chronic kidney disease
Encouraged patient verbalization regarding fears and concerns about disease and prognosis. Taught patient how to help with reality orientation and stimulation.
The patient was instructed in lyme disease to evade tick infested areas. The patient was advised to dress shirt inserted into pants and long pants inserted into boots when going into a wooden area. The patient was recommended to put on repellent before going into the wood.
The patient was instructed in ulcerative colitis (Crohn’s Disease, Inflammatory Bowel Disease in the need for perianal care daily and after each bowel movement. The patient was taught perianal and perianeal skin care. The patient was encouraged a diet is bland, low in residue, fiber, and fat, but high in protein, calories, carbohydrates, and vitamins. The patient was recommended to evade seasoned foods, raw fruits and vegetables, foods containing rough cereals, bran, seeds or nuts, milk, fatty or fried foods, caffeine, alcohol and carbonated beverages.
Patient instructed in Coronary Artery Disease (CAD) is when the heart vessels become narrow, which decreases the blood flow to the heart muscle. The narrowing of the heart vessels can be caused by plaque build-up from high cholesterol, fat, and calcium. The decrease in blood flow decreases the oxygenation of the heart muscle and leads to heart damage.
Instructed patient Eat a heart-healthy diet Eating a healthy diet can reduce your risk of heart disease. A diet rich in fruits,
vegetables and whole grains can help protect your heart. Beans, other low-fat sources of protein and certain types of fish
also can reduce your risk of heart disease. Stop your activity if you feel short of breath, dizzy, or have any pain in your chest. Do not do any activity
or exercise that causes pulling or pain across your chest, (such as using a rowing machine, twisting, or lifting weights.
SN instructed that a healthy diet is a major factor in reducing your risk of heart disease. A healthy diet and lifestyle can reduce your risk of heart disease, heart attacks, and stroke. Most fruits and vegetables are part of a heart-healthy diet. They are good sources of fiber, vitamins, and minerals. Most are low in fat, calories, sodium, and cholesterol. Eat five or more servings of fruits and vegetables per day. Choose whole grain foods (such as bread, cereal, crackers, and pasta) for at least half of your daily grain intake. Grain products provide fiber, vitamins, minerals, and complex carbohydrates. Eating too many grains, especially refined grain foods (such as white bread, pasta, and baked goods) can cause weight gain. Avoid high-fat baked goods such as butter rolls, cheese crackers, and croissants and cream sauces for pasta. Lean proteins, poultry, seafood, dried peas, lentils, nuts, and eggs are good sources of protein, B vitamins, iron, and other vitamins and minerals. Avoid foods with a lot of saturated fats including animal products such as butter, cheese, whole milk, ice cream, sour cream, lard, and fatty meats such as bacon.
SN instructed caregiver that Alzheimer’s disease progresses and a loss of appetite often becomes apparent. Primary caregiver may notice that the patient does not eat as much or refuses to eat at all. Possible causes of a poor appetite include: inability to recognize food, poorly fitting dentures, certain medications, lack of physical activity, diminished sense of smell and taste.
SN instructed on Alzheimer's. Patient shouts at moments; Assessed patient’s ability for thought processing. Observed patient for cognitive functioning, memory changes, disorientation, difficulty with communication, or changes in thinking patterns. Assessed patient’s ability to cope with events, interests in surroundings and activity, motivation, and changes in memory pattern. Instructed caregiver to orient patient to environment as needed, if patient’s short term memory is intact. Using of calendars, radio, newspapers, television and so forth, are also appropriate. Assessed patient for sensory deprivation, concurrent use of CNS drugs, poor nutrition, dehydration, infection, or other concomitant disease processes. Maintain a regular daily schedule routine to prevent problems that may result from thirst, hunger, lack of sleep, or inadequate exercise. Provide positive reinforcement and feedback for positive behaviors. SN instructed family in methods to use with communication with patient: listen carefully, listen to stories even if they’ve heard them many times previously, and to avoid asking questions that the patient may not be able to answer. Divert attention to a client when agitated or dangerous behaviors like getting out of bed by climbing the fence bed. Eliminate or minimize sources of hazards in the environment. Caregiver verbalized fair understanding.
SN teaching about Gastroesophageal reflux disease ( GERD ). Examples of things to reduce or steer clear of in your diet include: high fat foods, caffeine products, chocolate, onions, peppermint, carbonated beverages, citrus and tomato products. Do not lie down immediately after eating, avoid late evening snacks, avoid tight clothing and bending over after eating. Elevate the head of the bed six to eight inches to prevent reflux when sleeping. Extra pillows, by themselves, are not very helpful.
Discharge planning initiated on today's visit. Reviewed with patient /PCG s/s of disease exacerbation that need to be reported to health care providers including steps on what to do in an event of an emergency. Medication pill box set up checked and emphasized the importance of timely refill of medications to prevent missing or skipping doses, pain management, continue following prescribed diet regimen. Re-instructed on infection control measures and practicing standard precautions, most importantly, frequent proper hand washing to prevent disease complications.