“acute coronary syndrome non st elevation myocardial infarction, hypertensive cardiovascular...

IV. PATIENT AND HIS CARE

A. Medical Management

a) IVF, Condom Catheter, Oxygen Therapy

Nursing Responsibilities:

BEFORE:

Verify prescriptions for IV therapy check solution label and identify patient Explain procedure to the patient Carry out hand hygiene and put on disposable non-latex gloves Apply a tourniquet 4-6 inches above the sites apply identify a suitable vein Choose site. Use distal veins of hands and arms first Raise bed for comfortable working height and position for patient and adjust lighting

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Type of IVF

Date orderedDate performed

Date changeD/C

General description Indication(s) or Purpose(s)Client’s response to the

treatment

PNSS 1L

X 100 cc/hrDate Ordered:

November 25, 2009

Date Performed:November 25, 2009

Date Changed:November 26, 2009

to D5W 500 cc

An isotonic type of solution that exerts the same osmotic pressure that can be found in plasma. It is used to supply water calories and electrolytes to the body.Plain normal saline solution contains 308 mosm/L

To provide hydration and electrolyte to the patient.

To provide route for medicine administration.

PNSS was given to prevent further increase in blood glucose levels

The patient responded well to the treatment without any abnormal signs and symptoms felt. Maintenance of fluid volume was noted as evidenced by no signs of dehydration. No further increase in blood glucose levels was noted.

DURING:

Explain to the client what you are going to do, why it is necessary, and how she can cooperate Question the patient carefully about sensitivity to latex, use blood pressure cuff rather than latex tourniquet if there

is sensitivity Apply a new tourniquet for each patient and palpate for a pulse distal to the tourniquet With hand not holding the venous access devise, steady patient’s arm and use finger to pull skin taut Hold needle bevel up and at 5-25 degree angle, depending on the depth of vein If backflow of blood is visible, straighten angle and advance needle. Additional steps for catheter is inserted over

the needle: Hold needle hub, and slide catheter over the needle and vein

o Remove while pressing lightly on the skin over the catheter tipo Release tourniquet and attach infusion tubing: open clamp enough to allow dripo Cover and tape the small loop of IV tubing onto the dressingo Calculate infusion rate and regulate flow of infusion

AFTER:

Document date and time therapy initiated Monitor vital signs Check the level of the IV as per hospital policy Tape the IV lines Dress and label the venipuncture according to the hospital policy Instruct the client to inform the health care professionals should there be any swelling or redness on insertion site

which may be a sign for dislodged IV line Regularly check regulation of IVF

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BEFORE:

Check the doctor's order. Check the expiration date of Intravenous fluid. Inform the patient's SO about the IV fluid to be given. Explain the procedure to the SO.

DURING:

Check the IVF level. Check the patency of the tube Select an appropriate site. Use aseptic technique.

98

Type of IVF


Date changeD/C


treatment

D5W 500 cc X 20 cc/hr

Date Ordered:November 26, 2009

Date Performed:Novemeber 26, 2009

Date Discontinued:December 02, 2009

It is used to supply water and calories to the body. It is also used as a mixing solution (diluent) for other IV medications. Dextrose is a natural sugar found in the body and serves as a major energy source. When used as an energy source, dextrose allows the body to preserve its muscle mass.

Patient needs D5W for fluid volume maintenance and for the prevention of sudden decrease in blood glucose levels.

The patient did not manifest a sudden decrease in blood glucose levels.

AFTER:

Regulate the IVF as ordered. Monitor the response of the patient. Check for any presence of infiltrations. Check if there is presence of air. Record all procedures done

Catheter


Date changeD/C

General descriptionIndication(s) or

Purpose(s)Client’s response to

the treatment

Condom Catheter Date Ordered:

Novmber 26, 2009

Date Performed: November 26, 2009

The use of catheters can be under patient control and can be designed to fit into their lifestyle.This device should be applied

to clean, dry skin. The condom is commonly

made from a latex material and attaches to the penis with adhesive. A plastic tube is attached

to the condom, which leads to a bag taped to

the leg or a pouch surrounding the penis.

The attached bag accumulates all the urine

until it is emptied. The bag must be emptied

every 30 minutes and the condom device must be changed and cleaned at least every other day to protect the skin of the

penis.

Since patient had DM for 5 years, catheterization was performed to accurately monitor urine output of the patient for possible nerve damage that affects renal excretion of waste products.

Also due to restriction on the patient’s activity and continuous cardiac monitoring in which in this case needs not be removed.

The patient was able to maintain urine output AEB no bladder distension noted.

99


BEFORE:

Check the doctor's order. Inform the patient's SO about the condom catheter to be used. Explain the procedure to the SO.

DURING:

The penis should be gently washed and dried. Make sure the penis is dry before you put on the condom catheter. Use aseptic technique. Make sure the condom catheter is inserted securely. The condom catheter should fit snugly without being too tight. Make sure the skin does not show any signs of damage such as sores or cuts.

AFTER:

Monitor the response of the patient. Check for any presence of skin breakdown. regular cleaning of any leakage is very important Record all procedures done

100


BEFORE:

Check the doctor's order. Check the patency of the nasal cannula Inform the patient regarding the purpose of the therapy

DURING:

Check whether the O2 flow rate is within the desired level. Restrict smoking. Put a no smoking sign on the patient’s room. Recheck patency of the tubing.

AFTER:

Regulate O2 flow rate as ordered Monitor the response of the patient.

101

O2 Flow Rate


Date changeD/C


treatment

2LPM Date Ordered:November 25, 2009

Date Discontinued:Novemeber 28, 2009

Oxygen therapy usually supplied via a nasal cannula regulated in accordance to the amount of oxygen the patient needs.

It was given to the patient to maintain the effective level of oxygen saturation in the body. The patient is experiencing dyspnea AEB with a RR: 25 upon admission he was given O2 inhalation to relieve from dyspnea.

The patient was able to cope up and respond positively to the therapy as evidenced by patient was able to show an absence of signs and symptoms of respiratory distress AEB a decrease in RR of 25 to 18 cpm.

Record all procedures done

b) Drugs

Name of Drugs, generic nameBrand name

Date orderedDate taken/given

Date changed/ D/C

Route of Admin., Dosage & frequency

of admin.

General actionFunctional

ClassificationMechanism of action

Indication(s) or Purpose(s)

Clients response to the medications with

actual side effects

Generic Name: Atropine sulfate

Brand Name: Atropen


Date Discontinued:November 25, 2009

1 ampule IV Anticholinergic Agent Atropine sulfate is indicated to the patient to increase the heart rate of the patient and to prevent bradycadia.

The patient’s heart rate increased from 60 bpm to 200 bpm.


BEFORE:

Check the doctor’s order. Check the drug label, contents, and appearance. Check the right dosage, route and time of administration. Use aseptic technique. Explain to the client what the purpose of the drug.

DURING:

Observe proper medical asepsis. May be taken with or without food.

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AFTER:

Monitor the client’s reaction to the drug. Document the findings.



Date changed/ D/C


of admin.


ClassificationMechanism of axn.



actual side effects

Generic Name: Lidocaine

Brand Name: Xylocard


Date Consumed: November 26, 2009

7.5mg/hr via lidocaine drip

Antiarrhythmic Upon admission the patient’s initial ECG shows marked ST segment depression (11-25-09/9:00 pm), then when it was repeated the patient had atrial fibrillation with rapid ventricular response (11-25-09/9:30 pm). The drug is indicated to the patient to relieve the patient from arrhythmia.

The patient responded well on the drug as evidenced by patient has normal sinus rhythm as reflecte from the patient’s ECG as of 11-26-09 (8:00 am).


BEFORE:

Check the doctor’s order. Check the drug label, contents, and appearance. Check the right dosage, route and time of administration. Use aseptic technique.

103

Explain to the client what the purpose of the drug

DURING:

Observe proper medical asepsis. May be taken with or without food.

AFTER:




Date changed/ D/C


of admin.





actual side effects

Generic Name: Furosemide

Brand Name: (Lasix)



Date Shifted:November 27, 2009 to

Aldazide

1 ampule nowq then, 40 mg 1tab X 3 days

25mg/tab BID

Loop Diuretics

Inhibits the reabsorption of Na and Cl from the loop of henle and distal renal tubule. Increases renal excretion of h2o, Na, Cl, Mg, H2, and Ca.

It is used for hypertensive crisis. Used to lowers down blood pressure AEB blood pressure of 190/130 upon admission.

The pt. manifested a decreased in blood pressure AEB blood pressure from 190/130 mmHg to 100/70 mmHg.


104

BEFORE:

Assess signs of metabolic acidosis. Assess signs of hypokalemia Assess rate, depth, rhythm of respiration Assess skin turgor and edema Note rashes, temperature elevation. Weight, and I & O to determine fluid loss. Check BP prior giving of medication

DURING:

Give early in the day to prevent sleeplessness. Administer via SIVP

AFTER:

Check BP of the patient Note for any side effects of the drug. Monitor the patient after taking the drug. Prepare the client in his comfortable position after giving the medication. Document or chart that the medicine was given.



Date changed/ D/C


of admin.





actual side effects

Generic Name: Captopril

Brand Name: Capoten


25 mg/tab ¼ tab q12 ACE inhibitor Patient has hypertension due to diabetes mellitus for 5 years. Diabetes causes continued and consistently high blood glucose levels. Because of the viscosity of the blood, the blood flow is

The patient manifested a decreased in BP from 190/130 to 100/70 mmHg.

105

*Home Medicationrestricted, the blood pressure increases. The drug is given to promote decrease in blood pressure.

Nursing Responsibilities

BEFORE:

Check the written medication order for completeness. It should include the drug name, dosage, frequency, and duration of the therapy.

Check to see if there are any special circumstances surrounding administration of the dose to the patient. Be certain that you know the expected action, safe dosage range, special instructions for administration and

adverse effects associated with drug orders. Prepare the necessary equipment. Wash your hands. Prepare the dosage as ordered. Check the label on the medications three times before administering any drug. Never prepare a dosage of medication, which is discolored, has precipitated, and is contaminated or outdated. Make sure that the patient has taken her meal before giving the medication.

DURING:

Identify the patient expresses any doubt about the medication; always recheck the order, drug label and dosage on the container.

AFTER:

Following administration, be certain that the patient is comfortable, then immediately record the procedure. Note for any allergic reactions.

Name of Drugs, generic name






106

Brand name Date changed/ D/C of admin.Classification

Mechanism of axn.actual side effects

Generic Name: Pantoprazole

Brand Name: Pantoloc


Date Shifted:November 26, 2009

Date Discontinued: December 30, 2009

40 mg IV shifted to 40mg 1 tab OD

Proton Pump Inhibitor Drug

The patient vomited twice on the 26th of November causing heartburn to the patient. To treat heartburn felt by patient this drug was given.

Patient was relieved from heartburn.


BEFORE:




DURING:


107

AFTER:




Date changed/ D/C


of admin.





actual side effects

Generic Name: Morphine Sulfate

Brand Name: Avinza, M-Eslon

Date Ordered: November 25, 2009

Last given: November 28, 2009

Date Discontinued: Dember 02, 2009

4 mg IV now then 2mg PRN

Opioid analgesic Patient has developed chest pain due to the disease condition. Acute Coronary Syndrome causes inadequate blood flow and oxygen supply to the myocardial cells of the heart resulting to chest pain. The drug is given to the patient to promote relief from chest pain. Also, compared to Meperidine, which is commonly used, this drug does not decrease the oxygen consumption of the patient. That is why it is chosen to be administered rather than Meperidine.

Patient was relieved from chest pain.


BEFORE:

108




DURING:


AFTER:




Date changed/ D/C


of admin.





actual side effects

Generic Name: Isosorbide Dinitrate

Brand Name: Isoket drip



Date consumed: 11-26-09

D5W 90 cc + isoket 10g/soluset@ 1.5mg/hr

Anti-angina As patient was admitted to the hospital, he was already experiencing chest pain. This drug was given in order to treat chest pain felt by the patient.


109

Isordil Date Performed:November 27, 2009

Date Discontinued: November 28, 2009

SL

Nursing responsibilities:

BEFORE:

Check and confirm the order (Dosage, frequency and route) Check and recheck the drug indication and computation Check patient’s identity Explain the importance of strict compliance to medical regimen.

DURING:

Give oral preparations on an empty stomach, 1 h before or 2 h after meals; take with meals if severe, uncontrolled headache occurs.

Give sublingual preparations under the tongue or in the buccal pouch; encourage the patient not to swallow. Give chewable tablets slowly, only 5 mg initially because severe hypotension can occur; ensure that patient does

not chew or crush sustained-release preparations.

AFTER:

Maintain life support equipment on standby if overdose occurs or cardiac condition worsens. Gradually reduce dose if anginal treatment is being terminated; rapid discontinuation can lead to problems of

withdrawal.

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Note for any side effects of the drug. Monitor the patient after taking the drug. Prepare the client in his comfortable position after giving the medication. Document or chart that the medicine was given.



Date changed/ D/C


of admin.





actual side effects

Generic Name: Enoxaparin sodium

Brand Name: Clexane



0.4 cc SQ now then q 12

Antithrombotic Patient is at risk to develop thrombus because of plaque rupture due to CAD. With this drug it helps in preventing the formation of clots and extension of existing clots within the blood.

Patient did not develop formation of thrombus.


BEFORE:




111

DURING:


AFTER:




Date changed/ D/C


of admin.





actual side effects

Generic Name: Magnesium hydroxide/aluminum hydroxide

Brand Name: Maalox



10ml TID Antacid On the 26th of November, the patient vomited resulting to acid accumulation thus causing hyperacidity onto the patient. To treat the hyperacidity this drug was ordered.

Patient was relieved from hyperacidity.


BEFORE:


112



DURING:


AFTER:




Date changed/ D/C

Route of Admin., Dosage &

frequency of admin.





actual side effects

Generic Name Metoprolol

Brand NameLopressor

Date Order: November -25-09

Date Change: November -25-09

50 mg/tab ½ tab BID Beta Adrenergic Blocking Agent

The patient when admitted had a blood pressure of 190/30, to decrease the blood pressure Metoprolol

The patient’s blood pressure decreased from 190/30 to 120/70.

113

was administered.


BEFORE:

Check the doctor’s order Check the drug labels, contents and appearance. Check the right dosage, route, and time of administration. Use aseptic technique. Explain to the patient what the purpose of the drug. Monitor BP and pulse before therapy, during dose titration, and periodically during therapy Monitor intake and output ratios and daily weight. Instruct to take food before taking the drugs.

DURING:

Explain the effects of the medication to the patient and SO . Instruct to avoid activities that require mental alertness. Report for symptoms of fluid overload such as sudden weight loss, SOB and swelling of extremities. Avoid activities that require mental alertness.

AFTER:

Monitor for the patient’s reaction to the drug. Document the findings. Document the procedure in the patient’s chart. Observe proper storage of drug. Monitor Vital Sign

Name of Drugs, Date ordered Route of Admin., General action Indication(s) or Clients response to

114

generic nameBrand name

Date taken/givenDate changed/ D/C

Dosage & frequency of admin.

Functional Classification

Mechanism of axn.

Purpose(s) the medications with actual side effects

Generic Name: Lactulose

Brand Name: Lilac

Date Order:November -25-09


30cc PO OD

Frequency: HS ( hour of Sleep)

Stool softener Patient is at risk to develop constipation due to prolong immobilization. This drug is indicated to the patient to prevent constipation and to be able to passage stool

The patient responded well as evidenced by passage of stool.


BEFORE:

Check the Doctor’s order before giving the medication. Observe the ten (10) rights in giving a medication. Explain the procedure and purpose of giving the medication. Assess for galactosemia, intestinal obstruction.

DURING:

Be alert for drug’s adverse reactions and drug interactions. Monitor vital signs especially blood pressure. Tell patient the possible side effects that may occur. Be alert for side effects such as diarrhea, vomiting and hypokalemia

AFTER:

Watch out for dependent. Document the dosage, route and frequency of the drug to the patient’s chart.







115



Generic Name: Clopidogrel

Brand Name: Plavix


Date Started: November -26-09

*Home Medication

75mg/tab OD Anti-coagulant Patient is at risk to develop formation of clot due to due to the plaque rupture. And so this drug is ordered to prevent the unwanted blood clot formation.

The patient did not develop clot formation.


BEFORE:

Check the doctor’s order. Check the drug label, contents, and appearance. Check the right dosage, route and time of administration. Use aseptic technique. Explain to the client what the purpose of the drug

DURING:

Observe proper medical asepsis. Administer the drug before meals

AFTER:








116



Generic Name: Aspirin

Brand Name: Aspirin



80 mg/tab OD Analgesic As patient was admitted, he was evidently having chest pain, Aspirin was immediately given in order to relieve pain.



BEFORE:




DURING:


AFTER:

Following administration, be certain that the patient is comfortable, then immediately record the procedure.

117

Note for any allergic reactions.



Date changed/ D/C


of admin.





actual side effects

Generic Name: Isosorbide mononitrate

Brand Name: Imdur



*Home Medication

60 mg/tab ½ tab OD Nitrates Patient was known to experience angina from the day he was admitted. Imdur was administered to the patient. It is a drug used principally in the treatment of angina pectoris. By dilating the vessels, it lowers the blood pressure therefore, leads to a reduction of myocardial oxygen requirement thus promoting relief from angina pectoris.

Patient did not manifest angina attacks.


BEFORE:



adverse effects associated with drug orders. Prepare the necessary equipment. Wash your hands. Prepare the dosage as ordered.

118

Check the label on the medications three times before administering any drug. Never prepare a dosage of medication, which is discolored, has precipitated, and is contaminated or outdated. Make sure that the patient has taken her meal before giving the medication.

DURING:


AFTER:




Date changed/ D/C


of admin.





actual side effects

Mixtard Date Order:November -26-09

Sliding Scale

20 “u” SC am

10 “u” SC pm

Home Dosage

Treatment for diabetes mellitus.

> anti-diabetics

Upon checking the initial HGT level the patient glucose level is high the result is 131mg/dl, this would indicate that the patient have diabetes mellitus. Mixtard was given to the patient to decrease the blood

The patient’s responded to drug AEB decrease in blood glucose level of 71mg/dl as of 11-27-09

119

*Home Medication 22 “u” Sc am

12”u” pm

glucose level.


BEFORE:

Check the doctor’s order Check the drug labels, contents and appearance. Check the right dosage, route, and time of administration. Use aseptic technique. Explain to the patient what the purpose of the drug. Assess patient for signs and symptoms of hypoglycemia and hyperglycemia. Monitor blood glucose and ketones every 6 hrs every therapy.

DURING:

Observe proper medical asepsis. Give the mediation to patient once a day for her strength and strong body tissue. Use only insulin syringes to draw up dose. When mixing insulin draw regular insulin into syringe first to avoid contamination of regular insulin vial.

AFTER:

Monitor for the patient’s reaction to the drug. Document the findings. Document the procedure in the patient’s chart. Observe proper storage of drug. Insulin should be stored in a cool place but does not need to be refrigerated.

Name of Drugs, Date ordered Route of Admin., General action Indication(s) or Clients response to the

120

generic nameBrand name

Date taken/givenDate changed/ D/C

Dosage & frequency of admin.

Functional Classification

Mechanism of axn.Purpose(s)

medications with actual side effects

Generic Name: Trimetazidine

Brand Name: Vastarel MR



*Home Medication

35 mg/tab BID By preserving the energy metabolism in cells exposed to hypoxia, trimetazidine prevents a decrease in intracellular ATP levels, thereby ensuring the proper functioning of ionic pumps and transmembranous sodium-potassium flow whilst maintaining cellular homeostasis.

Treatment of long term coronal insufficiency: angina pectoris. To decrease the frequency of angina attacks.

The client’s chest pain was relieved.


BEFORE:

Check the doctor’s order. Check the drug label, contents and appearance. Check the right dosage, route and time of administration. Obtain information about the drug before giving it.

DURING:

Use aseptic technique. Prepare the client and explain the procedure. Explain the purpose of the medication.

121

AFTER:




Date changed/ D/C


of admin.





actual side effects

Generic Name: Bromazepam

Brand Name: Lexotan



Date Change:November -27-09

15 mg 1 tab OD, HS Anxiolytic

In low dosage, selectively reduces tension and anxiety. In high dosage, sedative and muscle relaxant properties appear.

Indicated for the patient to relieve the patient’s anxiety which may aggravate the patient’s condition.

The client responded well AEB the patient fell asleep an hour and there is no episode of vomiting after administration.

122


BEFORE:

Check the doctor’s order. Check the drug label, contents and appearance. Check the right dosage, route and time of administration. Obtain information about the drug before giving it.

DURING:

Use aseptic technique. Prepare the client and explain the procedure. Explain the purpose of the medication.

AFTER:

Note for any side effects of the drug. Monitor the patient after taking the drug. Prepare the client in his comfortable position after giving the medication. Document or chart that the medicine was given



Date changed/ D/C


of admin.





actual side effects

Generic Name: Simvastatin

Brand Name: zocor


Shifted to Atorvastatin: November -26-09

80 mg/tab OD, HS

20 mg/tab OD, HS

Antilipemic

Inhibitor of 3-hydroxy-3 methylglutarylcoenzyme Areductase, similar actions to lovastatin but more potent HMGCoA reductase inhibitor increase HDL cholesterol

Adjunct to dietary therapy in the management of primary hypercholesterolemia and mixed dyslipidemias.

The patient’s cholesterol level remains normal and blood pressure decreases from 190/130 to 100/70 mmHg. It was shifted to Atorvastatin decrease the side effect of the drug such a upper respiratory infection.

123

and decrease LDL cholesterol synthesis.


BEFORE:

Check the doctor’s order Check the drug label, contents, and appearance Check the right dosage, route and time of administration Explain the purpose of the medication to the client

DURING:

Avoid large amounts of grapefruit juice during therapy; may increase risk of toxicity Witness the intake for oral medications.

AFTER:




Date changed/ D/C


of admin.





actual side effects

Generic Name: Atorvastatin

Date Order: November-26-09

20 mg/tab OD, HS It competitively inhibits HMG-CoA reductase, the

To lowers down cholesterol in the body. It

The patient cholesterol level remains normal.

124

Brand Name: Lipitor

Date Started: November-26-09

*Home Medication

enzyme that catalyses the conversion of HMG-CoA to mevalonic acid. This results in the induction of the LDL receptors, leading to lowered LDL-cholesterol concentration.

stabilizes plaques and prevents stroke.


BEFORE:

Check the doctor’s order Check the drug label, contents, and appearance Check the right dosage, route and time of administration Explain the purpose of the medication to the client

DURING:

Avoid large amounts of grapefruit juice during therapy; may increase risk of toxicity Witness the intake for oral medications.

AFTER:


125



Date changed/ D/C


of admin.





actual side effects

Generic Name:Spironolactone

Brand Name:Aldazide


Date Change: December -01-09

25mg/tab BID potassium-sparing diuretic

The patient was given aldazide to treat fluid retention AEB mild pulmonary congestion seen on chest x-ray. It was also given to maintain the potassium level, to counter act the potassium wasting effect of the other diuretics the patient is taking.

The patient responded on the drug as evidenced by a decreased sign and symptoms of pulmonary edema AEB diminished adventitious breath sounds.


BEFORE:

Check the doctor’s order. Check the drug label, contents, and appearance. Check the right dosage, route and time of administration. Assess fluid status. Check blood pressure. Use aseptic technique. Explain to the client what the purpose of the drug.

DURING:

Observe proper medical asepsis.

126

Check the patency of the IV site.

AFTER:

Monitor the client’s reaction to the drug. Document the findings. Assess for daily weight, intake and output ratios, amount and location of edema, skin turgor. Observe for any discomfort at the IV site.


c) Activity

Type of ActivityDate OrderedDate started

Date changed/ D/CGeneral Description


Client's response and/or reaction to the activity

CBR without BRP

May walk on Corridor




Date Started:November -29-09

Patient is remained at rest with a total activity restriction to prevent further increase in the cardiac workload.

Patient is encouraged to do activities to gain the normal function of the heart again.

The patient instructed to have CBR without BRP to prevent further increase in cardiac workload.

Patient was instructed to start activities specifically walking to promote circulation and exercise the cardiac muscle.

The patient complied with the ordered activity and remained on the bed.

The patient was able to tolerate slight walking since he feels tired easily.

127


BEFORE:

Check the doctor's order. Explain the purpose of the activity restriction.

DURING:

Stay with the patient, monitor clientAFTER:

Record patient’s response to activity.

d) Diet

Type of DietDate OrderedDate started

Date changedGeneral Description


Specific foods takenClient's response and/or

reaction to the diet

Low fat

Low salt

Date Order: 11-25-09

Date Started: 11-25-09

This diet reduces the concentrations of serum lipids, especially the cholesterol concentrations. Decreasing dietary saturated fatty acids, increasing the proportion of polyunsaturated are believed to retard the development of atherosclerosis.

This diet decreases or prevent having blood pressure

This was ordered to the client since she is hypertensive. In addition, to prevent atherosclerosis.

It was ordered since the patient is hypertensive.

Fruits, vegetables and fish, unsaturated and fatty foods are highly restricted.

Fruits, vegetables, fish and flakes, foods with high content of Na are highly restricted.

Patient started to exhibit stabilizing blood pressure and tolerated the diet.

Patient started to exhibit stabilizing blood pressure and tolerated the diet.

128


Before:

Explain the purpose and importance of the diet and what specific foods are allowed for the patient. Explain also the appropriate foods not to be taken.

During:

Assist the patient when eating As much as possible promote independence

After:

Monitor the reaction of the patient.

129

“acute coronary syndrome non st elevation myocardial infarction, hypertensive cardiovascular...

Documents

date change dc date

document date

fluidthe patient

patient control

procedures donecatheter

oxygen therapytype of

iv fluid

condom catheter