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This Concept Map, created with IHMC CmapTools, has information related to: cmap1, Medications: Simvastatin 40mg QD Levothyroxine 0.112mg QD Digoxin 0.125 mg QD Isosorbide mononitrate 60mg QD Potassium Chloride 40mEq QD Magnesium salt 84 mg QD Gabapentin 300mg BID ASA 81mg QD Latenoprost 1 gtt QD amiodarone HCL 100mg QD Warfarin dose scale Furosemide 40 mg QD ondansetron 4 mg QD Atenol 100mg QD D5 1/2NS 80 ml/hr Continous affect labs: 9/5/08: Dig level: .93 ng/mL- norm Thyroid: 4.390 μg/dL- low 9/7/08: RBC: 4.44x10^6 cells/mm^3- norm HGB: 13.5 g/dL- norm HCT: 41.0%- norm WB C: 6.5 cells/μL- norm PLT: 185x10^3/μL/mm^3- norm 9/8/08: INR: 2.64- high Na: 140 mEq/L- norm K: 4.0- mEq/L- norm Cl: 102- mEq/L-norm CO2: 30- mEq/L- norm BUN:11 mg/dL- norm CREAT:1.0 mg/dL- norm Glucose: 119mg/dL- high, medications Mg salts cause diarrhea by pulling water into the colon Furosemide causes an increased diuresis of fluid Nursing diagonis: risk for fluid volume deficient related to excessive urination and diarrhea., intervention: continuning to administer D5 1/2NS as ordered as well as assessing lyte levels such as potassium to assure they fall within the norm. Assess BP Qshift to assure adequate ciruclatory volume. Assess skin turgor to assure hydration status. administer medications, goal: pt's will produce adequate clotting factors as evidenced by an increased INR without creating blood clots within 3 days. remember to assess for blood clots by checking for edema, sob, headaches, chest pain, leg pain, and mental status, goal: Pt will have the most minimal bowel damage possible by the time of surgery. this will be achieved by intervention: assess pt for bowel sounds qhour to help identify bowel necrosis or parlytic colon as early as possible., AR is allergic to PCN and Ampicillin, this will be achieved by intervention: hold warfarin doseto allow body to make adequate clotting factors, intervention: continuning to administer D5 1/2NS as ordered as well as assessing lyte levels such as potassium to assure they fall within the norm. Assess BP Qshift to assure adequate ciruclatory volume. Assess skin turgor to assure hydration status. assess ????, labs: 9/5/08: Dig level: .93 ng/mL- norm Thyroid: 4.390 μg/dL- low 9/7/08: RBC: 4.44x10^6 cells/mm^3- norm HGB: 13.5 g/dL- norm HCT: 41.0%- norm WB C: 6.5 cells/μL- norm PLT: 185x10^3/μL/mm^3- norm 9/8/08: INR: 2.64- high Na: 140 mEq/L- norm K: 4.0- mEq/L- norm Cl: 102- mEq/L-norm CO2: 30- mEq/L- norm BUN:11 mg/dL- norm CREAT:1.0 mg/dL- norm Glucose: 119mg/dL- high ???? INR normal for pts recieving anticoagulant therapy., Nursing diagonis: risk for fluid volume deficient related to excessive urination and diarrhea. goal: Pt will maintain normal electrolyte balances as well as adequate hydration status while in the hospital., AR was assessed as having Vitals: 0600: temp 36.9, HR 60, BP 140/69, R 18, O2 0L, Pain 0/10 0930: HR 62, BP 172/80 1308: temp 36.0, HR 60, BP 119/63, R 20, O2 0L, Pain 0/10 Pt is alert and oriented x2. She needed reorientation to year. She knew day of week, day of month and month but said it was 1982. She agreed upon year after being told. She respondes appropriately to environment and obeys commands. Reflexs fall within normal limits. PERRL approximately 4mm in diameter. equal bilateral hand grasps. 3+ muscle strenght in all extermitites. speech is clear and coherent. Apical HR of 62 pulses palpated bilaterally in radial and brachial pulse sites. unable to locate dorsalis pedius and posterior tibial pulses but LE are warm to touch, pink, with cap refill less than 2 seconds. 2+ pitting edema in LEs bilaterally. no edema noted on UE. Skin is warm, pink, and dry with normal turgor. cap refill less than 2 seconds on fingers. no signs of skin breakdown. no incisions, wounds, or open lesions. Chest expansion is symmetrical. no cough noted. unlabored breathing, no use of accessory muscles. Breath sounds are clear over all lung fields. mucous membranes are pink and moist. Pts abdomen is firm and distented but nontender. hyperactive tinkling bowel sounds over all 4 quads. frequent liquid stools. unable to assess urine charateristics due to it being mixed with stools in commode. Pt is contient. Independent ADLs with limited ROM in shoulders. 20gauge IV in left forearm. Minimal anxiety with strong family support from daughter., risk for injury related to excessive anticoagulation This pt is on anticoagulants because of her increased risk for blood clots related to her a-fib. ????, AR has PMHX: HTN, A-fib, hyperthryroidism treated with radioactice isotope, glaucoma, hypothryoidsm, lumbar spondylosis, anxiety, CHF with EF 40%, sinusitis, Pneumonia with empysema PSHX: Dual Chamber pace maker placement., intervention: assess pt for bowel sounds qhour to help identify bowel necrosis or parlytic colon as early as possible. assessment, risk for injury related to excessive anticoagulation ???? goal: pt's will produce adequate clotting factors as evidenced by an increased INR without creating blood clots within 3 days., intervention: continuning to administer D5 1/2NS as ordered as well as assessing lyte levels such as potassium to assure they fall within the norm. Assess BP Qshift to assure adequate ciruclatory volume. Assess skin turgor to assure hydration status. assess, AR is taking Medications: Simvastatin 40mg QD Levothyroxine 0.112mg QD Digoxin 0.125 mg QD Isosorbide mononitrate 60mg QD Potassium Chloride 40mEq QD Magnesium salt 84 mg QD Gabapentin 300mg BID ASA 81mg QD Latenoprost 1 gtt QD amiodarone HCL 100mg QD Warfarin dose scale Furosemide 40 mg QD ondansetron 4 mg QD Atenol 100mg QD D5 1/2NS 80 ml/hr Continous, Nursing diagonis: risk for impaired tissue intergrity related to possible colon obstruction. goal: Pt will have the most minimal bowel damage possible by the time of surgery., 82 year old white female, admitted for abdominal pain to 3A on 9/5/08. DOB 8/31/26. Possible colon obstruction. has Nursing diagonis: risk for impaired tissue intergrity related to possible colon obstruction., risk for injury related to excessive anticoagulation INR shows increased clotting time which means that the pt is at increased risk for bleeding which increases her surgical risk.