diverticulosis-and-diverticulitis
Physical assessment done to patient after chemotherapy . Medication checked and reconciled. Hydration and nutritional status checked. Diet reviewed. Denies chest pain. Tube care done per physician ( MD ) order. Dressing changed. Still complained in pain in fingers, patient taught that one side effect of chemotherapy is pain in fingers which is called peripheral neuropathy, it results from some type of damage to the peripheral nerves. Certain chemotherapy drugs can cause peripheral neuropathy such as Vinca alkaloids ( vincristine ), cisplatin, Paclitaxel, and the podophyllotoxins ( etoposide and tenoposide) . Other drugs used to treat cancer such as thalidomide and interferon also can cause peripheral neuropathy.
SN explain that Heart failure is a condition in which the heart can not pump the amount of blood the body needs. Heart failure does not mean that the heart has stopped or is about to stop working. It indicates that the heart can not pump blood the way it should. It can affect one or both sides of the heart the weakening of the pumping capacity of the heart causes: Accumulation of blood and fluid in the lungs Accumulation of fluid in the feet, ankles and legs called edema Tiredness and shortness of breath The most common causes of heart failure are coronary artery disease, high blood pressure and diabetes. It is most common in people over 65, African - Americans, overweight people, and people who have already had a heart attack. Men are at greater risk than women.
SN explain about congestive heart failure ( CHF ). As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues. Fatigue, a tired feeling all the time and difficulty with everyday activities, such as shopping, climbing stairs, carrying groceries or walking. The heart can't pump enough blood to meet the needs of body tissues. The body diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain. Lack of appetite, nausea, a feeling of being full or sick to your stomach. The digestive system receives less blood, causing problems with digestion. Confusion, impaired thinking, memory loss and feelings of disorientation. A caregiver or relative may notice this first. Changing levels of certain substances in the blood, such as sodium, can cause confusion. If you have 2 or more of these symptoms you may need to seek medical attention.
SN instructed patient / caregiver on Zofran - ondansetron. This medication blocks the actions of chemicals in the body that can trigger nausea and vomiting. Zofran is used to prevent nausea and vomiting that may be caused by surgery, cancer chemotherapy, or radiation treatment. Serious side effects include blurred vision or temporary vision loss ( lasting from only a few minutes to several hours ), slow heart rate, trouble breathing, anxiety, agitation, shivering, feeling like you might pass out, and urinating less than usual or not at all. Stop taking Zofran and call your doctor at once if you have any of these side effects. Ondansetron may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Zofran side effects get emergency medical help if you have signs of an allergic reaction to Zofran: rash, hives, fever, chills, difficult breathing, swelling of your face, lips, tongue, or throat. Call your doctor at once if you have: severe constipation, stomach pain, or bloating, headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats, fast or pounding heartbeats, jaundice ( yellowing of the skin or eyes ); blurred vision or temporary vision loss ( lasting from only a few minutes to several hours ); high levels of serotonin in the body - agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting. Patient / caregiver verbalized understanding. Instruct to call agency for questions or concerns.
SN instructed patient on medication Torsemide. This medication is used to treat high blood pressure and edema ( fluid retention, excess fluid held in body tissues ) caused by various medical problems, including heart, kidney, or liver disease. In addition to taking this medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking and using alcohol in moderation. To help you remember to take torsemide, take it around the same time every day. Torsemide controls high blood pressure and edema but does not cure these conditions. SN instructed to patient to continue to take torsemide even if you feel well. Do not stop taking torsemide without talking to your doctor. Common side effects of Torsemide includes: Dizziness or lightheadedness when standing or sitting up, excessive urination, constipation, headache and nausea.
Patient and CG instructed on Pravastatin. Pravastatin is used to lower cholesterol and triglycerides (types of fat) in the blood. Pravastatin is also used to lower the risk of stroke, heart attack, and other heart complications in people with or without coronary heart disease or other risk factors. Pravastatin can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. This condition may be more likely to occur in older adults and in people who have kidney disease or poorly controlled hypothyroidism (underactive thyroid). Get emergency medical help if you have signs of an allergic reaction to pravastatin: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. In rare cases, pravastatin can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Stop using and call your doctor at once if you have:unexplained muscle pain, tenderness, or weakness; fever, unusual tiredness; dark colored urine; chest pain; upper stomach pain, loss of appetite; or jaundice (yellowing of the skin or eyes). Common pravastatin side effects may include: muscle or joint pain; nausea, vomiting, diarrhea; headache; or cold symptoms such as stuffy nose, sneezing, sore throat.
SN educated patient and caregiver on the importance of always using assistive device with ambulation and transfers to avoid falls or injuries. Nurse instructed patient and caregiver on the importance of home safety such as proper lighting, and to keep walkways free of debris and clutter. Patient was instructed to contact PCP or home health agency if they fall or if current health status declines. Patient was instructed to not walk unassisted when not feeling steady . Patient verbalized understanding
SN educated patient on the importance of daily vital sign monitoring. Due to patients disease processes it is important to monitor blood pressure, weight, pulse and oxygen daily if equipment is available. SN instructed patient to weigh correctly they need to wake up, pee and than weigh daily at the same time if possible, same amount of clothing, same area. Patient is to weigh prior to eating/drinking in the morning. Notify home health or PCP if -/+ 3 lbs in a day or +/-5 lbs in a week is seen. SN educated patient to monitor blood pressure and pulse, and instructed to check before medications and if elevated/low recheck in 1-2 hours. SN educated patient to always log vitals so patients MD has a larger snap shot on what is going on.Patient/CG verbalized understanding
SN instructed patient and caregiver that potassium is available in foods such as asparagus, tomatoes and green leafy vegetables such as spinach. Some salt substitutes contain potassium. Avoid fruits like bananas and oranges if you are on a diabetic diet. If levels drop too low or spike too high, your heart function suffers, becoming slow or erratic, a condition known as arrhythmias. Because abnormal potassium levels greatly impact your heart function and can ultimately lead to a heart attack, it’s essential to follow your doctor’s advice carefully. Most common reasons for potassium loss is from vomiting, diarrhea, laxative use and diuretic use.
SN instructed patient on heart healthy diet: reduce na intake by choosing fresh vegetables instead of canned, choose healthy fats which includes olive and canola oil, walnuts and flax seeds, avoid foods that include margarine, avoid fried foods, and eat more soluble fiber foods such as apples, broccoli, carrots and avoid fatty meats such as hotdogs, sausage and bacon.