RN101
Home of the Registered Nurses (RN) and
Licensed Practical Nurses (LPN)
Therapeutic Nursing Plan (TNP)
SITUATION I
Mrs. A, a 27-year-old primapara gave birth via normal spontaneous delivery at 9:45 AM following a difficult labor. She has suffered a 3rd degree perineal tear and undergone perineal tear repair under local anesthesia. She was transferred to the post-partum unit at 11:00 AM.
Question 1:
What additional findings you must enter into your TNP?
Question 2:
Provide at least two nursing directives for your answer?
SITUATION II
Mrs. B, age 90, who lives in a private seniors home was brought to the emergency department yesterday due to delirium of infectious origin of unknown etiology. Today, she was transferred to the medical unit, incoherent and unaccompanied by her family which makes data collection impossible.
Medical history:
-Type II diabetes for 20 years, well-controlled with oral hypoglycemic agents
-MMSE (folstein test) 21/30 December 28, 2013
Medical orders:
-Capillary blood glucose qid, notify if blood glucose >10 mmol/L
-Septic screen stat: CXR, Swabs: nose, throat and anus, urinalysis and culture, blood culture if oral temp is >37.8
-CBC, electrolytes, BUN and creatinine
Medications:
Ciprofloxacin 200 mg IV q 12 h, metformin (Glucophage) 750 mg bid, glyburide (Diabeta) 10 mg qd, and acetaminophen 325 mg q 4h PRN for pain or oral temp. >37.8
Question 1:
Give two additional priority problems and one nursing directive for each.
At 13:00, you called the private seniors home nurse to get more information about the patient. She states that a few days ago she noticed that Mrs. B starts to loss her autonomy; no longer washes without assistance, neglects clothing and physical appearance, doesn't eat much (eat with assistance), need to stimulate to walk, movements are limited, and 4 to 5 days ago she is having urinary incontinence.
Question 2:
Adjust your TNP according to your findings after calling the private home nurse? (2 priority problems and give 2 nursing directives each).
SITUATION III
At 15:30, Mr. C, age 20, was admitted to the psychiatric unit against his will for preventive confinement due to major depression with high suicide risk after being brought by his parents to the emergency room this morning.
Question 1:
Adjust your TNP according to patient's situation by completing the slots provided?
SITUATION IV
Mrs. D, age 80, developed a venous ulcer on the lower 3rd medial aspect of her right leg and is now taking acetaminophen, 325 mg 1 to 2 tabs q 4 h PRN for her right leg pain.
Her venous ulcer is assessed every two days by the nurse and dressing is changed at 10:00 by the LPN.
Wound treatment plan no. 1:
-Cleanse wound with NaCl 0.9%
-Hydrocellular foam dressing
Question 1:
Adjust your TNP according to the scenario? (2 priority problems and 2 nursing directives for each priority problem)
Question 2:
Today, at 10:00 (2015-09-01) you assessed the patient's right leg and noticed edema. Adjust your TNP according to your assessment.
(One priority problem and two nursing directives)
SITUATION V
Mr. D, age 50, was admitted to palliative care unit for severe headaches associated with cerebral metastastases.
Medical orders:
-Dexamitasone 4 mg PO qid
-Gabapentin (Neurontin) 100 mg PO tid
-Morphine LA 30 mg PO q 12 h
-Morphine 5 mg PO q 45 to 60 min. PRN
-Lorazepam (Ativan) 0.5 mg tid SL PRN
At 20:00, you go to Mr. D's room who is complaining of headache (at forehead that radiates to the back), he states that the pain rates 7/10 (scale of 0-10) and the pain has never gone away completely since breakfast. You offered the patient his Morphine 5 mg PO PRN (breakthrough dose) but he refuses and says to you that he is afraid to take it because he thinks that he is taking too much medication and is afraid ot the side effects especially those of morphine. Also, he told you that he is becoming drowsy, slows his breathing, and will become dependent (addicted) each time he takes the narcotics. You noticed on the patient's Medication Administration Record (MAR) that he already refused twice his breakthrough dose at 8:00 and 11: 30.
Question 2:
Adjust your TNP according to patients condition? (One priority problem and two nursing directives)
