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NURS 121L-A Concept Map Erickson’s Developmental Stage Related to pt. & Cite References (1) He is in 8th stage of this theory, he is very content with the life he lived, bragging about his granddaughter, and his past in cuba and coming in Miami, FL.

Student Name: Karelis Sanchez Instructor: Emilio Xiques Patient Education (In Pt.) & Discharge Planning (home needs)

Erikson’s psychosocial theory of development considers the impact of external factors, patients and society on personality development from childhood to adulthood. According to Erikson’s theory, every person must pass through a series of eight interrelated stages over the entire life. This stage begins approximately at age 65 and ends at death. It is during this time that we contemplate our accomplishments and can develop integrity if we see ourselves as leading a successful life. [ CITATION Vog09 \l 1033 ] [ CITATION Mal16 \l 1033 ]

The patient has a referral twice a day for physical therapy to maintain and/or improve muscle weakness, and for occupational therapy to maintain and/or improve everyday functions. Current orders include fall risk precautions, regular diet, & accucheck q 4 hrs. Discharge planning included social work for any home safety devices needed. He would also need follow ups with his PCP, and a specialist.

Cultural considerations, ethnicity, occupation, religion, family support, insurance. (1) (14) The patient is retired and lives with his son and his granddaughter in Miami, FL. He is a Cuban male that was married and catholic. He was a participant of the Cuben Revolution. Chief Complaint

Patient Information (1) Name: J.G.M Age: 70 yrs-old Gender: Male Code Status: Full code DPOA: N/A Living Will: N/A

Diagnostic Test/ Lab Results with dates and Normal Ranges (3)

Norms

Date

Na

Test

133-145

10/28/20

Current Value 144

K

3.3-5.1

10/28/20

3.7

Chloride

96-108

10/28/20

106

Glucose

70-100

10/28/20

148

Co2

15-35

10/28/20

29.0

BUN

8.0-23

10/28/20

19

Ammonia

16-53

10/28/20

84.0

WBC

4.5-11.0

10/28/20

2.8

RBC

4.5-6.0

10/28/20

3.92

Platelet

130-500

10/28/20

63

10/29/20

Clear

CT Scan

NURS 121L-A Rev. 2-20

The patient fell on the way back from the restroom at night in his home. Complaining of muscle weakness, dizziness, fatigue.

Admitting Diagnosis Myopathy

Medical Management/ Orders/ Medications & Allergies (2) Name

Dose

RT

q.

MOA

Xifaxan

550 mg

PO

BID

Lactulose

30 mL

PO

Daily

Nadolol

20 mg

PO

Daily

A semi-synthetic derivative of rifampin & acts by binding to the betasubunit of bacterial DNAdependent RNA polymerase blocking one of the steps in transcription. Is metabolized in the colon by colonic bacteria to monosaccharides, & then to volatile fatty acids, hydrogen, & methane. It wokrs by relaxing blood vessels & slowing HR to improve blood flow & decrease BP

RN Considerations Complete tx, even if youre feeling better.

Stay on lowprotein diet.

Chedck your BP regularly to determine your response to the meds.

History of Present Illness (HPI), Pathophysiology of Admitting Dx (Cite References) Medical, Surgical, Social History (1). Patient is a 70 year-old male with history of hepatic encephalopathy episodes; Diabetes; Polyneuropathy; Thrombocytopenia; Osteoarthritis; Cirrhosis of liver. He presented at Westchester Hospital with epidsodes of confusion and myopathy. He was admitted and then transferred to West Gables Rehabilitation. Medical History Patient is a 70 year-old male with history of hepatic encephalopathy episodes; Diabetes; Polyneuropathy; Thrombocytopenia; Osteoarthritis; Cirrhosis of liver. He presented at Westchester Hospital with epidsodes of confusion and myopathy.

Surgical History No surgical history found.

Social History The patient is retired and lives with his son and his granddaughter in Miami, FL. He is a Cuban male that was married and catholic. He was a participant of the Cuben Revolution.

Priority nursing diagnosis #1



Impaired, Immobility Physical related to muscle weakness/ Myopathy AEB decreased ROM, decreased strength, & pain.

Outcome/Goal #1 Maintain and/or increase strength & function of affected body parts by walking 25ft by end of shift.

`

Vital Signs (4) Temp: 98.0 F (Oral); Pulse: 73 bpm; Resp: 15bpm; Pulse Ox: 98%; BP: 135/77; Pain: 0/10

Neurological (5)

Respiratory (7)

Cardiovascular (6)

Patient is alert and oriented x4 to person, place, time, and situation; No delayed speech.

Heart rythym regular; S1 and S2 present; peripheral pulses are palpable. No edema, capillary refill under 2 secs.

Nutrition/Hydration (8)

GI (9)

GU (10)

Rest/ Exercise (11)

Patient is receiving 25– 30 ml/kg/d water 1 mmol/kg/day sodium, potassium, chloride 50– 100 g/day glucose (e.g. glucose 5% contains 5 g/100ml). He is also eating normal.

Soft nontender nondistended abdomen, patient stated normal bowel movements. No abdominal pain, normal bowel sounds in all four quadrants, no tubes. Last bowel movement was 3 hours ago.

Patient voids regularly, no foley catheter. Reports no burning, itching, or blood in the urine. No perineal care necessary.

Patients bed is at lowest position, guard rails up, no assistive device needed. Patient feels safe at home.

Ht/Wt 5’9 / 210lbs (95.3kg)

Integumentary (12) Normla range temp: 97.0 degrees to 100.4 degrees; no tugor, no rash, ulcers or breakdown.

Endocrine (13) Patient cranial nerves are intact and no visible abnormalities.

Breath sounds clear bilaterally, normal respiratory effort.

Psychosocial (14) Patient has recollection of memories and is very adamant on getting better to get home to his family.

Priority nursing diagnosis #2  Skin Integrity, Impaired related to infection AEB redness, drainage, & heat.

Outcome/Goal #2 Maintain skin integrity by reducing redness to affected areas by end of shift

Musculoskeletal Based on 5 muscle strength grading scale, 0 menaing no muscle activity to 5 meaning full ROM. Patient has weakness in his arms and legs, patient is at a 2. Muscle strength weak.

Interventions #1

Interventions # 2 Change positions at least q. 2 hrs  Reposition extremities in functional position.  Inspect the skin regularly over bony prominences. Gently massage any redness areas & provide aids.  Evaluate muscle weakness. 

  



Assess the extent of impaired limitation. Begin active or passive ROM to all extremities. Continue physical & occupational therapy regiment twice a day. Improving the patient’s self-esteem by not being judgmental.

Assessment/ Evaluation #2

Assessment/ Evaluation #1



Goal met upon patient being able to walk 25ft from his room to rehab on the 1st floor.

1. Potential Complications/ at risk for: 1.

Risk for falls

2.

Risk for bleeding

PC Outcomes/Goal 1.

No falls by end of shift

2. No new cuts or bleeding by end of shift

NURS 121L-A Rev. 2-20

2.



Goals met upon re-examination after reposition of patient q. 2 hrs no signs of breakdown.

PC Interventions Place bed at the lowest position; bed rails raised, kept the room well lit; provided grip socks; frequent rounding. Is to make sure sharp are put away; no shaving; educate patient on being careful with hitting himself.

PC Evaluation Plan Patient had no falls all shift, and is beginning to have more strength in his arms and legs. [ CITATION Bjö00 \l 1033 ]

References: 1. Björvell, C., Thorell-Ekstrand, I., & Wredling, R. (2000). Development of an audit instrument for nursing care plans in the patient record. Quality in health care : QHC, 9(1), 6–13. https://doi.org/10.1136/qhc.9.1.6 2. Carpenito, L. J. (2009). Nursing care plans & documentation: nursing diagnoses and collaborative problems. 5th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 3. Gulanick, M., & Myers, J. L. (2017). Nursing care plans: diagnoses interventions, & outcomes. 9th edition. St. Louis, Missouri: Mosby, an imprint of Elsevier Inc. 4. Malone, J. C., Liu, S. R., Vaillant, G. E., Rentz, D. M., & Waldinger, R. J. (2016). Midlife Eriksonian psychosocial development: Setting the stage for late-life cognitive and emotional health. Developmental psychology, 52(3), 496–508. https://doi.org/10.1037/a0039875 5. Vogel-Scibilia, S. E., McNulty, K. C., Baxter, B., Miller, S., Dine, M., & Frese, F. J., 3rd (2009). The recovery process utilizing Erikson's stages of human development. Community mental health journal, 45(6), 405–414. https://doi.org/10.1007/s10597-009-9189-4...