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SHORTNESS OF BREATH UPON EXERTIEON: quiere decir falta de aire al esfuerzo Diabetico que se va a ensenar a poner Levemir SN to instruct/assess patient on proper way to self-administer insulin , insert appropriated needle and adjust to proper units, check doses carefully, clean injection sites with alcohol and to change injection site daily to prevent scarring, following aseptic technique and universal precautions. DIABETICO Patient instructed on Vitamin D 2 used to for pEreventing and treating rickets, a disease that is caused by not having enough vitamin D (vitamin D deficiency). Vitamin D is also used for treating weak bones (osteoporosis). It can be found in small amounts in a few foods, including fatty fish such as herring, mackerel, sardines, tuna and through exposure to sunlight. Side effects include: weakness, fatigue, sleepiness, headache, loss of appetite, dry mouth, metallic taste, nausea, vomiting, and others. Teaching about infection control Para el pie del diabetico SN instructed caregiver to inspect patient's lower extremities and report any alteration in skin integrity to physician. Caregiver was instructed about foot care: always wear shoes or slippers. Always wear socks with the shoes, since leather, plastics, and manmade shoe materials can irritate your skin and quickly bring on blisters. While the Diabetic patient might prefer the look of hose, nylon knee-highs, or thin socks, may find that these doesn't give the toes or heels enough protection. SN instructs patient/caregiver on importance the prescribed diet, monitoring blood sugar levels as ordered with glucometer, and seeing a physician, dentist, and eye doctor regularly in order to maintain a good management of the diabetes process. SN instructs caregiver to limit the amounts of fats and sweets eaten each day and to eat at about the same times each day. Patient's caregiver(daughter) is unable to perform injection administration due to lack of time since she has a busy work schedule. Skilled nurse instructed patient's caregiver that following prescribed diabetic diet is a measure aimed to managing/controlling Diabetes Mellitus (DM). Patient's caregiver instructed in how to recognize signs and symptoms of diabetes such as excessive thirst, fatigue, increase urination,increase apetite, slow healing wounds, itching,change in vision, and weight loss. SN instructed on importance to eat food rich in calcium and vitamin D and high content of protein, always with restriction proper for diverticular disease. SN promotes good nutrition: Eat high calorie, high protein diet, take vitamins and mineral supplements including zinc and vitamin C. SN instructs caregiver that excessive consumption of food , insufficient insulin, sedentary lifestyle, and infection can all lead to high blood sugar and diabetes decompensation.

SN to instruct/assess patient on proper way to self administer insulin , insert appropriated needle and adjust to proper units, check doses carefully, clean injection sites with alcohol and to change injection site daily to prevent scarring, following aseptic technique and universal precautions. EI trastornos gástricos en el paciente: pueden ser patient with Hx of GERD, dysphagia, irritable bowel syndrome, gastritis, diverticulitis. Dieta: SN instructed on importance to eat food rich in calcium and vitamin D and high content of protein, always with restriction proper for diverticular disease. SN promotes good nutrition: Eat high calorie, high protein diet, take vitamins and mineral supplements including zinc and vitamin C. SN taught that stress, infection and a defective autoimmune system are factors that may increase the risk of exacerbating Rheumatoid Arthritis. SN instructed the patient's caregiver on emergency preparedness plan, consent of treatment and importance of follow up MD appointments. SN instructed the patient/caregiver to avoid smoking or allowing people to smoke in patient's home. Instruct patient to avoid irritants/allergens known to increase SOB Patient is unable to reliably perform self care due to poor manual dexterity, location of wound and complexity of procedure. There is no caregiver willing or able to perform this skilled care at this time. Procedure well tolerated by patient. Sharps needles discarded in sharp containers. OJO patients taking Enbrel and methotrexate had their rheumatoid arthritis go into remission Osteoarthritis SN informed patient and caregiver in the importance or administer Enbrel and methotrexate in order for the rheumatoid arthritis to go into remission. SN instructed in factors that may increase the risk of osteoarthritis such as trauma, advancing age, poor body posture, genetic tendency, metabolic or endocrine abnormalities, and others. Patient was instructed on Osteoporosis. After the age of about bone thinning is a natural process and cannot be stopped completely. Whether you develop osteoporosis depends on the thickness of your bones early in life, as well as your health, diet, and physical activity later in life. Patient verbalized understanding of instructions. Instructed on the importance of eating a well-balanced diet, high in calcium, protein and vitamin D as a measure aimed to managing/controlling Osteoporosis. Also patient was instructed on the importance of exercising regularly, as directed by MD, as a measure aimed to developing high-density bones.

LVN/LPN Supervisory Note SN instructed the patient in complications of Rheumatoid Arthritis. It include inflammation of the heart and blood vessels, which can lead to skin infections, stomach ulcers, nerve damage, stroke and heart conditions Skilled Nurse instructed patient how to prevent injury by maintaining clear walkways, nightlights, and in the event of any fall or injury, do not try to get up, call 911 or a family member immediately for assistance. SN reinforced in the importance to patient uses assistance device for ambulation in order to avoid falls. Falls and balance Patient was instructed on balance. With age, a combination of factors decreases balance. The nerve endings in our feet don't detect impulses as readily and the balance control centers in our brain and our ears operate more slowly. Age-related changes in vision and hearing, even when subtle, also contribute to the decline in balance. Emergency plan SN instructed the patient's caregiver on emergency preparedness plan, consent of treatment and importance of follow up MD appointments. Also reinforced instruction regarding importance of a prescribed diet and to monitor blood sugar levels with a glucometer machine prior to insulin administration as ordered by MD.

SN instructed the patient's caregiver on emergency preparedness plan, consent of treatment and importance of follow up MD appointments. Patient and caregiver instructed on fall prevention like identifying treatable medical conditions and side effects of medications like fainting spells, and vertigo.

SN instructed the patient's caregiver on emergency preparedness plan, consent of treatment and importance of follow up MD appointments. Also reinforced instruction regarding importance of a prescribed diet and to administration Methotrexate sodium injection as ordered by MD. HTA SN instructed caregiver on the ways to avoid a stroke. Lifestyle choices, such as diet, high cholesterol, stress leading to hypertension, are all major factors that can contribute to a stroke. Intervention de UTI SN instructed the caregiver if any signs/symptoms of UTI to report to MD/SN, such as pain, foul odor, cloudy or blood-tinged urine and fever.

SN instructed the caregiver on UTI signs/symptoms such as foul odor, cloudy or bloody-tinged urine, pain or burning sensation during urination and fever. Report to MD/SN if any are present. SN instructed patient/caregiver on the importance of drinking water, to prevent and avoid dehydration/UTI infections. Intervencion en Sensorio SN instructed patient/family on new medications action and side effects, assess compliance and side effects and notify md of any abnormality. Goals Patient will be free of exacerbations that would require hospitalizations, will take all meds as ordered by md at appropriate times and dosages

Intervention respiratory Patient has a COPD. SN explained the need to avoid persons with infections, especially upper respiratory tract infections. SN instructed patient and caregiver on energy conservation measures including frequent rest periods, small frequent meals, avoiding large meals/overeating, controlling stress, keep often-used items (such as phone, glass of water, tissues) at bedside or by chair, or where they can be obtained easily without bending or reaching or lifting.

SN to instruct patient/caregiver on the importance of drinking water, to prevent and avoid respiratory complications. Con O2 intervention SN instructed patient on oxygen precautions, to report cough and yellow/green sputum. Emergency Plan donde estan las vacunas Instructed to obtain a generator in case of hurricane to ensure 0xygen use and/or register pt with fire department in case of evacuation needed Goals Riesgos en piel: skin fragility elderly Intervention skin

SN instructs patient on measures to take to prevent skin cancer which include wearing protective clothing, applying sunscreen, refraining from sun exposure during the midday. Patient instructed to avoid prolonged sitting on a hard surface to avoid pressure ulcer formation, to keep clean and dry. Patient was instructed on skin care. Drinks lots of fluids, especially water to keep the skin moist and healthy. To prevent dry skin when the temperature drops. Interventions***** SN instructed patient/caregiver on skin care. Goals ********Patient/caregiver is expected to demostrate knowledge regarding proper skin care. SN taught that stress, infection and a defective autoimmune system are factors that may increase the risk of exacerbating Osteoarthritis. SN instructed the patient's caregiver on emergency preparedness plan, consent of treatment and importance of follow up MD appointments. Fall Risk Intervention SN instructed patient on strategies that can significantly help decrease the risk of a fall such as: Skidproof mats or strips in the shower and bathtub, removal of furniture that can slip away if grabbed accidentally for support, supportive non-slip footwear and not walking in stocking feet. Patient currently uses walker while ambulating, SN emphasized the importance of the use of assistive device when ambulating to prevent falls or complications LVN/LPN Supervisory Note Patient and caregiver instructed on fall prevention like identifying treatable medical conditions and side effects of medications like fainting spells, and vertigo. SN instructed caregiver in the importance to change patient's position every two hours to avoid press ion ulcer. Also to keep clean path way to avoid falls. or ‘’’’’SN instructed patient on strategies that can significantly help decrease the risk of a fall such as: Skidproof mats or strips in the shower and bathtub, removal of furniture that can slip away if grabbed accidentally for support, supportive non-slip footwear and not walking in stocking feet. Patient currently uses walker while ambulating and states that it helps her with her balance.

Goals The patient caregiver will demostrate transfer techniques and knowledge on falls prevention and safety precautions.

SN instructed patient on strategies that can significantly help decrease the risk of a fall such as: Skidproof mats or strips in the shower and bathtub, Removal of furniture that can slip away if grabbed accidentally for support, supportive non-slip footwear and not walking in stocking feet. Patient currently uses cane while ambulating and states that it helps her with her balance. She verbalized understanding. SN instructed caregiver in the importance to patient follow up correct diet in order to avoid diabetes complications.

SN instructed caregiver in the importance to patient follow up correct diet in order to avoid diabetes complications.

HHA EVERCARE Patient receives HHA daily from United Health Care LTC Program.(Evercare) La depresion está siendo tratada.

Se pone ,,,,,,,, Depressed mood under treatment at this moment

Intervencion SN to instruct patient/caregiver about measure to prevent depression complications and to report if any signs/symptoms of exacerbation Goals The remains free of depressive symptoms increase during the episode. En mental status SN instructed patient / caregiver on changes in neurological status and to report to SN / MD Requires prompting cues and remainders in new and complex situations or under stressful conditions SN to instruct patient/caregiver about measure to prevent depression complications and to report if any signs/symptoms of exacerbation Si anxiety intervencion

SN instruct patient's caregiver on signs/symptoms of anxiety with emphasis on any verbal , or other jeopardize personal safety, report agency and MD if any of these appear. SN instructed patient/caregiver to inform the physician of any changes in condition. SN instructed patient to report any symptoms of anxiety such as feeling apprehensive, feeling powerless, having a sense of impending danger, panic or doom, having an increased heart rate, breathing rapidly (hyperventilation), sweating, trembling, and or feeling weak or tired to SN or MD immediately to help prevent further complications. Goals Patient will remain free from increased anxiety during the episode Depress Interventions SN to instruct patient/caregiver about measure to prevent depression complications and to report if any signs/symptoms of exacerbation. Goals Patient will remain free from complications of depressed during the episode. Or Patient will remain free from increased depressed during the episode.

Depression is being treated SN to instruct patient/family on hypnotics/sedatives/sleep medications, their action and side effects, also assess compliance as well as side effects. Notify md of any abnormality. PAIN Patient instructed caregiver to alternate resting periods, following short ambulation to decrease fatigue and decrease pain Patient/caregiver will implement measures to alleviate pain and is expected to demonstrate the proper techniques needed to manage episodes of pain for optimal relief/control. Si vertigo se le puso a artemia que siempre pone Lurdes SN to instruct the Patient/Caregiver to contact agency for increased dizziness or problems with balance. HTA si esta estable

arterial hypertension controlled in this moment with treatment En el paciente que se le diagnostic un fallo cardiac y se le va a dar de alta sin exacerbation xxxxxPatient has been diagnosed with heart failure but has not exhibited any exacerbation of symptoms leading to heart failure since previous OASIS. Patient had shortness of breath with minimal exacerbation in the resumption of care which was informed to the Doctor and now has improved to SOB with moderate exacerbation with no other sign or symptom of present heart failure.

Teaching Enbrel: reducing signs and symptoms RA SN taught that eating well-balanced meals high in protein, vitamins and iron is a measure aimed to controlling/managing Rheumatoid Arthritis. SN instructed caregiver in the importance to patient's follow up Occupational and Physical Therapist home exercise in order to improve his functional limitation. SN instructed caregiver in the importance to patient uses assistance device for transfer to avoid complications. Instructed patient's caregiver on herpes zoster (shingles) it is usually a self-limited dermatomal rash with pain, herpes zoster can be far more serious; in addition, acute cases often lead to postherpetic neuralgia, reinforced in the importance to patient take medication as MD orders to avoid complications. SN instructed caregiver in the importance to patient have regular follow up with his PCP to avoid complications. Wound care Patient was instructed about to tell the doctor about any changes in sensation in the toes, feet, or legs. Speak up if note pain, tingling, a pins-and-needles feeling, numbness, or any other unusual signs - even if it seems trivial to the patient. Medications SN to instruct the patient/caregiver on precautions for high risk medications, such as, sedative hypnotics, narcotics, antiarrhythmics, antineoplastics, skeletal muscle relaxants. Artritis SN taught that performing active or passive range-of-motion exercises, as directed by MD, is a measure aimed to controlling/managing Rheumatoid Arthritis.

SN instructed in never ignore numbness or tingling as these sensations are often related to nerve compression, and they may be warning signs indicating serious injury that should always be seen by a physician. SN instructed in factors that may increase the risk of osteoarthritis such as trauma, advancing age, poor body posture, genetic tendency, metabolic or endocrine abnormalities, and others. SN instructed in complication of rheumatoid arthritis such as deformity and disability, infections and osteoporosis. Wound SHORTNESS OF BREATH UPON EXERTION: quiere decir falta de aire al esfuerzo Diabetico que se va a ensenar a poner Levemir SN to instruct/assess patient on proper way to self-administer insulin , insert appropriated needle and adjust to proper units, check doses carefully, clean injection sites with alcohol and to change injection site daily to prevent scarring, following aseptic technique and universal precautions. DIABETICO Patient instructed on Vitamin D 2 used to for preventing and treating rickets, a disease that is caused by not having enough vitamin D (vitamin D deficiency). Vitamin D is also used for treating weak bones (osteoporosis). It can be found in small amounts in a few foods, including fatty fish such as herring, mackerel, sardines, tuna and through exposure to sunlight. Side effects include: weakness, fatigue, sleepiness, headache, loss of appetite, dry mouth, metallic taste, nausea, vomiting, and others. Teaching about infection control Para el pie del diabetico SN instructed caregiver to inspect patient's lower extremities and report any alteration in skin integrity to physician. Caregiver was instructed about foot care: always wear shoes or slippers. Always wear socks with the shoes, since leather, plastics, and manmade shoe materials can irritate your skin and quickly bring on blisters. While the Diabetic patient might prefer the look of hose, nylon knee-highs, or thin socks, may find that these doesn't give the toes or heels enough protection. SN instructs patient/caregiver on importance the prescribed diet, monitoring blood sugar levels as ordered with glucometer, and seeing a physician, dentist, and eye doctor regularly in order to maintain a good management of the diabetes process. SN instructs caregiver to limit the amounts of fats and sweets eaten each day and to eat at about the same times each day. Patient's caregiver(daughter) is unable to perform injection administration due to lack of time since she has a busy work schedule. Skilled nurse instructed patient's caregiver that following prescribed diabetic diet is a measure aimed to managing/controlling Diabetes Mellitus (DM).

Patient's caregiver instructed in how to recognize signs and symptoms of diabetes such as excessive thirst, fatigue, increase urination,increase apetite, slow healing wounds, itching,change in vision, and weight loss. SN instructs caregiver that excessive consumption of food , insufficient insulin, sedentary lifestyle, and infection can all lead to high blood sugar and diabetes decompensation.

SN to instruct/assess patient on proper way to self administer insulin , insert appropriated needle and adjust to proper units, check doses carefully, clean injection sites with alcohol and to change injection site daily to prevent scarring, following aseptic technique and universal precautions. EI trastornos gástricos en el paciente: pueden ser patient with Hx of GERD, dysphagia, irritable bowel syndrome, gastritis, diverticulitis. Dieta: SN instructed on importance to eat food rich in calcium and vitamin D and high content of protein, always with restriction proper for diverticular disease. SN promotes good n...