NUR 116 NUR : Pre-Sim Assignment – Christopher Parrish

Name: NUR : Pre-Sim Assignment – Christopher Parrish Scenario Background  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 ...

Name: NUR : Pre-Sim Assignment – Christopher Parrish Scenario Background  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. A 8-Fr, 42- inch feeding tube was placed in his right nare, and x-ray has confirmed placement in the stomach. He is on bed rest with bathroom privileges.  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. Learning Objectives General  Assess patients to recognize normal versus abnormal findings.  Respond to changes in patient status  Assume accountability for the plan of care by order of priority, implementation, and evaluation  Use standard precautions when caring for the patient  Ensure patient and healthcare provider safety  Collaborate appropriately with the healthcare team in a timely, organized, and patient-specific manner  Use critical thinking when making clinical judgements and decisions  Establish a therapeutic environment for the patients and their families  Use therapeutic communication techniques in a manner that illustrates caring for the patient’s overall well-being Scenario Specific  Implement safety precautions for a patient receiving enteral feeding  Implement enteral feeding through NG tube  Assess patient’s diet intake  Provide patient education on nutritional needs and nutritional therapy Recommended Reading 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  Cystic Fibrosis (below are a couple of good supplemental resources) This study source was downloaded by 100000831988016 from CourseHero.com on 04-14-2022 14:43:11 GMT -05:00 https://www.coursehero.com/file/59464665/ChristopherParrish-presim-final-copydocx/ o https://www.cff.org/What-is-CF/About-Cystic-Fibrosis/ o http://www.hopkinscf.org/what-is-cf/treatments/pancreas-gastrointestinal-tracttreat/ Procedures  Enteral tube feeding, gastric Enteral tube feeding, gastric  Safe medication administration practices, general Safe medication administration practices, general Pathophysiology  Describe the pathophysiology of cystic fibrosis and how it relates to weight loss and fatigue as you would to educate your patient, including common signs/symptoms or findings. List any addition teaching that is pertinent to the condition, including possible treatment options. Cystic fibrosis is a genetic disorder caused by mutation (change) in the cystic fibrosis transmembrane conductance (CFTR) gene. CFTR controls the flow of salt and fluids in and out of cells and defect in this gene causes a build- up of thick, sticky mucus in the body's ducts. CF is seen only when both copies of the gene (one inherited from each parent) are defective. CF affects cells that make mucus, sweat and digestive fluids. These fluids are thick in CF patients and cause the blockage of ducts throughout the body leading to a range of symptoms. The lungs and digestive system are the main areas that are affected. Symptoms may appear soon after birth or in early childhood. In rare cases, they are not manifested until adulthood. Some sx are: Persistent cough with phlegm, postnasal drip, salty tasting skin, wheezing, shortness of breath, sinusitis, Inability to exercise, male infertility, repeated lung infections, foul- smelling, bulky greasy stools, poor growth and low body weight despite a good appetite, blockage in the intestinal especially in newborns, diarrhea/constipation. Cystic fibrosis cannot be cured. Several treatment options are available to help manage symptoms and reduce complications.  Briefly describe how to perform a focused assessment related to the description of the given background scenario. Patient should have a focused respiratory assessment done. Therefore, I would auscultate lung sounds, L and R sides in the front and back as well as bilaterally. I would also check his cap RF in his hands and feet. I would listen to his heart sounds, I would check the color of skin ton for oxygenation and check for nasal flaring ,pursed lips or cyanosis. I would check and ensure the nasal canula was not applying pressure to the skin causing skin breakdown. I would check his oral mucosa for dryness, swelling or lesions. I would also check his tube placement as well. Medication Review  Look up the following medications and list the following: o Generic name(s) o Classification of medication o Describe, in your own words, what this medication does o List any pertinent adverse effects or nursing considerations (i.e needed assessments)  Medications o Pancrelipase enzymes (PO) Creon; pancreatic enzyme; digestive enzyme to help the body breakdown and digest food when the pancreas does not release enough enzyme to do so; side effects are diarrhea, abd pain/ cramps, nausea; nurse should monitor This study source was downloaded by 100000831988016 from CourseHero.com on 04-14-2022 14:43:11 GMT -05:00 https://www.coursehero.com/file/59464665/ChristopherParrish-presim-final-copydocx/ bowel routine and bowel sounds and for pain o Multivitamin (PO) Vitamin; supplement, nausea, nurse should monitor for nausea Order Review  Diet: high-fat, high-calorie, high protein with high-protein snacks  Fluid nutrition 1.5 kcal/mL, 720 over 8 hours o Given that normal fluid nutrition is 1.0 kcal/mL, why does this patient need so many extra calories in addition to the high-fat, high-calorie, high protein diet? Fat soluble vitamins such as ADE and K are poorly absorbed in those who have pancreatic insufficiency. Pancreatic enzyme replacement is not enough hence children with pancreatic insufficiency will also need to take A, D, E and K supplements. Metabolic demands may be greater in patients with CF and so nutrition and growth are closely monitored to achieve optimal growth. Build up shakes can be used to supplement meals, not take place of, and in extreme cases of malnutrition poor weight gain may be necessary to have supplemental of enteral feeding. Nursing Care Plan  List three possible nursing diagnos