Health Medical Homework Help

Patient Introduction

Location: Medical-Surgical Unit 2315

Report from day shift nurse:

Situation: Christopher Parrish is an 18-year-old male who was admitted at 1900 today. His mother visited him at his college dormitory and was very concerned with his health; he seemed weak and had lost weight since she last saw him. She took him to see his primary care provider, and the provider admitted him and has ordered a tube feeding. I placed an 8-Fr, 42-inch feeding tube in his right nares about an hour ago, and x-ray just called and confirmed placement in the stomach. The pump is in his room. He is up to the bathroom prn; otherwise bed rest.

Background: Christopher was diagnosed with cystic fibrosis as a child and has had frequent hospitalizations previously. He reports fatigue and has recently lost 6 kg (13.2 lb) after he registered at the local college and moved to live in a dormitory. Chris’s mom was here earlier, but she is a single parent and has two younger boys, so she had to go home.

Assessment: Christopher is awake and alert. His heart rate and rhythm are regular at 80–85/min. Breath sounds are fine with a respiratory rate at 18/min. His color is a bit pale. Blood pressure is 118/78 mm Hg. He reports no pain and states he’s not had much appetite the past few weeks. His belly is flat and nontender. Bowel sounds are normoactive.

Recommendation: Christopher is due for vital signs and assessment. The tube feeding just arrived, and you will need to start it on the pump. He needs 720 kilocalories over 8 hours overnight. His regular diet is high calorie, high fat, but he wasn’t too hungry this evening; just had a bit of his chocolate shake. You will need to give his pancreatic enzymes orally before you start the tube feeding. You should also assess his diet and reinforce patient education on nutrition.

Fundamentals of Nursing Care

Taylor, C., Lynn, P., Bartlett, J. (2019). Fundamentals of Nursing: The Art and Science of Person-Centered Care, 9th Edition.

The Individual’s Basic Human Needs, Chapter 4, pp. 66-71

Using Standard and Transmission-Based Isolation Precautions, Chapter 24, pp. 867-871

Preventing and Responding to Medication Errors and Teaching About Medications, Chapter 29, pp. 867-871

Assessing the Abdomen, Chapter 26, pp. 724-725

The Adolescent and Young Adult, Chapter 22, pp. 550-558

Nutrition, Chapter 36, pp. 1279-1315

Administering a Tube Feeding, Chapter 36, pp. 1306-1314, Skill 36-2

Diseases and Conditions

Expert Clinical Content from Lippincott Advisor

Cystic Fibrosis

Nursing Care Plans

Expert Clinical Content from Lippincott Advisor

Nursing care plans for medical diagnoses: Cystic fibrosis

Pharmacology

Expert Clinical Content from Lippincott Advisor

Pancrelipase

Procedures

Expert Clinical Content from Lippincott Procedures

Enteral tube feeding, gastric

Safe medication administration practices, general

9/24/2020Objective Data:?BMI is below normal?Albumin level is 3?Vitamin D level is 10?Protein level is 5.8Subjective Data:?Patient verbalized not being able to get to the cafeteria to eat before it closes, resulting in patient not being able to get an actual meal and using snacks as a substitute.?Patient verbalized he is supposed to be on a high-fat, high-calorie diet for his CF.Nursing Diagnosis:?Imbalanced Nutrition: Less than Body Requirementsr/t: inadequate intake of high-fat, high-calorie foods secondary to cystic fibrosisGoal: Patient will tolerate a total of 480 mL of fluid nutrition within an 8-hourperiod during my shift.VN, SRN9/24/2020Nursing Interventions:1.Consider six small nutrient-dense meals instead of three larger mealsdaily to lessen thefeeling of fullness.2.Determine time ofday when the patient’s appetite is at peak and offer highest calorie and fat meal at that time.3.Encourage the patient to set an alarm to remind them of when thecafeteria may close so they do not miss out on getting a nutrient meal.4.Administer an extra tube feedingat night while hospitalized.Rationales:1.Eating small, frequent meals lessens the feelingof fullness and decreases the stimulus to vomit.2.Eating allows the patient to get most of his high-calorie, high-fat intake for the day.3.Setting an alarm helps remind the patient to go get food before the cafeteria closes. 4.Administering an extra tube feedingat night to help the patient gain weight a little faster.Evaluation:Goal met AEB: Patient tolerated the entire tube feeding without showing any signs of nausea or pain throughout the night.VN, SRN9/24/2020

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