QuestionAnswered step-by-step Student Name:             38C Grade:        /100REFLECTION (25 points)

QuestionAnswered step-by-step Student Name:             38C Grade:        /100REFLECTION (25 points)During the stimulations, I felt a lot of anxiety. Even though this was a preparation for the real world, I felt like I was in an urgent situation and had to act quickly, which increased my heart rate. After the first time through, I learned to do what was essential, then do everything else. However, I am still trying to understand what is the most important because in every situation, the assessment will change per patient. I learned to address the issue at hand and do reviews directly related to the needed interventions. I do not think I should have a timeline for achieving patient assessments. I am still learning health diagnoses and signs/symptoms as a student. The stimulations help me to know basic ways to address different diagnoses. I like that we play three different roles, being the students, the instructors, and the patients. Those roles give an insight into what to expect when out at practice sites. However, I had a lot to learn before I felt confident going into any patient room and addressing their issue. Even so, I think that the stimulation orientation should be divided into two sections to get a comfortable and formidability of the assessment and help reduce anxiety. Otherwise, I will not change anything.GENERAL INFORMATION (30 points)Primary Medical Diagnosis15 points Provide a detailed description of the primary medical diagnosis that will be used for this assignment. Include all symptoms, treatments, risk factors, medications, therapies, labs, and diet. In general, multiple sclerosis is an autoimmune disease in which the immune system fights the protective layer covering the nerves. This may result to nerve damage, hence hinder connection between the body and the brain. This condition cannot be cured, but treatment can reduce the severity of the symptoms.The symptoms are severe, and duration can vary from one person to another. In diagnosis, imaging and lab tests are required. Treatment for this condition involves many drugs, therapy, and general management. References: Dobson, R., & Govannoni, G. (2019). Multiple sclerosis. European journal of neurology.Potential Secondary Medical Complications5 points Identify two potential medical complications associated with the primary medical diagnosis. Explain why each is a potential complication.NOTE: These are NOT nursing diagnoses.1  Bladder and bowel problems like incontinence, constipation, or diarrhea. This occurs due to interruption of the communication between the brain and the bowel or urinary tract.2 Nerve damage affects transmission of signals; hence the body cannot receive information to release waste productsVision problems like blurred vision, double vision, nystagmus, or total vision loss. This occurs due to the damage of the nerve supply to the eye. References: Amarenco, G., Bosco, S., & Boiteau, F., (2001) Urologic complications of multiple sclerosis.  Nursing Care10 points Describe in detail all the appropriate nursing care for the primary medical diagnosis.NOTE: This is what you, as the nurse, will be doing to care for a patient with this diagnosis. For example: encourage, monitor, assess, teach, etc. Nursing care often does not require a provider order. Since the patient has decreased energy production, as a nurse, I will advise the patient to take enough food to provide energy and have enough rest to avoid energy loss.I will also provide the patient with the walking aids like walkers, wheelchairs, or braces since she has difficulty in walking and supporting herself.Provide the patient with physical therapy, massage her and give relaxing bath to help maintain her skin integrity.Advise her always to participate in groups involving fitness and exercise or to join multiple sclerosis societies.Administer medications as indicated in the treatment sheet.Encourage her to do self-care to her ability and assist her do the one she cannot do.Allow her to do most of the activities during morning hours when the energy level is still high.Encourage her to do stretching exercises and provide cold packs to help in proper alignment of the body.Establish a therapeutic relationship with her to alleviate anxiety and feel valued.Provide analgesics like tramadol, morphine, or pethidine to relieve pain and make her comfortable.   References: Halper, J & Holland, N., (2010). Comprehensive nursing care for multiple sclerosis. Springer Publishing Company.  PATIENT SPECIFIC INFORMATION (15 points)Primary Medical Diagnosis Findings10 points List patient specific assessment information and findings directly related to the primary medical diagnosis. Include all symptoms, medications, treatments, therapies, labs, and diet.Patient is alert and oriented x3 (person, place, time) vital signs as are followed, 02 sat is 96% on room air, R 18, T 98.5 F, B/P 124/76 patient 6 gaze is intact, right knee, and right elbow pain is 3/10 on the numeric pain scale. Bilateral legs numbness, tingling, and weakness. bruises to right knee and right elbow. Patient’s dorsiflexion and plantar flexion of bilateral feet equal but very weak. Patient last bowel movement was 1/26/2022. Diplopia (Double  vision), severe pain, fatigue, impaired coordination, Patient report severe neck pain and generalized muscle spasm, pain rate of 9 on a scale from 0-10. Flexeril 10 mg up to three times a day as neededInterferon beta- 1b (betaseron) 0.25 every other day subcutaneouslyPatient starts IV line-will be used to administer methylprednisolone daily IV for 5 daysAfter completion of IV methylprednisolone, patient will be starting on oral prednisone to be tapered down and eventually stopped over the course of six days Add PRN med: Hydrocodone- acetaminophen (5-325) 1 tablet every four hours as needed for severe pain. Bilateral numbness. In the laboratory, the tests that helps in ruling out the disease from other differential diagnosis like lumbar puncture, blood test or electrolytes imbalanced. Physical Therapy consult- patient is on bedrest until evaluated by physical therapy. Vital signs and input/output every 8 hours. Right knee and elbow x-ray, patient diet is regular.    Secondary Medical Diagnoses3 points List and define all the patient’s secondary medical diagnoses (maximum of 10).Differential diagnosis for multiple sclerosis includes Acute disseminated encephalomyelitis (Inflammation of brain and spinal cord), Sarcoidosis (growth of inflammatory cells in different body parts), Transverse myelitis (inflammation of both sides of a section of spinal cord). These differential diagnoses can be differentiated from multiple sclerosis through lab tests, MRI, and history taking.  References: Miller, D. H., Weinshenker, B. G., Fillipi (2008), Differential diagnosis of suspected multiple sclerosis. Allergies1 point List all the patient’s allergies to food, medication, latex.NOTE: Usually found in the provider orders. If the patient is allergy free from all of these, state “no known allergies to food, medication or latex”. The allergic reaction does not need to be listed.No known drug allergies Diet1 point Identify and describe the patient’s prescribed diet. Explain why this diet is appropriate for the patient.The patient’s diet should contain more energy giving food and whole grain meal. This will help in providing the energy needed, hence prevent fatigue. References: Payne, A (2001). Nutrition and diet in clinical management of multiple sclerosis.          Nursing Careplan 1 (15 Points)  Nursing Diagnosis (2 Points)No more than 1 potential diagnosis may be used Actual or Potential (1 Point)Highlight actual or potential. Expected Outcome (2 Points)Identify 1 outcome that will show maintenance or improvement of the selected nursing diagnosis.Ensure outcome is SMART:Specific – Measurable – Attainable – Relevant – Timebound Nursing Interventions (3 Points)Identify 3 patient specific interventions that will directly assist in meeting the expected outcome.At least 2 must be action-driven interventions. Rationales (3 Points)Provide 3 rationales that validate why the intervention will assist in meeting the expected outcome.One rationale per intervention.  Chronic pain  hour after providing nursing interventions, the patient will report an improvement in their level of comfort  4 hours after providing nursing interventions, the patient will report a significant reduction in pain severity levels (pain score <3/10) Upon discharge, the patient will be able to verbalize different pharmacologic and non-pharmacologic pain relief techniques which are available for them During the entire course of admission, no incidences of injury related to accidents should occur due to the patient’s diplopia perception   Upon discharge, the patient will be able to verbalize different measures required to promote safety and prevent injury related to disturbed visual perception in the home setting   Encourage deep breathing exercise  Apply warm compress at the affected area  Place on high-Fowler’s position    To facilitate pharmacologic pain relief To increase oxygenation and act as a type of diversional activity to reduce pain   To promote lung expansion and to decrease strain on the neck   Related To (R/T) (2 Points)Describe the patient’s specific situation and/or medical diagnosis that is directly linked to and causing the chosen nursing diagnosis. DO NOT state a medical diagnosis, but a description is appropriate.  Chronic inflammation of the autoimmune system, which mistakenly attacks the healthy tissue of the CNS. Inflammation may activate due to (bacteria, virus, or chemicals) Administer PRN analgesics as ordered (e.g., acetaminophen, ibuprofen)   Encourage diversional activity (e.g., watch TV, read  Promote rest and discourage unnecessary mobilization and movements   To promote local vasodilation and muscle relaxation to reduce tension and pain  To reduce the risks of progressing pain  To maximize the visual capacity of the patient and prevent accidents    As Evidenced By (AEB) (2 Points)List all necessary supportive patient data to support the chosen nursing diagnosis (assessment findings, history, medications, labs, therapies, diet). This information proves your nursing diagnosis is appropriate.   To increase oxygenation and act as a type of diversional activity to reduce pain  To promote distraction and place focus away from pain     Patient report severe neck pain and generalized muscle spasm, pain rate of 9 on a scale from 0-10. Flexeril 10 mg up to three times a day as neededInterferon beta- 1b (betaseron) 0.25 every other day subcutaneouslyPatient starts IV line-will be used to administer methylprednisolone daily IV for 5 daysAfter completion of IV methylprednisolone, patient will be starting on oral prednisone to be tapered down and eventually stopped over the course of six daysAdd PRN med: Hydrocodone- acetaminophen (5-325) 1 tablet every four hours as needed for severe pain    References: Stromberg, Holly. (2021). DeWitt’s Medical-Surgical Nursing: Concepts and Practice, ed. 4, Pg 574Oculomotor Nerve (Third Cranial Nerve): What Is It, Function & Anatomy (clevelandclinic.org)Janice, H. J., PhD RN, & PhD Rn, K. C. H. (2017). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th ed.). Wolters Kluwer. Tafti D, Ehsan M, Xixis KL. Multiple Sclerosis. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499849/    Nursing Careplan 2 (15 Points)  Nursing Diagnosis (2 Points)No more than 1 potential diagnosis may be used Actual or Potential (1 Point)Highlight actual or potential. Expected Outcome (2 Points)Identify 1 outcome that will show maintenance or improvement of the selected nursing diagnosis.Ensure outcome is SMART:Specific – Measurable – Attainable – Relevant – Timebound Nursing Interventions (3 Points)Identify 3 patient specific interventions that will directly assist in meeting the expected outcome.At least 2 must be action-driven interventions. Rationales (3 Points)Provide 3 rationales that validate why the intervention will assist in meeting the expected outcome.One rationale per intervention.   Risk for injury 1.During the entire course of admission, no incidences of injury related to accidents should occur due to the patient’s double vision perception  Upon discharge, the patient will be able to verbalize different measures required to promote safety and prevent injury related to diplopia (double vision) perception in the home setting. During the entire course of admission, no incidences of injury related to accidents should occur due to the patient’s diplopia perception  Upon discharge, the patient will be able to verbalize different measures required to promote safety and prevent injury related to diplopia (double vision) perception in the home setting    Encourage the use of ambulatory assistive devices as needed or completely assist during ambulation   Keep the floors always clean Always use adequate lighting in the room of the patientRefer to ophthalmology   1.To reduces the risk of accidental slips or falls related to decreased visual capacity during ambulation  To prevent accidentally slipping on object on the floor due to decreased visual capacity to facilitate further assessment and management to improve their vision.    Related To (R/T) (2 Points)Describe the patient’s specific situation and/or medical diagnosis that is directly linked to and causing the chosen nursing diagnosis. DO NOT state a medical diagnosis, but a description is appropriate.  Patient is having an impaired sensory function. There is a problem with the oculomotor nerve, which is the cranial nerve (CN III). Patient is having trouble controlling the muscle of the eyes which keeps it out of focus there is diplopia (double vision      As Evidenced By (AEB) (2 Points)List all necessary supportive patient data to support the chosen nursing diagnosis (assessment findings, history, medications, labs, therapies, diet). This information proves your nursing diagnosis is appropriate.       N/A  References:  Janice, H. J., PhD RN, & PhD Rn, K. C. H. (2017). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th ed.). Wolters Kluwer. Tafti D, Ehsan M, Xixis KL. Multiple Sclerosis. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499849/                  assessment finding02 sat 96% room airRR 18TEM 98.5 FALERT and oriented x36 gaze point intactdouble visionpain 3/10 to right knee and right forearm leg weakness, bruises to right knee and right elbowlast bowel movement 1/26/2022B/P 124/76I NEED HELP REVISING AND IF MORE INFORMATION NEEDED.THANKS Health ScienceScienceNursingLPN 104Share Question

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