SN instructed on the need for adequate fluid intake, establishing a toilet schedule such as every 2 hours, or before or after activities, meals, sleep, and rest periods.
Skilled nurse developed patient plan of care with patient/caregiver involvement to be countersigned by physician. SN to perform complete physical assessment each visit with emphasis on disease process. SN to assess other co-morbidities including list diseases and other conditions that present themselves during this episode of care. SN to recognize and intervene to minimize complications; notify physician immediately of any potential problems that impede completion of patient recovery and desired goals.
SN instructed patient/ CG about thickened liquids. SN explained that thickened liquids are used to treat patients with Dysphagia. Thick liquids decrease aspiration. Thick liquids may give the patient more time to perform additional swallows or other swallowing strategies. Thickened liquids slow down the bolus flow to compensate for a delayed swallow and reduced airway closure.
SN instructed patient and care giver to take Carafate (sucralfate) on an empty stomach, at least 1 hour before or 2 hours after a meal and avoid taking any other medications within 2 hours before or after you take Carafate. Side effects of Carafate include: nausea, vomiting, GI upset/pain, constipation, diarrhea, insomnia, dizziness, drowsiness or headache.
SN instructed the patient about care of incision site. Patient was instructed to check the incision daily for signs and symptoms of infection like increased drainage or bleeding from the incision site, redness in or around it, foul odor or pus coming from the incision, increased swelling around the area and fever above 101.0°F or shaking chills.
SN used hand cleaner, donned gloves. Drainage bag from old catheter has clear yellow with sediments urine. SN donned sterile gloves, cleaned the perineum around the urinary meatus with chlorhexidine swabs. Flush Foley with 50 cc NS and immediately drained clear yellow urine. Then connected Foley to new drainage bag, then statlock placed on right thigh to secure catheter. Adult diaper put on patient. All items used for procedure disposed of in plastic bag, tied shut and put in household trash.
SN instructed patient / caregiver on service authorization, advance directives, rights and responsibilities, rights of the elderly and obtained necessary signatures. Instructed patient / caregiver on 24 hour nurse availability and provided / posted the agency telephone number. Also instructed that after hours, weekends and holidays an answering service will reach the nurse and he / she will return the patient / caregiver call and answer any questions or make a visit if needed. Patient and caregiver stated understanding. Patient and caregiver educated on diabetic diet, diabetic foot care, symptoms / signs ( s / s ) of depression, managing pain with medications, healthy skin, and pressure ulcer prevention. Leaflets left in home.
Patient was given teaching on good body mechanics to avoid injury such as: keep your back straight as you walk and also when lifting making sure to never bend at the waist. If sitting put a pillow or rolled towel to support your lower back.
SN instructed patient on the importance of daily monitoring of the blood pressure; along with reporting an elevated BP of 160/90 and above to MD/SN stat.
SN instructed patient on low salt diet. SN instructed patient on how to read nutritional labels on commercially prepared foods. Other salt alternatives such as Mrs. Dash was encouraged. SN explained how sodium affects blood pressure and water retention.