patient-unable
SN instructed patient and caregiver on how to change the colostomy bag. SN instructed how to properly closes the bag and explains that there are different types; do not expect to see the same bag always. SN instructed that patient and caregiver have to wash their hands and always use gloves before working on the colostomy area.
Instructed caregiver clean patient's skin daily: Clean the patient's skin around your tube 1 to 2 times each day.
SN instructed patient in pulmonary fibrosis and in how it harms the tissues deep in the lungs. The air sacs in the lungs and their supporting structures become inflamed and scarred. If scarring progresses happen, then it makes your lungs thick and stiff. That makes it hard for the patient to catch their breath, and their blood may not get enough oxygen.
SN instructed patient that a seizure can occur at any time and without warning, patient should shower only with someone in attendance. Leave the bathroom door unlocked, use shower chair, take shower rather than tubs baths.
Instructed patient to avoid foods which might increase acid reflux. Food that is very hot or very cold, fried foods, peppermint, coffee, drinks that contain caffeine, spicy, highly seasoned foods, tomato-based dishes, citrus fruits and juices, chocolate and sweets. If patient any reflux symptoms, instructed on not lie down right after eating and to remain upright for at least 2 hours.
Patient also instructed on Clostridium difficile colitis (C. diff) and the increase risk due to the multiple ABT. Patient instructed that the most common symptoms of Clostridium difficile colitis (C. diff) infection include: watery diarrhea, fever, loss of appetite, nausea, belly pain and tenderness. Instructed to clean their hands with soap and water or an alcohol-based hand rub often and every after going to the restroom.
Skilled nurse remove PICC,line per doctor order, the catheter tip should also be examined and there is no breakage at the end, no S/S of infections noted. Skilled nurse applied at the insertion site with sterile gauze to prevent bleeding which and when the bleeding stops, the gauze is removed and a sterile dressing is applied. Instructed patient the dressing should remain for approximately 24 hours. After this time, the site should be assessed and a new dressing applied if needed. Patient understand the instructions given.
Skilled nurse teach patient's and describe each step of the procedure , encouraging participation in ostomy care,teach patient about a new stoma techniques to use for cleansing. No signs of symptoms of infections noted.
SN instructed patient about oxycodone/ acetaminophen ,non-serious adverse reactions include lightheadedness, dizziness, drowsiness or sedation, nausea, and vomiting. These effects seem to be more prominent in ambulatory than in no ambulatory patients, and some of these adverse reactions may be alleviated if the patient lies down. Other adverse reactions include euphoria, dysphoria, constipation, and pruritus. Serious SE/AR include respiratory depression, apnea, respiratory arrest, circulatory depression, hypotension, and shock .
SN instructed patient on low salt diet. SN instructed patient on how to read nutritional labels on commercially prepared foods. Other salt alternatives such as Mrs. Dash was encouraged. SN explained how sodium affects blood pressure and water retention.