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Planning the Care of a Patient 7 Days Post Femoropopliteal Bypass Surgery

Planning the Care of a Patient 7 Days Post Femoropopliteal Bypass Surgery Alicia A. Johnson Duke University School of Nursing

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Planning the Care of a Patient 7 Days Post Femoropopliteal Bypass Surgery

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Mr. R is a 52 year old African American male who is day 5 post femoropopliteal bypass surgery. The patient has peripheral vascular disease, hypertension, blindness related to 3 CVAs that occurred in 2000, and a history of depression and smoking 35 pack/year. He quit smoking in 2000. The patient’s blindness allows him to only shapes and shadows. The patient is married and has no children. The patient is independent with the use of a walking stick and his wife provides support for him in some functional ADLs e.g. cooking and cleaning. This surgery was done electively and the patient has no marked sensory deficits in his distal limbs upon admission. The patient’s wife stays with him during the day and slept in the room for the past 2 days. The patient lives in an apartment on the first floor of a complex. The patient lives within walking distance of grocery stores and a local park. The patient reported that the closest pharmacy or healthcare store e.g. CVS is not within walking distance for him so his wife or a friend must go for him on a regular basis. Mr. R’s main income comes from his wife’s income as a part-time accountant and Social Security. Mr. R decided to get this surgery at the recommendation of his doctors after chronic bouts of intermittent claudication. Mr. R states that he does not “watch his diet” and is usually home-bound on most days or is driven most places. Mr. R states that his depressive symptoms began in 2000 and feels that his depression is well-maintained on Prozac.

Planning the Care of a Patient 7 Days Post Femoropopliteal Bypass Surgery

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NURS211, Adult Health Plan of Care Clinical Database De-identified Patient Information: Patient's Age: 52 LOS: 5 days Gender: M

Reason for Admission: Elective femoropopliteal bypass in R leg. Past Medical History: 3 CVAs in 2000; legally blind can see shapes and shadows; peripheral vascular disease, DM Type 2 over 10 years. Hx of depression since CVAs Past/Recent Surgical Procedure: 2 years status post hybrid revascularization of the R lower extremity

Unique Code: Student Initials: AAJ Week: 2 Name of Agency: Advance Directives: None Living Will: None Healthcare Power of Attorney: Copy of AD in chart: No DNR Status: Full code Source of Information: Ebrowser database of Duke 2300 Floor

Treatments: Physical Therapy once a day Assistive Devices: Cane, bedside commode, urinal. Pertinent Diagnostic Tests---Radiology, Laboratory, EKG, etc.: aPTT: 71s Pathology Report: N/A Infection Control: Universal Precautions

Allergies – food, environmental, mediations (indicate response for allergies): NKDA Medications: (generic name, indication, dose, frequency) Amlodipine, HTN, 5mg PO daily; Clindamycin, surgical prophlaxis; 600 mg IV Q8h; Fluoxetine, major depressive disorder 20mg PO daily; Gabapentin , peripheral neuropathy pain 300mg PO Q8h; Heparin, thromboembolism prophylaxis, 500 units/hr IV continuous, target aPTT 40-90s; Insulin glargine injection, long-acting insulin; 20 units subcutaneous; insulin lispro injection, short-acting insulin, 2 units subcutaneous, must be given with meal in room; lidocaine patch 5%, local anesthesia at site of fem-pop surgery, 2 units topical Q24h; sennosides-docusate, constipation related to immobility, 2 tabs PO BID; simvastatin, hypercholesterolemia, 40mg PO QHS; Topiramate, neuropathic pain (off-label use), 100mg, PO QHS, Dextrose 50% injection for hypoglycemia; naloxone injection if RASS is less than or equal to 3; Ondansetron, antinausea medication after sedation, IV 4mg Q8HPRN; Oxycodone, pain, 5mg if pain rating is 4/5, 10mg if pain rating 6-7/10, 15mg if pain rating 8-10/10 PO Q4PRN. Activities of Daily Living/Level of independence prior to admission: Able to perform all basic ADLs by self (personal hygiene and grooming, dressing and undressing oneself, feeding oneself, functional transfers, elimination, and ambulation). Due to vision impairment, has difficulty performing some functional ADLs (housework, meal preparation, taking medication, managing money); lives with wife whom supports these ADL

Planning the Care of a Patient 7 Days Post Femoropopliteal Bypass Surgery deficits.

Psychosocial/ Cultural/ Spiritual Assessment: Patient lives with wife whom works full-time; brother and brother-in-law live nearby.

Risk Assessment: Falls risk related to impaired vision and impaired mobility; risk for pressure ulcers related to pain and immobility; risk for atelectasis related to opiate medications and immobility; risk for infection; risk for ineffective coping

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Planning the Care of a Patient 7 Days Post Femoropopliteal Bypass Surgery

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NURS211, Adult Health Plan of Care Physical Assessment Findings Chief Complaints (subjective data): Pain in R lower leg post-surgery Current Level of Independence: Limited sight; bed to chair with 1-person assist. Activity Order: Bed to chair TID; turn q2 hours. Incentive spirometry q10 breaths an hour. Cardiovascular System Apical pulse: 80/min bounding Pulses: Carotid: 80 bounding Radial: 80 Doppler pulse: DPS2 Capillary refill: