CRITICAL THINKING SUMMARY

Student: ___Haley VanWormer______________________

Patient Dx: __Anemia and Sepsis_________________________ Age: __69__

Allergies: __Benadryl Allergy Sinus_______________________________
The MEDICAL DIAGNOSIS that brought the patient to the hospital is:
Right nostril bleed on and off. Patient is actively receiving chemotherapy treatment.

PATHOPHYSIOLOGY of diagnosed disease: (From text)
Anemia is the reduction in the mass of circulating blood cells and subsequently reducing
hemoglobin levels. Not typically considered an isolated disease; rather, it represents the
manifestation of another problem. Can be the result of hemorrhage, decreased red blood
cell production, or vitamin and mineral deficiency. In this case, it was a result of decreased
blood cell production. This patient was actively receiving chemotherapy. The chemo drugs
suppressed his blood cell production which resulted in low hemoglobin, platelets, and white
blood cell count. The low platelets was what caused the nostril bleed that brought him into
the emergency department. The low white blood cell count lead to the development of
sepsis from a urinary tract infection. Sepsis is a bacterial infection of the blood.




SYMPTOMS typically seen with this diagnosis include (as identified in your text):
Can be asymptomatic but can also cause fatigue, weakness, lightheadedness,
breathlessness, palpitations, headache, syncope, and/or tachycardia



PATIENTS SYMPTOMS of the diagnosed disease include:
Fatigue, weakness, light headedness



NUTRITIONAL ASSESSMENT:
Height (actual or estimated): __177.8 cm___ Weight (actual or estimated): ___71.8 Kg___

Estimate Ideal Body Weight (Male: 105lb + 6lb/inch > 5. Female: 100lb + 5lb/inch >
5):165lbs_____

Does this patient have characteristics of a well-nourished person? Yes _____ No __X___
Explain your answer.
Patient is slightly underweight, however, this patient is actively receiving chemotherapy
which could have led to a decrease in weight.

PSYCHOSOCIAL STAGE OF DEVELOPMENT

What is the patients developmental stage?
Ego Integrity VS Despair

Has he/she met the necessary accomplishments? Yes __X___ No _____
Explain.
Patient was happy and positive about his life. He is close with his daughter and spends a lot
of time with her, but he does live alone.


How is this illness affecting the patients ability to meet these necessary accomplishments?
His daughter takes care of his medical needs like making sure his medications are in order
and taking him to his appointments. Overall, he does not seem to be limited on his
activities. He is still able to care for himself and perform the normal activities of daily living
well. He wanted to get home as soon as possible, but was alright with staying longer if
needed. He just wanted to feel better.

NURSING DIAGNOSIS/OBJECTIVES/INTERVENTIONS
Indicate below the 2 priority nursing diagnoses that are most relevant for your patient.
#1 NURSING DIAGNOSIS (problem r/t)
Fatigue related to anemia
DEFINING CHARACTERISTICS (S/S) that support this diagnosis:
Patient must take frequent breaks while participating in activity and labs show a low
hemoglobin level

OBJECTIVE/PATIENT OUTCOME for this diagnosis:
Patient will be able to perform activities of daily living and participate in activity without the
need for breaks by the time of discharge

NURSING INTERVENTIONS that will assist the patient to resolve the above identified diagnosis:

1. Collaborate with physician on ways to increase hemoglobin levels such as with blood
transfusion

2. Help patient understand why he may need some help even if he does not feel he does

3. Allow patient to rest when needed and/or able

#2 NURSING DIAGNOSIS (problem r/t)
Ineffective protection related to drug therapies
DEFINING CHARACTERISTICS (S/S) that support this diagnosis:
Patient has a decreased white blood cell count as a result of chemotherapy. This has lead to
the development of a urinary tract infection

OBJECTIVE/PATIENT OUTCOME for this diagnosis:
Urinary tract infection will be cleared and white blood cell count up before discharge

NURSING INTERVENTIONS that will assist the patient to resolve the above identified diagnosis:

1.Collaberate with physician on administration of antibiotics

2.Monitor for fever, chills, flushed skin, edema, and/or any other signs of worsening
infection

3.Initiate neutropenia isolation precautions (mask, washed hands, and gloves for anyone in
the room with patient to protect from infection)

COMPLICATIONS:
If this patients condition were to worsen, what would be the most likely reason and why?
His hemoglobin could become lower due to the decrease in production of blood cells or his
sepsis could get worse and cause more problems and/or damage because of his lack of
protective white blood cells.

How would you know this is happening?
Lab values of hemoglobin would decrease, or he could develop a fever

What will you do if this happens?
Notify physician immediately. He may order stronger and/or different antibiotics and/or a
blood transfusion. Could place cool washcloth on forehead and administer PRN Tylenol to
decrease fever.

PHYSICIAN PRESCRIBED MEDICATIONS AND INTERVENTIONS

MEDS/IVs/TX/DIET
(Include dose,
route, frequency)
REASON
PRESCRIBED
(Drug Classification,
What is it treating?)

NURSING
IMPLICATIONS FROM
TEXT
(Checking for adverse
reactions, preparation
& administration
concerns)
PATIENT DATA FROM
YOUR ASSESSMENT
(What data is
important to know
before & after giving)
Carafate (sucralfate)
1 gm PO bid
11:00 and 21:00

Anti-ulcer agent
For management of
duodenal ulcers
Anaphylaxis,
constipation, abdominal
pain
Administer on an empty
stomach. Assess for
abdominal and flank
pain
Protonix
(pantoprazole)
40 mg PO bid
9:00 and 21:00
Proton pump inhibitor
To decrease GERD
Pseudomembranos
colitis, abdominal pain
Assess for flank pain
abdominal pain
Lipitor (atorvastatin)
10 mg PO qhs
21:00

Lipid lowering agent.
To decrease
cholesterol
Heartburn, abdominal
pain, cramping,
diarrhea
Have cholesterol and
triglycerides checked
routinely
KlonoPIN
(clonazepam)
200 mg PO qhs
21:00
Benzodiazepine
To decrease anxiety
Suicidal thoughts,
hypotension, nausea,
ataxia, dizziness,
drowsiness
*Fall Risk Medication*
Monitor patient for
anxiety level
Dilantin (phenytoin)
200 mg PO qhs
21:00

Antiarrythmic/
anticonvulsant
Prevent seizures or
cardiac arrhythmia
Suicidal thoughts,
ataxia, hypotension,
nausea
Monitor behavioral
changes. Assess
mental status
Prozac (fluoxetine)
20 mg PO Daily
9:00

Antidepressant Seizures, suicidal
thoughts, anxiety,
drowsiness, decrease
in appetite
Monitor mood changes
and appetite
Vitamin B (folic acid)
1 mg PO Daily
9:00

Antianemic, water
soluble vitamin
Rash, fever, irritability Monitor plasma folic
acid levels
Multivitamin
1 tab PO Daily
9:00

Provide essential
vitamins and minerals
toxicity Assess for toxicity
Flomax (tamsulosin)
0.4 mg PO Daily
9:00

Decrease symptoms
of prostatic
hyperplasia
Dizziness, headache Assess for complete
bladder emptying after
urination
Tylenol
(acetaminophen)
650 mg q4hrs
PRN for Mild Pain
and/or Mild Fever
Antipyretic, analgesic
for mild pain
Hepatotoxicity Assess for liver function
before administration. If
given for pain, assess
pain before and 30-60
minutes after
administration. If given
for fever, assess
temperature before and
30-60 minutes after.
Compro
(prochlorperazine)
10 mg q6hr
PRN for Nausea
Antiemetic. To
manage nausea
Dry eyes, dry mouth,
constipation, blurred
vision
Monitor blood pressure
and nausea after
administration

Ambien (zolpidem)
5 mg PO qhs
PRN for Insomnia

Sedative. Sleep aid Drowsiness, dizziness,
anaphylaxis
*Fall Risk Medication*
Assess mental status
and ability to fall and
stay asleep after
administration

















ANALYSIS OF DIAGNOSTIC TESTS

DIRECTIONS:

1. List all diagnostic and laboratory tests pertinent to the patient's medical diagnosis or
medical treatments (i.e. medications) and provide the patient values for each test. Explain
why they are pertinent for this patient.

2. List any screening diagnostic and laboratory tests that are not within normal limits. Explain
why these tests are increased or decreased in relation to your patient's medical condition.

Diagnostic/Lab Test Patient Values Analysis of Values
Blood tests:
CMP
CBC
See Attached Labs Sheet See attached Labs Sheet
Nuclear Medicine GI
Blood Loss Imaging

No Active BI Bleeding No Active GI Bleeding
Chest X-Ray


Normal heart and lungs
image. Porta Cath in
Superior Vena Cava
Normal/ No pneumonia or
infection of the lungs noted
Stool Culture


Normal Flora. No
Salmonella growth
No infection in GI
Urine Culture


Staphlococcus Species
growth 10,000-100,000
Active Urinary Tract Infection
Peripheral Blood Culture


No bacterial growth after
72 hours
No bacteria in blood. Negative for
septicemia
Blood Culture from Port


No bacterial growth after
72 hours
No bacteria in blood or port.
Negative for septicemia and
infection in porta cath