital signs, giving prescribed medications, and promoting fluid intake to assist the body flush out the infection (Normal saline 0.9% IV push) Hgb 12-16 g/dL (L) 11.9 g/dL An insufficient supply of healthy red blood cells (sign of anemia) Encourage the patient to eat foods that are high in protein and iron. Patient’s vital signs may need to be watched Hct 33% – 45% 35%’ WNR RBC 3.70 -5.00 (10×3/uL) 4.67 (10×3/uL) WNR MCV 80 – 95 fL (H) 98 Fl Anemia giving vitamin B12 or folic acid supplements MCH 27 – 31 pg 31 pg WNR MCHC 32 – 36 g/dL 31.9 g/dL WNR Platelet Count 150 – 450 (10×3 uL) (L) 89 (10×3/uL) Low; Hemorrhage: The patient may need to be watched for symptoms of bleeding, such as bruises or petechiae, to be given drugs as directed to aid in clotting like Eliquis Complete Metabolic Panel (CMP) Glucose 70 – 99 mg/dL (H) 135 mg/dL Sign of diabetes Monitoring the patient’s blood glucose levels, giving insulin or education about healthy diet and lifestyle changes since patient BMI > 30 Sodium 136- 145 mEq/L 143 mmol/L WNR Potassium 3.5 – 5.0 mmol/L 3.6 mmol/L WNR Chloride 96 – 106 mEq/L (H) 110 mmol/L sign of dehydrationor kidney failure Promoting fluid intake, keeping track of the patient’s electrolyte balance, and giving drugs or other treatments as directed. (Normal saline 0.9% IV push) CO2 21- 31 mEq/L 23 mmol/L WNR Creatinine 0.7 to 1.3 mg/dL 1.35 mg/dL WNR BUN 10-20 mg/dL (H) 25 mg/dL Renal failure Monitoring the patient’s fluid intake and output, looking for indications of kidney dysfunction, and maybe giving drugs GFR 75 mL/min/1.73 m2 (L) 53 ml/min/1.73m2 renal disease or kidney failure Monitoring the patient’s fluid intake and output, looking for indications of kidney dysfunction, and maybe giving drugs Calcium 8.5 to 10.2 mg/dL 8.7 mg/dL WNR Albumin 3.4 to 5.4 g/dL 3.9 g/dL WNR Total Protein 6.4-8.3 g/dL 6.9 g/dL WNR Alk Phos 30-120 U/L 91 U/L WNR ALT 4-36 U/L 12 U/L WNR AST 0-35 U/L 21 U/L WNR Magnesium N/A Phosphorus N/A Urinalysis Spec Gravity 1.005-1.03 1.011 WNR Leuk Esterase negative Moderate/abnormal UTI Casts none 0 -2 WNR Ketones none negative WNR WBC 0-4 per low-power field 6 – 10 abnormal Infection (UTI) ecommended antibiotics and keeping track of the patient’s reaction to therapy RBC ≤ 2 21 – 50 abnormal UTI, bacterial endocarditis, kidney stones Assess vital sign, bodyweight, check for edema, Encourage a low salt diet because patient has hypertension Miscellaneous Labs PT/INR N/A PTT N/A D-Dimer N/A Anti-Factor X N/A Troponin N/A Myoglobin N/A CK-MB N/A BNP N/A Medication Allergies ____NKA____________________________________________________ Medication and classification Dose/ Frequency Route Mechanism of action down to the cellular level Patient Specific Implications (i.e. what do you: assess, teach & report)? Indication for this patient Side Effects Acetaminophen Analgesic/anti-pyretic 325 mg q 4 hrs PO 2tab Inhibit the synthesis of prostaglandins in the CNS leading to its analgesic and antipyretic effects Teach 3g daily limit Report rash Follow up pain assessment within 1 hour Pain Rash Nausea Liver Toxicity Allopurinol (antigout agents) 300 mg q.d 1tab PO Inhibits the production of uric acid by inhibiting the action of xanthine oxidase. Assess patient for rash, joint pain and swelling Teach patient to avoid driving Report skin rash, blood in urine Gout Rash, stevens-johnson syndrome, hypotension, hepersensivity reactions Apixaban (Eliquis) 2.5 mg BID 1 tab PO inhibit thrombin-induced platelet aggregation. Decreases thrombin generation and thrombus development. Assess patient for symptoms of stroke, DVT, PE, bleeding Report signs of bleeding (unusual bruising), red or black, tarry stools Teach patient to administer without regard to food Atrial fibrillation (heart arrhythmia) Bleeding, hypersensitivity Metoprolol (metprolol SCUCCINATE) (beta-blocker) 100 mg q.d 1 tab PO Blocks stimulation of beta1(myocardial)-adrenergic receptors. Does not usually affect beta2(pulmonary, vascular, uterine)-adrenergic receptor sites. Assess patient vital signs before giving this medication Teach patient and family how to check pulse daily and BP biweekly. Report if slow pulse, difficult breathing, wheezing,dizziness Hypertension Bradycardia, HF, pulmonary edema, fatigue, weakness Abiraterone (antineoplastics, enzyme inhibitors) (Medication from home) 1000 mg q.d 1 tab PO Inhibits the enzyme 17α-hydroxylase/C17,20-lyase (CYP17), which is required for androgen production. Assess for fluid retension and monitor BP Teach patient to take medications as directed and not to stop Report signs and symptoms of high blood pressure, low potassium, and fluid retention (dizziness, fast heartbeats, feel faint or lightheaded, headache) Cancer (Bone metastasis, Prostate cancer metastatic to bone) Treatment of metastatic castration-resistant prostate cancer (in combination with prednisone). Hypertension Torsades de pointes (hypokalemia) Hepatotoxicity predniSONE (corticosteroids) 5 mg q.d 1tab PO Decreases inflammation via suppression of the migration of polymorphonuclear leukocytes and reversing increased capillary permeability Assess patient for signs of adrenal insufficiency (hypotension, nausea, vomiting) Teach patient to take with food. Report abdominal pain or tarry stools Treatment of metastatic castration-resistant prostate cancer (in combination with Abiraterone) Nausea, vomiting, loss of appetite, heartburn, high blood pressure, Peptic ulceration, thromboembolism Levofloxacin (anti infectives/ fluoroquinolones) 750 mg q.d Inject IV Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme. Assess for infection, rash, suicidal tendencies, depression Teach patient to maintain fluid intake at least 1500 – 2000 ml/day Report fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Rash UTI ELEVATED INTRACRANIAL PRESSURE STEVENS-JOHNSON SYNDROME HEPATOTOXICITY HYPERSENSITIVITY Bisacodyl (Dulcolax) (laxatives) 10 mg q.d PO Alters fluid and electrolyte transport, producing fluid accumulation in the colon Assess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Teach patient increase fluid intake to at least 1500-2000 mL/day to prevent dehydration Report abdominal pain, fever, nausea, or vomiting. constipation abdominal cramps, nausea, diarrhea, rectal burning, muscle weakness Magnesium hydroxide (anti-ulcer agents/ antacids) 30 mg 1-3 hr after meals and at bedtime PO Neutralize gastric acid following dissolution in gastric contents. Inactivate pepsin if pH is raised to ≥4 Assess for heartburn and indigestion as well as location, duration, character, and precipitating factors of gastric pain. Teach patient patient not to take this medication within 2 hr of taking other medications. Report black, tarry stools; coffee-ground emesis Antacid aluminum salts — constipation, magnesium salts, diarrhea. hypophosphatemia Ondansetron (antiemetics) 4 mg Q4 – 8hr IV push 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. Assess patient for nausea, vomiting, abdominal distention, and bowel sound Report symptoms of irregular heartbeat, rash Teach patient to take as directed. Prevention of nausea and vomiting associated with Chemotherapy. TORSADES DE POINTES constipation, diarrhea, abdominal pain, Rash – stevens – johnson syndrome

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