Exparel (bupivacaine liposome) Tikosyn (dofetilide) Cerdelga (eliglustat)Antiarrhythmic: Monitor ECG continuously and BP and respiratorystatus frequently during administration.● Anesthetic: Assess degree of numbness of affected part.● Transdermal: Monitor for pain intensity in affected area periodically duringtherapy.● Decrease in ventricular arrhythmias.● Local anesthesiaMay cause drowsiness and dizziness. Advisepatient to call for assistance duringambulation and transfer.(Vallerand, Hazard & Sanoski, 2018)
ACUTE CARE CLINICAL #314across cell membranes withlittleor no effect on heartrate.Two Nursing Care Plans:1.Impaired skin integrity related to immobility and prolonged bed rest, mechanical forces (pressure, shear, friction), pronounced body prominence, poor circulation, bladder/bowel incontinence, Poor nutritional status, edema, dry skin, abnormal/non-healing woundsGoal date: by dischargeSkin remains intact, wounds healedACTION/INTERVENTIONMonitor wound for: healing, bleeding Observe itchiness and scratching, pruritus Keep skin clean and moistened at all times Monitor skin for: redness, irritation, dryness and scaling Nutrition consult if necessaryMonitor wound for: healing, bleedingReinforce/change dressing as orderedWear loose-fitting clothing when edema is presentPerform Active ROM or Passive ROMTurn and reposition every 2 hrs.2.Ineffective breathing pattern/gas exchange related to pulmonary edema and aspiration pneumonia.Goal date: by discharge----------------------Clear lung soundsRemains alert, oriented and calmDecreased dyspnea
ACUTE CARE CLINICAL #315Adequate ventilationMaintain effective breathing pattern as evidenced by: unlabored breathing, no use of accessory muscles, regular rate, and O2 sat within normal limitsACTION/INTERVENTIONObserve vital signs and ABG as ordered Auscultate lung sounds and document changes Administer O2 as ordered Provide rest periods and quiet environment Assist and encourage pt. to increase activity and early ambulation Administer bronchodilators as ordered and evaluate effectiveness Observe and document respiration, noting quality, depth and breathing effortsMonitor cardiac rhythm for dysrhythmiasKeep HOB elevatedSuction orally or nasotracheal if pt. is unable to clear.Recommendations:It is recommended that Mr. P. be put on comfort care to increase quality of life. Mr. Ps family’s goal is to keep him alive for as long as possible, however, most treatments (such as attempting to ween off ventilation) would be futile at this point. With regard to life saving measures, any CPR performed would be traumatic to the veteran and would cause an unpleasant end-of-life experience.
ACUTE CARE CLINICAL #316ReferencesDoenges, M. E., Murr, A. C., & Moorhouse, M. F. (2016). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales(Vol. Edition 14). Philadelphia, PA: F.A. Davis. Retrieved from ?direct=true&AuthType=ip,shib&db=nlebk&ANVallerand, A. H. (2018). Davis's drug guide for nurses. FA Davis.