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This Concept Map, created with IHMC CmapTools, has information related to: 10-6 CMAP Caddle, Ineffective airway clearance related to increased thick mucous secretions as evidenced by rhonchi. Intervention Provide oral suctioning as needed to maintain a patent airway and assist client to expectorate sputum., Ineffective cerebral tissue perfusion related to interruption of blood flow as evidenced by changes in level of conciousness. Intervention Elevate HOB 10 degrees and maintain head and neck midline to promote circulation and venous return., Calcium Gluconate Classification Electrolyte replacement, Calcium product, CBC 10/4 WBC=9.3 RBC=4.75 Hgb=14.1 Hct=42.1 Plt=163, Diltiazem Reason for Recieving Pt was in a rhythm of A-fib RVR, Calcium Gluconate Pertinent Labs Ca= 7.9, Aspirin Brand Name Aspirin, Aspirin Nursing Indications Increased bleeding risk. GI irritation, give with food or milk to decrease symptoms., Ineffective airway clearance related to increased thick mucous secretions as evidenced by rhonchi. Intervention Increase fluid intake, if client's cardiac system will allow, to at least 2000ml/day to help liquify secretions., Nitroglycerin Physician's Order Nitro patch .4mg transdermal Q8h, Ineffective cerebral tissue perfusion related to interruption of blood flow as evidenced by changes in level of conciousness. Intervention Perform frequent neuro assessments and interview client's family to better understand the client's baseline., CBC 10/5 WBC=10.7 RBC=4.39 Hgb=12.7 Hct=37.8 Plt=153, Diltiazem Nursing Indications Assess cardiac status frequently. Infusion cannot be run for more than 24 hours at time, Risk for decreased cardiac output related to myocardial ischemia and altered electrical conduction. Intervention Avoid use of restraints as they may be agitating to the client and increase cardiac workload., Gen. Chem. 10/5 Ca=8.0 Gluc=96 BUN=23 Cr=.86 Na=137 K=3.7 Cl=104 CO2=27, Piperacillian/Tazobactam Physician's Order 3.375mg in D5W 50ml IV Q6hr, Vital Signs 14:00 Temp:37.2 BP:122/61 HR:110 Resp:15 SpO2:97% 11L Aerosol Mask, Piperacillian/Tazobactam Classification Antiinfective, broad-spectrum, Extended- spectrum penicillian, B-lactamase inhibitor, Gen. Chem. Interpretation Ca on low end of range, patient is receiving calcium gluconate. BUN is slightly elevated, want to monitor renal studies carefully to watch for acute renal failure related to rhabdomylosis., Calcium Gluconate Reason for Recieving Ca supplement, treatment of hypocalcemia