https://padlet.com/juanitaharris/wem3d7uiuekmhvn7 en-us 2023-04-11 22:55:40 UTC 2023-04-13 16:04:56 UTC hello@padlet.com juanitaharris https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550771327 2023-04-11 22:57:58 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550771327 juanitaharris https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550772419 2023-04-11 22:59:59 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550772419 juanitaharris https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550772483 2023-04-11 23:00:03 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550772483 juanitaharris https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550780396 2023-04-11 23:14:20 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550780396 juanitaharris https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550780773 2023-04-11 23:14:59 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550780773 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550809421 Nursing diagnosis: Risk for infection
Care Plan: Focused Skin assessment, Pain meds, wound care, antibiotics, IV fluids, frequent repositioning, bed alarm, fall risk]]> 2023-04-11 23:55:36 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550809421 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550810233 Nursing Diagnosis: Dehydration (Fluid Deficient)
Care Plan: 
- Provide IV fluids
 ]]> 2023-04-11 23:56:36 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550810233 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550810240 Care plan: Administering IV fluids and adequate nutrition to prevent infection and promote healing. Pain medications. Prioritizing ambulation and repositioning.]]> 2023-04-11 23:56:36 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550810240 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550810264 2023-04-11 23:56:39 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550810264 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550810343 Administer oxygen, assist with ambulating, assess skin around ulcer site, maintain fluid balance

]]> 2023-04-11 23:56:44 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550810343 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550810571 Focused care: Wound care and pain medication. ]]> 2023-04-11 23:57:02 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550810571 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811036 Nursing Diagnosis: Risk for skin breakdown
Care Plan: Reposition, fluids, assess skin for pressure injury, pain meds]]> 2023-04-11 23:57:38 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811036 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811197 maintain wound dryness/cleaniness 
maintain pain medication, provide IV fluids
determine if she is potentially diabetic, or what could be the cause of the wound healing delay. Obtain a blood culture for the wound and assess if antibiotics are needed]]> 2023-04-11 23:57:50 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811197 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811327 Pain management
Reposition every 2hours
Request assistive device/equipment such as specialty bed to relieve pressure.
Moisturize skin
Risk for infection as evidence by stage 3 non-healing pressure ulcer
Assist with ambulation]]> 2023-04-11 23:57:59 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811327 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811476 Pain medications, ambulation, O2 therapy, wound care, fall risk, Iv fluids, impaired skin/tissue integrity]]> 2023-04-11 23:58:10 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811476 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811497 Impaired skin integrity
Pain meds 
wound care
Education wound cleaning

]]> 2023-04-11 23:58:11 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811497 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811841 Evidence by non healing pressure ulcer. 
Patient is running a low grade fever. 
Care Plan: Ensure wound is clean and does not have any discharge or drainage. 
See if patient can start an antibiotic to help the ulcer heal. 

]]> 2023-04-11 23:58:34 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550811841 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550812101 2023-04-11 23:58:55 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550812101 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550812111 Care plan: skin assessment, wound care, high protein diet to increase wound healing. pain medication. Wound cleaning if needed/ antibiotics 

]]> 2023-04-11 23:58:56 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550812111 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550812115 Impaired skin integrity 
risk for infection 
risk for ineffective health maintenance]]> 2023-04-11 23:58:57 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550812115 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550812242 Impaired skin integrity related to immobility as evidenced by stage 3 ulcer.



]]> 2023-04-11 23:59:07 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550812242 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550812303 Chronic sacral ulcer:
pain, damaged tissue. Color changes. Swelling. 

Patient reports pain level 5/10.
Wound Stage 3.

Pain meds
Wound debrid/Care

Decreased pain level within 1 hour.
Decreased wound size]]> 2023-04-11 23:59:12 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550812303 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550813918 Nursing Diagnosis: Risk for Sensory Perception
Diagnosis: Sensory Processing Disorder
Intervention: Joint compression, Repositioning]]> 2023-04-12 00:01:22 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550813918 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550820709 As evidence by nausea vomiting. 
Ensure patient is getting the proper fluids as he is already showing signs of dehydration. 
Patient teaching ensure the patient understands the importance of getting the proper amount of fluids and nutrition to help with the healing process. ]]> 2023-04-12 00:08:54 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550820709 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550820872 2023-04-12 00:09:06 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550820872 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550820897  fluid volume deficient related to vomiting as evidence by patient vomiting and weight loss




]]> 2023-04-12 00:09:08 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550820897 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550820997 Make sure to have 2 liters of water daily
Daily multi Vitamin: Calcium
Diet: Low fiber, High proteins/calories 
Administer analgesics 
Avoid alcohol

]]> 2023-04-12 00:09:15 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550820997 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550822255 NV, weakness, decreased oral intake 3 days, 15 days p/o, UC, drinks alcohol. Abd Pain, emptied mult x day. 

Fluids, pain meds

Increase fluids
Monitor Electrolytes
Vitals


]]> 2023-04-12 00:10:41 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550822255 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550822771 Administer IV fluids, patient teaching for adequate nutrition, patient teaching for stoma care]]> 2023-04-12 00:11:22 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550822771 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823207 Get vitals
Administer Fluid
Monitor weight
Patient education on drinking and diet
Assess colostomy 
Pain management


]]> 2023-04-12 00:11:53 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823207 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823213 Nursing Diagnosis: Risk for site infection at TPN site, Risk for abnormal serum electrolyte levels
Maintain adequate hydration
Manage pain with pain medication, manage nausea and vomiting with antiemetic medications
Assess IV insertion site at the start and end of each shift 

]]> 2023-04-12 00:11:54 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823213 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823359 Risk of dehydration
- Provide fluids]]> 2023-04-12 00:12:02 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823359 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823528 Obtain patient's vitals and determine electrolyte values. Provide fluids as needed. Provide possible antiemetics. 

]]> 2023-04-12 00:12:15 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823528 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823591 Plan of care: IV fluids, administer antiemetic. Vitals signs are needs. 
Fall risk related to weakness as evidence by nausea. Bed alarm and call light withing reach when needing to get out of bed. 
 ]]> 2023-04-12 00:12:20 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823591 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823877 2023-04-12 00:12:37 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823877 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823936 Get vitals
Check electrolytes
Make him show his butt for skin breakdown (liability)

RN dx: Deficient Fluid Volume related to dehydration as evidenced by nausea and vomiting.



]]> 2023-04-12 00:12:42 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823936 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823973 Electrolyte imbalance: decreased oral intake, nausea/vomiting. administer fluids. 

Educate: nutrition and fluid intake 
  ]]> 2023-04-12 00:12:45 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550823973 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550824527 NANDA: Risk for imbalanced nutrition 
fluid volume deficit 
check vitals
check ABGs
check electrolytes 
promote fluid intake


]]> 2023-04-12 00:13:17 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550824527 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550824731 ineffective coping .. ]]> 2023-04-12 00:13:30 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550824731 https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550825158 Nursing Diagnosis: Risk for electrolyte imbalance
Care Plan: Ausculate and palpate Addomin,  Iv fluids , pain management 



]]> 2023-04-12 00:13:59 UTC https://padlet.com/juanitaharris/wem3d7uiuekmhvn7/wish/2550825158