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Nursing Case Analysis-AVF

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Nursing Case Analysis: Laparoscopic Cholecystectomy

Submitted by: Jed Mikhail Tabangcura RLE 3-9.

I. Assessment
I. Demographic Profile Clients Initials: SVE Age: 56 y/o Address:Purok 2 Barangay Mercedes,Camarines norte Religion: Roman Catholic Civil Status: Widowed Nationality: Filipino Date of Birth: July 4,1955 Place of Birth: Daet, Camarines Sur

History
Family History: (+) Hypertension- Mother (+) Allergy to sea foods siblings (-) DM,CVD,Asthma,Cancer,Thyroid Disease Medical History: 1 month PTA patient complained of non-radiating epigastric pain relieved by food intake.. Admitted for 3 days at a local hospital. 2 weeks PTA- (+) vomiting for 5 hours of previously ingested food. Was admitted for 3 days UTZ- cholelithiasis. Was advised surgery. Opted for a second opinion in our institution,was advised surgery. Hence,admission.

II. Anatomy and Physiology


Gallbladder- The gallbladder is a small pearshaped organ that lies near the liver. The function of the gallbladder is to store bile and concentrate. Bile is a digestive liquid continually secreted by the liver. The bile emulsifies fats and neutralizes acids in partly digested food. A muscular valve in the common bile duct opens, and the bile flows from the gallbladder into the cystic duct, along the common bile duct, and into the

III.Pathophysiology
Steal Syndrome-Clinical conditon caused by arterial insufficiency distal to a hemodialysis AV fistula or graft due to the diversion of blood into the fistula or graft.

Creation of arterio-venous fistula Backflow of blood from artery to vein due to low flow resistance of vein

Arterial insufficiency

Decrease in tissue perfusion in the distal extremities

Weakness and loss of function of limb

Pain and tenderness due to tissue ischemia

Pallor of the extremity due to poor blood flow

IV. OR Procedure
AVF Ligation- An arterio-venous fistula is a
connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm. Ligation of AVF is performed to stop the blood flow through the fistula.

Procedure
-The patient was brought to the operating room and placed on the operating room table in supine position . -The whole body was draped with only the left arm exposed. The arm was then prepared by Glutacept spray to the entire forearm -The area overlying the proximal portion of the fistula was infiltrated with 2% lidocaine.

-A transverse incision was then made overlying the fistula. Following this,the proximal outflow tract of the fistula was encircled. This was then ligated with Silk 4.0 ties. -The flow in the fistula was thus stopped. Hemostasis was inspected and found obtained. The wound was closed in two layers with Silk 4.0 sutures.

V. Drug analysis
Generic name Brand name Action Rationale Nursing Intervention

Amlodipine

Norvasc

acts by relaxing the smooth muscle in the arterial wall, decreasing tota l peripheral resistance and hence reducing blood pressure; in angina it increases blood flow to the heart muscle.

is a longacting calcium channel blocker used as an antihypertensive a nd in the treatment of angina.

Take BP before giving.


Give only if BP is not below 120/80 Report shortness of breath, palpitations, irregular heartbeat, nausea, or constipation to physician.

Generic name

Brand name

Action

Rationale

Nursing Intervention

Saxagliptin

Onglyza

slows down the breakdown of incretin hormones, including increasing insulin production in response to meals and decreasing the amount of glucose that the liver produces.

Blood sugar reduction and control for DM type 2

Instruct patient to take saxagliptin as directed. Take missed doses as soon as remembered, unless it is almost time for next dose; do not double doses.

Generic name

Brand name

Action

Rationale

Nursing Intervention

Atovorstatin

Lipitor

used to lower cholester ol levels by inhibiting the enzyme HMGCoA reductase, which plays a central role in the production of cholesterol in the liver.

for the treatment of dyslipidemia and the prevention of cardiovascul ar disease

Administer drug without regard to food but at the same time each day
Monitor for concurrent alcohol use. (Alcohol may affect liver function.)

Generic name

Brand name

Action

Rationale

Nursing Intervention

Isosorbide mononitrate

Imdur

acts by dilating the blood vessels so as to reduce the blood pressure

used principally in the treatment of angina pectoris

Give oral preparations on empty stomach,1 hr before or 2 hrs after meals


Create a nitrate free period to minimize tolerance

Generic name

Brand name

Action

Rationale

Nursing Intervention

Pregabalin

Lyrica

binds to calcium channels on nerves and may modify the release of neurotransmitt ers .Reducing communication between nerves may contribute to its effect on pain and seizures.

an anticonvulsa nt drug used for neuropathic pain

Pregabalin therapy should be stopped gradually over at least 1 week to decrease risk of seizure activity and avoid unpleasant symptoms such as diarrhea, headache, insomnia, and nausea.

Generic name

Brand name

Action

Rationale

Nursing Intervention

Celecoxib

Celebrex

Analgesic and antiinflammatory activities related to inhibition of Cox-2 enzyme

Management of pain and inflammation in the surgical site

Assess patient for allergy to sulfonamides, aspirin, or NSAIDS. Patients with these allergies should not receive celecoxib.
May be administered without regard to meals.

Generic name

Brand name

Action

Rationale

Nursing Intervention

Advise patient to notify health care professional promptly if signs or symptoms of GI toxicity (abdominal pain, black stools), skin rash, unexplained weight gain, edema occurs.

Generic name

Brand name

Action

Rationale

Nursing Intervention

Co-amoxiclav

Augmentin

destroys Prophylactic bacteria by antibiotic disrupting their ability to form cell walls.

If the patient develops a rash, wheezing, itching, fever or swelling in the joints, this could indicate an allergy and should be reported. - Patients must ensure they take the full course of the medicine. - The medicine must be taken

Generic name

Brand name

Action

Rationale

Nursing Intervention

- The medicine must be taken in equal doses around the clock to maintain level in the blood.
Report diarrhoea, cramping and blood in stools as pseudomembr anous colitis may occur.

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