Case study - FDM
Content
Saint Paul University Quezon City Nursing Department
Disseminated Cadidiasis
Fe Del Mundo Medical Center
Submitted By: BSN – IV Tanchuan, Toni Roque, Ryan
I.
Introduction Cadidiasis is an infection caused by Candida fungi, especially Candida albicans. These fungi are found almost everywhere in the environment. Some may live harmlessly along with the abundant "native" species of bacteria that normally colonize the mouth, gastrointestinal tract and vagina. Usually, Candida is kept under control by the native bacteria and by the body's immune defenses. If the native bacteria are decreased by antibiotics or if the person's immune system is weakened by illness (especially AIDS or diabetes), malnutrition, or certain medications (corticosteroids or anticancer drugs), Candida fungi can multiply to cause symptoms. Candida infections can cause occasional symptoms in healthy people. Candidiasis can affect many parts of the body, causing localized infections or larger illness, depending on the person and his or her general health. Patient LDR is a 77 year old man who was admitted in Fe Del Mundo Medical Center on June 26, 2010 due to itchy skin rashes on inguinal area. He was later diagnosed with disseminated candidiasis on the same day of his admission. This is a detailed study about the patient, Mr. LDR and his disease as well as the nursing management done and health teaching involved during hospital stay. II. Objectives A. General 1. To analyze and interpret the past and present condition of the client in order to construct a comprehensive nursing care plan. B. Specific 1. To assess the needs of the client 2. To provide nursing interventions suitable to the client’s needs 3. To recognize how the disease affects the normal body functions 4. To analyze the progress and development of the disease 5. To evaluate the effectiveness of the nursing intervention 6. To create sufficient and adequate health teaching plan that promotes wellness III. Personal Data Name: L.D.R Age: 77 Sex: Male Nationality: Filipino Place of Birth: Bulacan Date of Birth: June 23, 1933 Civil Status: Married Address: Sibul San Miguel Bulacan Religion: Catholic Date of Admission: June 26, 2010 Attending Physician: Dr. Baldomero Chief Complaint: skin rashes, itchiness, skin lesions Final Diagnosis: Disseminated candidiasis all over secondary to prolonged steroid use IV. Nursing Assessment A. History of present Illness Two weeks prior to admission the patient noted hyperurecemia over ingiinal area, dry but no association with itchiness. This later spread over other skin fold areas in the body associated with puritus. Patient LDR came to Fe del Mundo Medical center on June 26 where he was consulted and admitted by Dr. Baldomero with a diagnosis of disseminated candidiasis. B. Past and Present Medical History • Patient has asymptomatic abdomen aortic neurysm and is current on Metoprolol 50mg tab BID
•
He has hypertension. • Recently treated for Steven Johnson’s and is currently taking Prednisone 20mg tab BID C. Current Health Status • The patient is allergic to Gemfibrosil. • The patient has been fully immunized. • He lives in a clean and safe environment. D. Family History • The patient’s grandfather has hypertension and arthritis. E. Personal History • Mr. LDR has been a smoker for 30 year. • He is also a previous alcoholic drinker. F. Nursing Theory KOLCABA'S COMFORT THEORY The theoretical structure of Kolcaba's comfort theory has real potential to direct the work and thinking of all healthcare providers within one institution. Comfort as a concept During the development of the comfort theory, Kolcaba conducted a concept analysis of comfort that examined literature from several disciplines including nursing, medicine, psychology, psychiatry, ergonomics, and English. This review confirmed that comfort is a positive concept and is associated with activities that nurture and strengthen patients. Forms of comfort Kolcaba described comfort as existing in 3 forms: relief, ease, and transcendence. If specific comfort needs of a patient are met, for example, the relief of postoperative pain by administering prescribed analgesia, the individual experiences comfort in the relief sense. If the patient is in a comfortable state of contentment, the person experiences comfort in the ease sense, for example, how one might feel after having issues that are causing anxiety addressed. Lastly, transcendence is described as the state of comfort in which patients are able to rise above their challenges. An example of comfort in this form is evident in the patient who is involved in a physical therapy or rehabilitation program. While these types of programs are often associated with physical discomfort, Kolcaba and Kolcaba asserted that they eventually lead to a state of transcendence or renewal, in which the individual has moved past the initial discomfort with the end result being increased individual strength. Kolcaba’s theory is relevant to patient LDR because his illness causes him plenty of discomfort which includes pain and itchiness on the affected parts. The nurse must formulate care plans structured on this theory to alleviate the discomfort the patient is experiencing. G. Physical Examination • Vital Signs as follows: - Temperature: 36.3°C - Pulse Rate: 73BPM - Respiratory Rate: 21CPM - Blood Pressure: mmHg • Height: 5’5 • Weight: 66 kilos Physical examination was done on June 26, 2010 Conscious, coherent, afebrile HEENT Pink conjunctiva, anicteric sclera Chest/lungs symmetric with clear breath sounds CNS Adynamic precordium
Abdomen Extremities Skin
(-) murmur Globular, soft, non-tender (-) organmegaly No edema with good pulses (+) dry, hyperemic areas over inguinal areas, acute cubital areas, nape area, waistline, and upper back
V. Anatomy and Physiology The Skin The skin is an organ because it consists of different tissues that are joined to perform specific activities. It is one of the largest organs of the body in surface area and weight. In adults, the skin covers an area of about 2 square meters, and weighs 4.5 to 5 kg. It ranges in thickness from 0.5 to 4.0 mm, depending on location. The skin is not just a simple, thin coat that keeps the body together and provides protection. It performs several essential functions. Dermatology is the medical specialty that deals with diagnosing and treating skin disorders.
Anatomy of the Skin Structurally, the skin consists of two principal parts. The outer, thinner portion, which is composed of epithelium, is called the epidermis. The epidermis is attached to the inner, thicker, connective tissue part called the dermis. Beneath the dermis is a subcutaneous (subQ) layer. This layer, also called the superficial fascia or hypodermis, consists of areolar and adipose tissues. Fibbers from the dermis extend down into the subcutaneous layer and anchor the skin to it. The subcutaneous layer, in turn, attaches to underlying tissues and organs. Physiology of the Skin Skin serves several functions, which are introduced here. Regulation of body temperature. In response to high environmental temperature or strenuous exercise, the evaporation of sweat from the skin surface helps lower an elevated body temperature to normal. In response to low environmental temperature, production of sweat is decreased, which helps conserve heat. Changes in the flow of blood to the skin also help regulate body temperature.
Protection. The skin covers the body and provides a physical barrier that protects underlying tissues from physical abrasion, bacterial invasion, dehydration, and ultraviolet (UV) radiation. Hair and nails also have protective functions. Sensation. The skin contains abundant nerve endings and receptors that detect stimuli related to temperature, touch, pressure, and pain. Excretion. Besides removing heat and some water from the body, sweat also is the vehicle for excretion of a small amount of salts and several organic compounds. Immunity. Certain cells of the epidermis are important components of the immune system, which fends off foreign invaders. Blood reservoir. The dermis of the skin houses extensive networks of blood vessels that carry 8 to 10% of the total blood flow in a resting adult. In moderate exercise, skin blood flow may increase, which helps dissipate heat from the body. During hard exercise, however, skin blood vessels constrict (narrow) somewhat, and more blood is able to circulate to contracting muscles. Synthesis of Vitamin D. Vitamin D is a group of closely related compounds. Synthesis of vitamin D begins with activation of a precursor molecule in the skin by ultraviolet (UV) rays in sunlight. Enzymes in the liver and kidneys then modify the molecule, finally producing calcitriol, the most active form of vitamin D. Calcitriol contributes to the homeostasis of body fluids by aiding absorption of calcium in foods. According to the synthesis sequence just described, vitamin D is a hormone, since it is produced in one location in the body, transported by the blood, and then exerts its effect in another location. In this respect, the skin may be considered an endocrine organ. Reference: http://www.wildcrafted.com.au/Articles/Anatomy_and_Physiology/The_Skin.html
VI.
Pathophysiology Predisposing factors: Age Sex
Precipitating factors: drugs (antibiotics, corticosteroids, birth control pills pregnancy being overweight bacterial infection several health conditions (weakened immune system, diabetes, psoriasis
→
Compromised normal body mechanism
←
↓
Penetration of organism by direct contact (Candida albicdans)
↓
Colonization and Reproduction in skin (scaly, erythematous, papular rash, sometimes covered with exudates)
VII.
Medical Management a. Laboratory Results
Result Hematology Date: June 26, 2010 Normal Range 12-15 g/dL 36-46 % 4-4.5 x 10^6/L 80-100 fl 27-31 pg 32-36% 150-400 x 10^3/L 4.5-11 c 10^3/L 1-4% Interpretation
Hemoglobin Hematocrit RBC count MCV MCH MCHC Platelets WBC Eosinophil
14.7 43.8 4.49 89.6 30.1 33.6 275 7.6 7
Neutrophil Lymphocyte Monocyte RDW
47 40 6 14.8
36-66% 22-40% 4-8% 8.5-15
Normal Normal Normal Normal Normal Normal Normal Normal Above normal range Increase may indicate asthma, hay fever, parasitic infections, chronic myelocytic leukemia, Hodgkin’s disease, metastasis Normal Normal Normal normal
Urinalysis
Macroscopic Color Transparency Specific Gravity pH (reaction) Glucose (sugar) Date: June 26, 2010 Result Normal Yellow Straw to dark yellow Hazy Slightly turbid to clear 1.025 1.016-1.025 5 4.6-6.5 Negative Negative Chemistry Blood +3 Interpretation Normal Normal Normal Normal normal
Bilirubin Uribilinogen Ketone Nitrite Leucocyte Pus cells Red cells Epithelial cells Mucous threads Bacteria
Negative Negative Negative Negative Negative
Negative 0.1-1 Negative Negative Negative
Normal Normal Normal Normal Normal
Microscopic 0-2/HPF Too numerous to count Few Small amounts Plenty rare none Microbiology Report June 26, 2010
Normal Normal
Request: KOH smear Specimen: skin scraping at inguinal area Microscopic findings: positive for fungal elements
b. Drug study
Generic Name 1. hydrocortsione 100 mg IV q4
Brand Name Cortizan Cortef
Action Glucocorticoid with anti inflammatory effect because of its ability to inhibit prostaglandin synthesis Unknown, may suppress activity in key regions of subcortical areas of CNS
Indication Treatment of rheumatic disorders, allergic diseases, adrenal cortex insuffeciency Ictrogenic allergic reactions
Side/adverse effects Flushing, sweating, headache, hypertension, embolism, acne, poor wound healing Involuntary motor activity, mylagia, myoritis, myopathy
Nursing Consideration Assess patient’s condition first before starting therapy Monitor weight, input and output Monitor plasm and control levels Monitor for adverse reactions Monitor weight and blood pressure Assess patient’s condition before starting therapy and reassess regularly
2. hydroxyzine
Altaraz, Iterax, Vistrasil
VIII.
Nursing Care Plan
Assessment Name: L.D.R Age: 77 Sex. M Subjective: “Masakit itong kanang kamay ko” –as verbalized by the patient - with pain scale of 6/10 Objective Vital signs as follows: BP: 130/80 PR: 78 RR: 25 T: 35.9 °C With IVF on right metacarpal vein Redness on IV site Observed evidence of pain Restlessness
Nursing Diagnosis Alteration in comfort: Acute pain related to physical injury caused by the infiltration on IV site
Inference Infiltration on IV site ↓ Redness and swelling ↓ Stimulation of nociceptors ↓ Sending electrical impulses to the spinal cord ↓ Which travels to the brain ↓ Causing pain
Planning After 30 minutes to 1 hour of nursing interventions, the pain scale will be reduced from 6/10 to 3/10.
Nursing Interventions Independent: 1. Monitor vital signs
Rationale - To note alterations and baseline data - the meaning of the pain will directly influence the patient’s response - Patients may experience an exaggeration to pain/decreased ability to tolerate painful stimuli if environmental intrapersonal, intraphsychic factors are future stressing them. -prompt response to complaint may result in decrease anxiety in patient - to alleviate pain and promote blood circulation - If condition worsens change iv site to promote comfort
Evaluation The goal was partially met. After 2 hours of nursing interventions, the pain scale was reduced from 6/10 to 2/10. “Di na masyadong masakit.” - as verbalized by the patient
2.
Asses pain characteristics
3.
Evaluate what the pain means to the individual 4. Eliminate additional stressors or sources of discomfort when possible
5.
Respond immediate to complaint of pain
6.
Apply warm compress on injured area
Dependent: 1. Change IV site
IX.
Health Teaching a. Medicines • • • b. Exercise and Activities
Prednisone 20mg tab BID Hydroxyzyme 25mg tab BID Fluconazole 150 mg OD
• Encourage the patient to do light aerobic exercise (walking, biking, swimming, golfing, and jogging) at least three times a week. • Inform the client that he must refrain from sexual activity to prevent spread of the disease at least until one week after alleviation of signs and symptoms or as directed by doctor. c. Treatment Most localized cutaneous candidiasis infections may be treated with any number of topical antifungal agents (eg, clotrimazole, econazole, ciclopirox, miconazole, ketoconazole, nystatin). If the infection is a paronychia, the most important aspect of therapy is drainage of the abscess, followed by oral antifungal therapy with either fluconazole or itraconazole. In cases of extensive cutaneous infections, infections in immunocompromised patients, folliculitis, or onychomycosis, systemic antifungal therapy is recommended. For Candida onychomycosis, oral itraconazole (Sporanox) appears to be most efficacious. Two treatment regimens are available: the daily dose of itraconazole taken for 3-6 months or the pulsed-dose regimen that requires a slightly higher daily dose for 7 days, followed by 3 weeks of no drug administration. The cycle is repeated every month for 3-6 months. d. Health Teaching • Inform patients and their families about the risk factors associated with mucosal and systemic candidiasis. In addition, inform them that the systemic form of the disease is extremely serious and is associated with high morbidity and mortality rates unless aggressive action is undertaken. e. Out-Patient • Instruct the patient to follow up after one week. f. Diet • Regular diet g. Spiritual • Encourage patient to spend more time with God through prayer, going to church.
Disseminated Cadidiasis
Fe Del Mundo Medical Center
Submitted By: BSN – IV Tanchuan, Toni Roque, Ryan
I.
Introduction Cadidiasis is an infection caused by Candida fungi, especially Candida albicans. These fungi are found almost everywhere in the environment. Some may live harmlessly along with the abundant "native" species of bacteria that normally colonize the mouth, gastrointestinal tract and vagina. Usually, Candida is kept under control by the native bacteria and by the body's immune defenses. If the native bacteria are decreased by antibiotics or if the person's immune system is weakened by illness (especially AIDS or diabetes), malnutrition, or certain medications (corticosteroids or anticancer drugs), Candida fungi can multiply to cause symptoms. Candida infections can cause occasional symptoms in healthy people. Candidiasis can affect many parts of the body, causing localized infections or larger illness, depending on the person and his or her general health. Patient LDR is a 77 year old man who was admitted in Fe Del Mundo Medical Center on June 26, 2010 due to itchy skin rashes on inguinal area. He was later diagnosed with disseminated candidiasis on the same day of his admission. This is a detailed study about the patient, Mr. LDR and his disease as well as the nursing management done and health teaching involved during hospital stay. II. Objectives A. General 1. To analyze and interpret the past and present condition of the client in order to construct a comprehensive nursing care plan. B. Specific 1. To assess the needs of the client 2. To provide nursing interventions suitable to the client’s needs 3. To recognize how the disease affects the normal body functions 4. To analyze the progress and development of the disease 5. To evaluate the effectiveness of the nursing intervention 6. To create sufficient and adequate health teaching plan that promotes wellness III. Personal Data Name: L.D.R Age: 77 Sex: Male Nationality: Filipino Place of Birth: Bulacan Date of Birth: June 23, 1933 Civil Status: Married Address: Sibul San Miguel Bulacan Religion: Catholic Date of Admission: June 26, 2010 Attending Physician: Dr. Baldomero Chief Complaint: skin rashes, itchiness, skin lesions Final Diagnosis: Disseminated candidiasis all over secondary to prolonged steroid use IV. Nursing Assessment A. History of present Illness Two weeks prior to admission the patient noted hyperurecemia over ingiinal area, dry but no association with itchiness. This later spread over other skin fold areas in the body associated with puritus. Patient LDR came to Fe del Mundo Medical center on June 26 where he was consulted and admitted by Dr. Baldomero with a diagnosis of disseminated candidiasis. B. Past and Present Medical History • Patient has asymptomatic abdomen aortic neurysm and is current on Metoprolol 50mg tab BID
•
He has hypertension. • Recently treated for Steven Johnson’s and is currently taking Prednisone 20mg tab BID C. Current Health Status • The patient is allergic to Gemfibrosil. • The patient has been fully immunized. • He lives in a clean and safe environment. D. Family History • The patient’s grandfather has hypertension and arthritis. E. Personal History • Mr. LDR has been a smoker for 30 year. • He is also a previous alcoholic drinker. F. Nursing Theory KOLCABA'S COMFORT THEORY The theoretical structure of Kolcaba's comfort theory has real potential to direct the work and thinking of all healthcare providers within one institution. Comfort as a concept During the development of the comfort theory, Kolcaba conducted a concept analysis of comfort that examined literature from several disciplines including nursing, medicine, psychology, psychiatry, ergonomics, and English. This review confirmed that comfort is a positive concept and is associated with activities that nurture and strengthen patients. Forms of comfort Kolcaba described comfort as existing in 3 forms: relief, ease, and transcendence. If specific comfort needs of a patient are met, for example, the relief of postoperative pain by administering prescribed analgesia, the individual experiences comfort in the relief sense. If the patient is in a comfortable state of contentment, the person experiences comfort in the ease sense, for example, how one might feel after having issues that are causing anxiety addressed. Lastly, transcendence is described as the state of comfort in which patients are able to rise above their challenges. An example of comfort in this form is evident in the patient who is involved in a physical therapy or rehabilitation program. While these types of programs are often associated with physical discomfort, Kolcaba and Kolcaba asserted that they eventually lead to a state of transcendence or renewal, in which the individual has moved past the initial discomfort with the end result being increased individual strength. Kolcaba’s theory is relevant to patient LDR because his illness causes him plenty of discomfort which includes pain and itchiness on the affected parts. The nurse must formulate care plans structured on this theory to alleviate the discomfort the patient is experiencing. G. Physical Examination • Vital Signs as follows: - Temperature: 36.3°C - Pulse Rate: 73BPM - Respiratory Rate: 21CPM - Blood Pressure: mmHg • Height: 5’5 • Weight: 66 kilos Physical examination was done on June 26, 2010 Conscious, coherent, afebrile HEENT Pink conjunctiva, anicteric sclera Chest/lungs symmetric with clear breath sounds CNS Adynamic precordium
Abdomen Extremities Skin
(-) murmur Globular, soft, non-tender (-) organmegaly No edema with good pulses (+) dry, hyperemic areas over inguinal areas, acute cubital areas, nape area, waistline, and upper back
V. Anatomy and Physiology The Skin The skin is an organ because it consists of different tissues that are joined to perform specific activities. It is one of the largest organs of the body in surface area and weight. In adults, the skin covers an area of about 2 square meters, and weighs 4.5 to 5 kg. It ranges in thickness from 0.5 to 4.0 mm, depending on location. The skin is not just a simple, thin coat that keeps the body together and provides protection. It performs several essential functions. Dermatology is the medical specialty that deals with diagnosing and treating skin disorders.
Anatomy of the Skin Structurally, the skin consists of two principal parts. The outer, thinner portion, which is composed of epithelium, is called the epidermis. The epidermis is attached to the inner, thicker, connective tissue part called the dermis. Beneath the dermis is a subcutaneous (subQ) layer. This layer, also called the superficial fascia or hypodermis, consists of areolar and adipose tissues. Fibbers from the dermis extend down into the subcutaneous layer and anchor the skin to it. The subcutaneous layer, in turn, attaches to underlying tissues and organs. Physiology of the Skin Skin serves several functions, which are introduced here. Regulation of body temperature. In response to high environmental temperature or strenuous exercise, the evaporation of sweat from the skin surface helps lower an elevated body temperature to normal. In response to low environmental temperature, production of sweat is decreased, which helps conserve heat. Changes in the flow of blood to the skin also help regulate body temperature.
Protection. The skin covers the body and provides a physical barrier that protects underlying tissues from physical abrasion, bacterial invasion, dehydration, and ultraviolet (UV) radiation. Hair and nails also have protective functions. Sensation. The skin contains abundant nerve endings and receptors that detect stimuli related to temperature, touch, pressure, and pain. Excretion. Besides removing heat and some water from the body, sweat also is the vehicle for excretion of a small amount of salts and several organic compounds. Immunity. Certain cells of the epidermis are important components of the immune system, which fends off foreign invaders. Blood reservoir. The dermis of the skin houses extensive networks of blood vessels that carry 8 to 10% of the total blood flow in a resting adult. In moderate exercise, skin blood flow may increase, which helps dissipate heat from the body. During hard exercise, however, skin blood vessels constrict (narrow) somewhat, and more blood is able to circulate to contracting muscles. Synthesis of Vitamin D. Vitamin D is a group of closely related compounds. Synthesis of vitamin D begins with activation of a precursor molecule in the skin by ultraviolet (UV) rays in sunlight. Enzymes in the liver and kidneys then modify the molecule, finally producing calcitriol, the most active form of vitamin D. Calcitriol contributes to the homeostasis of body fluids by aiding absorption of calcium in foods. According to the synthesis sequence just described, vitamin D is a hormone, since it is produced in one location in the body, transported by the blood, and then exerts its effect in another location. In this respect, the skin may be considered an endocrine organ. Reference: http://www.wildcrafted.com.au/Articles/Anatomy_and_Physiology/The_Skin.html
VI.
Pathophysiology Predisposing factors: Age Sex
Precipitating factors: drugs (antibiotics, corticosteroids, birth control pills pregnancy being overweight bacterial infection several health conditions (weakened immune system, diabetes, psoriasis
→
Compromised normal body mechanism
←
↓
Penetration of organism by direct contact (Candida albicdans)
↓
Colonization and Reproduction in skin (scaly, erythematous, papular rash, sometimes covered with exudates)
VII.
Medical Management a. Laboratory Results
Result Hematology Date: June 26, 2010 Normal Range 12-15 g/dL 36-46 % 4-4.5 x 10^6/L 80-100 fl 27-31 pg 32-36% 150-400 x 10^3/L 4.5-11 c 10^3/L 1-4% Interpretation
Hemoglobin Hematocrit RBC count MCV MCH MCHC Platelets WBC Eosinophil
14.7 43.8 4.49 89.6 30.1 33.6 275 7.6 7
Neutrophil Lymphocyte Monocyte RDW
47 40 6 14.8
36-66% 22-40% 4-8% 8.5-15
Normal Normal Normal Normal Normal Normal Normal Normal Above normal range Increase may indicate asthma, hay fever, parasitic infections, chronic myelocytic leukemia, Hodgkin’s disease, metastasis Normal Normal Normal normal
Urinalysis
Macroscopic Color Transparency Specific Gravity pH (reaction) Glucose (sugar) Date: June 26, 2010 Result Normal Yellow Straw to dark yellow Hazy Slightly turbid to clear 1.025 1.016-1.025 5 4.6-6.5 Negative Negative Chemistry Blood +3 Interpretation Normal Normal Normal Normal normal
Bilirubin Uribilinogen Ketone Nitrite Leucocyte Pus cells Red cells Epithelial cells Mucous threads Bacteria
Negative Negative Negative Negative Negative
Negative 0.1-1 Negative Negative Negative
Normal Normal Normal Normal Normal
Microscopic 0-2/HPF Too numerous to count Few Small amounts Plenty rare none Microbiology Report June 26, 2010
Normal Normal
Request: KOH smear Specimen: skin scraping at inguinal area Microscopic findings: positive for fungal elements
b. Drug study
Generic Name 1. hydrocortsione 100 mg IV q4
Brand Name Cortizan Cortef
Action Glucocorticoid with anti inflammatory effect because of its ability to inhibit prostaglandin synthesis Unknown, may suppress activity in key regions of subcortical areas of CNS
Indication Treatment of rheumatic disorders, allergic diseases, adrenal cortex insuffeciency Ictrogenic allergic reactions
Side/adverse effects Flushing, sweating, headache, hypertension, embolism, acne, poor wound healing Involuntary motor activity, mylagia, myoritis, myopathy
Nursing Consideration Assess patient’s condition first before starting therapy Monitor weight, input and output Monitor plasm and control levels Monitor for adverse reactions Monitor weight and blood pressure Assess patient’s condition before starting therapy and reassess regularly
2. hydroxyzine
Altaraz, Iterax, Vistrasil
VIII.
Nursing Care Plan
Assessment Name: L.D.R Age: 77 Sex. M Subjective: “Masakit itong kanang kamay ko” –as verbalized by the patient - with pain scale of 6/10 Objective Vital signs as follows: BP: 130/80 PR: 78 RR: 25 T: 35.9 °C With IVF on right metacarpal vein Redness on IV site Observed evidence of pain Restlessness
Nursing Diagnosis Alteration in comfort: Acute pain related to physical injury caused by the infiltration on IV site
Inference Infiltration on IV site ↓ Redness and swelling ↓ Stimulation of nociceptors ↓ Sending electrical impulses to the spinal cord ↓ Which travels to the brain ↓ Causing pain
Planning After 30 minutes to 1 hour of nursing interventions, the pain scale will be reduced from 6/10 to 3/10.
Nursing Interventions Independent: 1. Monitor vital signs
Rationale - To note alterations and baseline data - the meaning of the pain will directly influence the patient’s response - Patients may experience an exaggeration to pain/decreased ability to tolerate painful stimuli if environmental intrapersonal, intraphsychic factors are future stressing them. -prompt response to complaint may result in decrease anxiety in patient - to alleviate pain and promote blood circulation - If condition worsens change iv site to promote comfort
Evaluation The goal was partially met. After 2 hours of nursing interventions, the pain scale was reduced from 6/10 to 2/10. “Di na masyadong masakit.” - as verbalized by the patient
2.
Asses pain characteristics
3.
Evaluate what the pain means to the individual 4. Eliminate additional stressors or sources of discomfort when possible
5.
Respond immediate to complaint of pain
6.
Apply warm compress on injured area
Dependent: 1. Change IV site
IX.
Health Teaching a. Medicines • • • b. Exercise and Activities
Prednisone 20mg tab BID Hydroxyzyme 25mg tab BID Fluconazole 150 mg OD
• Encourage the patient to do light aerobic exercise (walking, biking, swimming, golfing, and jogging) at least three times a week. • Inform the client that he must refrain from sexual activity to prevent spread of the disease at least until one week after alleviation of signs and symptoms or as directed by doctor. c. Treatment Most localized cutaneous candidiasis infections may be treated with any number of topical antifungal agents (eg, clotrimazole, econazole, ciclopirox, miconazole, ketoconazole, nystatin). If the infection is a paronychia, the most important aspect of therapy is drainage of the abscess, followed by oral antifungal therapy with either fluconazole or itraconazole. In cases of extensive cutaneous infections, infections in immunocompromised patients, folliculitis, or onychomycosis, systemic antifungal therapy is recommended. For Candida onychomycosis, oral itraconazole (Sporanox) appears to be most efficacious. Two treatment regimens are available: the daily dose of itraconazole taken for 3-6 months or the pulsed-dose regimen that requires a slightly higher daily dose for 7 days, followed by 3 weeks of no drug administration. The cycle is repeated every month for 3-6 months. d. Health Teaching • Inform patients and their families about the risk factors associated with mucosal and systemic candidiasis. In addition, inform them that the systemic form of the disease is extremely serious and is associated with high morbidity and mortality rates unless aggressive action is undertaken. e. Out-Patient • Instruct the patient to follow up after one week. f. Diet • Regular diet g. Spiritual • Encourage patient to spend more time with God through prayer, going to church.
