Concept Map

Jason Barber N360

Infection: Bacterial Pneumonia, Empyema, Sepsis -lung abscess, 2 chest tube drains, WBC 25.34 Tx: Clindamycin IVPB 900mg Q8H Vancomycin HCL in Dextrose 1,000mg IV Q8H At discharge-Sodium chloride 0.9% 50ml with ceftriaxone 2gram IV Q24H therapy for 6 months (sister is to administer- taught how to give therapy by Pharmacare) Impaired Physical Mobility: Fall precautions Lethargy/fatigue Chest tubes x2 Tx: In bed ROM exercises; patient assist to toilet chair, compression hose Pain: Surgical wound, Chest Tubes Tx: Bupivacaine disposable pain pump PRN-oxycodone 5-10mg PO Q4H Morphine 2mg IV push Q1H

Impaired Oxygenation: Right lung lower/middle lobectomy Chronic Bronchitis Bacterial Pneumonia Tx: Antibiotics: (bacterial pneumonia infection & surgical/chest tube prophylactic) Clindamycin-IVPB 900mg Q8H Vancomycin HCL in Dextrose 1,000mg IV Q8H PRN Albuterol Sulfate nebulizer Q4H Bronchospasms: Albuterol sulfate nebulizer (bronchospasms)

Chief Medical Diagnosis: Loculated Empyema and abscess of right lung (lower & middle lobes) Priority Assessments: Oxygenation Pain Chest tube (CT) drainage Infection-surgical site, CT site

Alcohol Abuse: Clinical Institute Withdrawal Assessment (CIWA) = no significant withdrawal symptoms Tx: folate, thiamine supplement Social work consultation Patient teaching

Leukocytosis: (Surgical Stress, Chronic infection) WBC peaked at 25.34 on 2/28 Tx: -Antibiotics: Clindamycin-IVPB 900mg Q8H Vancomycin HCL in Dextrose 1,000mg IV Q8H

Anxiety: Patient stated he was worried about his condition and nervous that he might accidently pull out his chest tubes. Chronic pain Language barrier Tx: Teaching/Education on diagnosis and purpose of chest tubes; pain management

Malnutrition: Albumin 2.1 on 3/3 Prelbumin 14 on 3/11 BUN 7 & Creatinine 0.8 (both WNL so no kidney failure) Patient stated his nausea made him not want to eat. Tx: PRN Ondansetron 4mg IV push Q3H and Promethazine IPB 6.25-12.5mg Q4H for nausea and vomiting

Diabetes Mellitus II: Blood glucose 128 on 3/24 (and unstable throughout hospital stay) Tx: Insulin aspart (Novolog OG Flexpen) sliding scale Nateglide 60mg PO TID Metformin XR 500mg upon discharge along with diabetic diet and exercise teaching